CA-125 Significance in Cirrhosis and Correlation with Disease Severity and Portal Hypertension: A Retrospective Study

Abstract

Background and Aims: To evaluate the prevalence and significance of elevated cancer antigen-125 (CA-125) levels in patients with cirrhosis being treated in a tertiary care liver center and its correlation with objective markers of disease severity.Methods: We retrospectively reviewed medical records of 172 adult patients with cirrhosis (due to any etiology) after obtaining CA-125 serum analysis. Demographics, etiology of cirrhosis, model of end-stage liver disease (MELD) score, Child’s Turcotte-Pugh classification, albumin bilirubin (ALBI) score, degree of ascites, presence of esophageal varices, serum CA-125 level and various other parameters were collected. Statistical analysis was performed using SPSS software and descriptive statistics.Results: Elevated CA-125 levels were noted in 147 patients (85%) of the study population. Higher MELD score was associated with higher CA-125 levels (p = 0.001). Statistically significant correlation was observed between elevated CA-125 levels and degree of ascites (p < 0.001), ALBI score (p < 0.001) and Child’s Turcotte-Pugh class (p < 0.001). No correlation was observed with presence or absence of esophageal varices. Near-normal CA-125 levels were noted in patients with cirrhosis but undetectable ascites on ultrasound imaging. No differences were observed in mean values between male and female patients (p = 0.207). Regression analysis confirmed that CA-125 levels had a better correlation with degree of ascites than MELD score or ALBI score.Conclusions: Elevated CA-125 levels were noted in 85% of patients with cirrhosis at our center. Our study establishes that the more advanced the degree of decompensation based on MELD score, Child’s Turcotte-Pugh classification and ALBI score, the higher the elevation in CA-125. Absence of ascites was associated with normal CA-125 level, with a direct correlation between high levels and worsening ascites, but there was no statistically significant correlation with esophageal varices, indicating that elevated CA-125 levels could be related to mechanical stretch of the peritoneum rather than portal hypertension itself. Further multi-centered studies are required to confirm and validate these findings.

The Impact of Cyclooxygenase-2 Gene Polymorphism 899g/C and Certain Indices on Hepatitis C Related Liver Fibrosis

“…Also, serum CA19.9 and CA125levels were significantly higher in sever fibrotic patients than in mild fibrosis group. This is in accordance to several reports which illustrated an elevation of the tumor marker CA19.9 (Bertino et al, 2007, Bertino et al, 2013, Haque et al, 2015 and CA125 (Deschenes et al, 2001, Edula et al, 2018 in patients with liver cirrhosis. In addition, Singhal et al (2012) clarified that CA 19.9 and CA THE IMPACT OF CYCLOOXYGENASE-2 GENE ……..…”

CA-125 Significance in Cirrhosis and Correlation with Disease Severity and Portal Hypertension

“…More than 25 years ago our group published a prospective and comprehensive study of 159 patients with liver diseases, including 85 cirrhotics with and without ascites 3. In this article, cited by Edula et al as their reference 14, we found the same results as Edula et al 1 reported for ascitic and non-ascitic patients 1. Moreover, our group published other articles focused exclusively on patients without ascites 9,10.…”

“…Moreover, our group published other articles focused exclusively on patients without ascites 9,10. Like Edula et al ,1 we found that elevations of CA-125 concentrations in patients without ascites were uncommon, but also that these elevations were related to the degree of liver dysfunction.…”

“…Edula et al 1 said that cirrhotic patients without ascites had normal mean CA-125 concentrations, and define this observation as “a new finding”. However, these observations are not new.…”

“…Edula et al 1 in their retrospective study of 172 patients concluded that serum concentrations of cancer antigen-125 (CA-125) are elevated in cirrhotic patients with ascites. This relationship has been well known for several decades,2–6 as well as the relationship of CA-125 with pleural and pericardial effusions, among many other non-malignant conditions,4,5,7 because CA-125 is expressed in the coelomic epithelium 8.…”