Objective To investigate the prognostic significance of elevated levels of cancer antigen 125 (CA125), placental alkaline phosphatase (PLAP), free p human chorionic gonadotrophin (hCG) and cancerassociated serum antigen (CASA) in women with primary epithelial ovarian carcinoma.Design A two year follow up study of survival.Setting A tertiary care gynaecological oncology unit.Participants One hundred and eleven women with histologically confirmed epithelial ovarian cancer.
Main outcome measures Survival over a two year period.Results Stage corrected log-rank x2 tests demonstrated a significant effect on survival for all four tumour markers (CAI25 P = 0.0142; PLAP P < 0.0001; CASA P = 0.0098; hCG P = 0.0002). This was confirmed when each variable was fitted together with disease stage in Cox proportional hazard models. When fitted as multiple variables in a Cox proportional hazard model, the addition of free phCG and CASA to disease stage, PLAP concentrations and CAI25 levels did not demonstrate M e r prognostic value.Conclusions Levels of all four markers correlate with survival in patients with epithelial ovarian cancer.The combination of PLAP and CA125 concentrations together with disease stage may be used to predict survival but the addition of hCG and CASA levels do not give additional prognostic information.
INTRODUCTIONMeasurement of circulating tumour markers in cases of epithelial ovarian cancer has been advocated for monitoring disease progression'. More recently their value in predicting prognosis has been studied. In particular, serum concentrations of CA125 and placental alkaline phosphatase (PLAP) have been shown to have an inverse correlation with To date, over 40 monoclonal antibodies against ovarian tumour-associated antigens have been reporteds. It is therefore important to know if serum concentrations of other tumour markers may predict prognosis. Furthermore, it is as yet unclear if the use of multiple markers gives additional prognostic infomation. Cancer-associated serum antigen (CASA) has been reported to have a high sensitivity9. Products of human chorionic gonadotrophin (hCG) have a prognostic Correspondence: Mr T. Ind, Department of Obstetrics and Gynaecology, Watford Hospital, Vicarage Road, Watford WD 1 8HB, UK. association with many tumours of the female reproductive tract'0.''. In this study we examined the prognostic value of PLAP, CA125, free P-hCG and CASA in women presenting with primary ovarian cancer.
METHODSThe study included 111 consecutive women with histologically confirmed epithelial ovarian cancer who had serum collected before initial surgery between 199'1 and 1994. Serum was stored at -20°C. Specimens were available for PLAP measurements in all cases and in 99, 99 and 73 cases for CA125, CASA and free P-hCG respectively. This was due to inadequate sample volumes for the latter three analytes.The characteristics of the 111 women are summarised in Table 1
PLAPSerum concentrations of PLAP were measured in duplicate by an in-house immunoradiometric assay, as previously de...
