Prospective evaluation of serum CA 125 levels in a normal population, phase I: The specificities of single and serial determinations in testing for ovarian cancer

Zurawski, Vincent R.; Sjövall, K.; Schoenfeld, David; Broderick, Susan F.; Hall, Paul; Bast, Robert C.; Eklund, Gunnar; Mattsson, Britta; Connor, Robert; Prorok, Philip C.; Knapp, Robert C.; Einhorn, Nina

doi:10.1016/0090-8258(90)90130-d

Cited by 86 publications

(25 citation statements)

References 9 publications

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“…Interestingly, a 2-fold increase of CA125 was observed in one patient who further developed a peritoneal papillary cancer. The doubling of CA125 has been proposed by Zuraweski et al (30) to increase the specificity of the CA125 assay to detect ovarian cancer. Our results are consistent with those of Whitmore et al (27) who found that CA125 was elevated in two of four dermatomyositis patients with ovarian cancer (on stored serum obtained 5 and 13 months before the date of diagnosis of cancer) and in none of the 10 controls.…”

Section: Discussionmentioning

confidence: 99%

Tumor Antigen Markers for the Detection of Solid Cancers in Inflammatory Myopathies

Amoura¹,

Duhaut²,

Huong³

et al. 2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Dermatomyositis and polymyositis patients have an increased risk of developing cancers. We have assessed the diagnostic values of serum tumor markers for the detection of solid cancer in dermatomyositis/polymyositis patients. Serum carcinoembryonic antigen, CA15-3, CA19-9, and CA125 were assayed by immunoradiometric methods in 102 dermatomyositis/polymyositis patients. All the patients had complete physical examination, chest X-ray, echocardiogram, gastrointestinal tract endoscopic explorations, thoracoabdominopelvic computed tomography scan, and all women had gynecologic examination and mammogram. Exclusion criteria for study were childhood dermatomyositis, inclusion body myositis, myositis associated with a connective tissue disease, prior history of cancer, and the presence of benign conditions known to elevate serum tumor markers. After a median follow-up of 59 months, 10 (9.8%) patients had a solid cancer. Initial elevation of CA125 was associated with an increased risk of developing solid cancer [P = 0.0001 by Fisher's exact test; odds ratio (OR), 29.7; 95% confidence interval (95% CI), 8.2-106.6]. For CA19-9, there was a trend towards a significant association (P = 00.7; OR, 4.5; 95% CI, 1-18.7, respectively). Diagnostic values of elevated CA125 and CA19-9 at screening increased when the study analysis was restricted to patients who developed a cancer within 1 year (P < 0.0001 and P = 0.018, respectively) or to patients without interstitial lung disease (P = 0.00001; OR, 133; 95% CI, 6.5-2733 and P = 0.027; OR, 9; 95% CI, 1.5-53, respectively). Individual comparisons of the baseline and the second CA125 value showed that three of the eight patients with cancers versus 3 of the 76 patients without, displayed an increase of their CA125 level (P = 0.01 by Fisher's exact test). We conclude that CA125 and CA19-9 assessment could be useful markers of the risk of developing tumors for patients with dermatomyositis and polymyositis and should therefore be included in the search for cancer in dermatomyositis/ polymyositis patients, especially for patients without interstitial lung disease.

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Section: Discussionmentioning

confidence: 99%

Tumor Antigen Markers for the Detection of Solid Cancers in Inflammatory Myopathies

Amoura¹,

Duhaut²,

Huong³

et al. 2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Serum CA125 levels also are elevated in patients with benign and inflammatory diseases of the liver (64,65), pelvis (66), uterus (58), and ovary (42,53,58,67), and in patients with hematologic, bladder, breast, fallopian, gastrointestinal, liver, lung, and pancreatic cancers (68)(69)(70). Despite CA125's elevation in other diseases, immunoassay studies have documented specificities ranging between 95.4% and 96.7% (40,42,71,72).…”

Section: Introductionmentioning

confidence: 99%

Soluble Epidermal Growth Factor Receptor (SEG-FR) and Cancer Antigen 125 (CA125) as Screening and Diagnostic Tests for Epithelial Ovarian Cancer

Baron

Boardman

Lafky³

et al. 2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Epithelial ovarian cancer (EOC) is the leading cause of death among all gynecologic cancers in the United States. Because women who are diagnosed with early stage disease have a better prognosis than women diagnosed with late stage disease, early detection represents a potentially practical approach to reduce the mortality associated with EOC. Unfortunately, no single screening test has proven to be effective for this purpose, and a valid and feasible screening program to detect early stage EOC in the general population has not yet been devised. Consequently, research has focused on coupling two or more screening modalities to improve program validity and feasibility. Serum cancer antigen 125 (CA125) and a soluble isoform of the epidermal growth factor receptor (p110 sEGFR) have been studied individually as biomarkers of ovarian cancer. In this study, we compare serum CA125 levels and sEGFR concentrations in women with EOC to women with benign gynecologic conditions of ovarian and non-ovarian origin. We show that serum sEGFR concentrations are lower in patients with EOC than in women with benign gynecologic conditions, whereas serum CA125 levels are higher in patients to EOC compared with women with benign gynecologic conditions. These data also reveal that age and serum sEGFR concentrations modify the association between CA125 levels and EOC versus benign gynecologic disease. Hence, age-and sEGFR-dependent CA125 cutoff thresholds improve the ability of CA125 to discern EOC patients from women with benign ovarian tumors and non-ovarian gynecologic conditions. Our analyses show that parallel testing with fixed sEGFR and CA125 cutoff thresholds optimizes sensitivity to detect EOC, whereas serial testing with age-and sEGFR-dependent CA125 cutoff thresholds optimizes test specificity, and overall accuracy to discern patients with EOC from women with benign ovarian and non-ovarian gynecologic conditions. The combined use of serologic sEGFR and CA125, thus, has improved utility for screening and diagnosing EOC, which may increase the positive predictive value of a multimodal screening program that incorporates these biomarkers to detect and subsequently differentiate benign from malignant ovarian tumors. (Cancer Epidemiol Biomarkers Prev 2005;14(2):306 -18)

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“…Although many investigators regarded the CA-125 level of 35 U/ml as a cut-off level in endometrial carcinoma, some studies in early the 1990s reported that CA-125 levels lesser than 35 U/ml had prognostic significance in endometrial cancer. 23,24 Alagoz et al 25 demonstrated that 95% of patients who had been free of disease after surgery for endometrial cancer had CA-125 levels less than 20 U/ml, and suggested that an optimal cut-off level in early detection of disease recurrence could be 20 U/ml. Other reports suggested that a CA-125 level of 20 U/ml is clinically useful for management of patients with endometrial cancer.…”

Section: Discussionmentioning

confidence: 99%

Premenopausal early-stage endometrial carcinoma patients with low CA-125 levels and low tumor grade may undergo ovary-saving surgery

et al. 2009

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Objective: The purpose of this study was to determine the possible predicting factors of coexisting adnexal malignancies, and to evaluate the safety of ovary-saving surgery for early-stage endometrial carcinoma in premenopausal patients. Methods: A retrospective review of 107 patients with endometrial carcinoma who underwent surgical treatment at our institution was conducted. All patients were younger than 50 years of age and premenopausal status. Statistical analysis was performed. Results: Of the 107 patients, 78 patients had stage I to II disease and both preoperative CA-125 levels were measured and tumor grades evaluated. On multivariate analysis, preoperative CA-125 levels (p=0.018) and preoperative tumor grade (p=0.029) were independent predicting factors of adnexal diseases. The risk of coexisting ovarian malignancy was 1.8% in patients with preoperative CA-125 levels less than or equal to 34.5 U/ml and preoperative tumor grade 1 or 2. The risk increases to 20% for low CA-125 and grade 3, 13.3% for high CA-125 and grade 1 or 2, and 100% for high CA-125 and grade 3. Between patients who underwent unilateral salpingo-oophorectomy and those who underwent bilateral salpingo-oophorectomy, there was no statistically significant difference in terms of BMI, preoperative CA-125 levels, FIGO stage, histology, tumor grade, lymphadenectomy, and adjuvant treatment. Conclusion: Ovary-saving surgery for premenopausal, early-stage endometrial cancer patients may be considered as a treatment option in those with low preoperative CA-125 and low tumor grade.

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Prospective evaluation of serum CA 125 levels in a normal population, phase I: The specificities of single and serial determinations in testing for ovarian cancer

Cited by 86 publications

References 9 publications

Tumor Antigen Markers for the Detection of Solid Cancers in Inflammatory Myopathies

Tumor Antigen Markers for the Detection of Solid Cancers in Inflammatory Myopathies

Soluble Epidermal Growth Factor Receptor (SEG-FR) and Cancer Antigen 125 (CA125) as Screening and Diagnostic Tests for Epithelial Ovarian Cancer

Premenopausal early-stage endometrial carcinoma patients with low CA-125 levels and low tumor grade may undergo ovary-saving surgery

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