Serum Calcium and Serum Albumin Are Biomarkers That Can Discriminate Malignant from Benign Pelvic Masses

Abstract

Background: Biomarkers that aid in the differential diagnosis of malignant pelvic masses from benign ones prior to surgery are needed in order to triage women with malignant masses to appropriate specialist care. Because high albumin-adjusted serum calcium predicted ovarian cancer among women without evidence of disease, we hypothesized that it might predict cancer among women with pelvic masses that were evident radiographically.Methods: We studied a cohort of 514 women with pelvic masses who underwent resection at Wake Forest University Baptist Medical Center from July 2009 through June 2013. We divided patients into a "training" set, to identify associations in the data, and a "testing" set, to confirm them. Data were obtained from medical records. A best fit model was selected using the Akaike Information Criterion.Results: Albumin-adjusted serum calcium was significantly higher in women with malignant versus benign masses

<p>Increased Serum Calcium Level Promotes the Risk of Lymph Node Metastasis in Endometrial Cancer</p>

“…23 Kelly et al built a model using serum calcium and albumin to distinguish malignant and benign pelvic masses. 24 These studies provided us with new insight into the potential mechanism, but they did not consider the influence of calcium level categories on the risk of the diseases and found the special group by stratification analysis.…”

“…7 The association between higher serum calcium and different cancers had long been reported. Total and ionized serum calcium could elevate the risk for fatal prostate cancer, 22 acted as a risk factor for bone metastasis in bladder cancer 24 and discriminated malignant pelvic masses from benign. 28 All these results agreed with our observations that elevated ionized calcium levels were a negative prognostic factor for LNM in EC patients.…”

Serum Calcium, Albumin and Tumor Stage in Cutaneous Malignant Melanoma

“…Although hypercalcemia, an adjusted serum calcium >10.5 mg/dl was rare (∼2%), 'high normocalcemia', which we defined as an adjusted serum calcium that is high but within the normal range (between 10 and 10.5 mg/dl) was relatively common (74/564, 13%). In our previous study of 514 women with adnexal masses, in whom some of the masses were malignant but most of which were not, high normocalcemia was highly predictive of malignancy, with ORs >14.0 (95% CI: 5.7-32.1) [11]. We observed that serum albumin levels overall were significantly lower in stage 4 versus stages 1-3 (p ≤ 0.05; Table 2).…”

“…However, our recent work in women with ovarian cancer has clearly shown that in the absence of PTHrP, serum calcium and albumin alone may provide significant clinical information. In women with pelvic masses who presented for surgical resection, high normocalcemia was associated with an approximately 14-fold increase in malignancy (OR: 13.57; 95% CI: 5.7-32.1) and albumin-corrected serum calcium explained 20% of the variance in outcome [11]. It is conceivable that serum albumin levels in our study may have been affected by differences in BMI, for which patient data were not available.…”

“…Although hypercalcemia (i.e., serum calcium beyond the normal reference range: 8.5-10.5 mg/dl) is rare in MM, with incidence rates ranging from 1 to 12% [9,10], we reasoned that serum calcium levels that are high but that do not meet the threshold for hypercalcemia (i.e., 'high normocalcemia') might be more frequent and reflect tumor growth. For example, high normocalcemia strongly predicted malignancy among women who presented with pelvic masses [11] and predicted cancer-specific death in prostate and ovarian cancers even though hypercalcemia in these cancers is rare [12][13][14]. The association between high normocalcemia and prostate and ovarian cancers is likely caused by PTHrP, an oncofetal protein RESEaRch aRticlE Datta, Savage, Lovato & Schwartz future science group that is overexpressed in many cancers and acts like parathyroid hormone to raise calcium levels in serum [15].…”