Clinical Significance of CA125 Level with Clinicopathological Variables and Peritoneal Dissemination in Patients with Gastric Carcinoma

Abstract

Background: Serum tumor markers have been shown to correlate with the clinical status of patients with advanced gastric cancer. However, the clinical significance of tumor marker in patients with peritoneal dissemination has not been fully verified. Peritoneal metastasis is a crucial factor for the prognosis in gastric cancer, but its diagnosis is difficult before laparotomy. This study analyzed the usefulness of tumor marker CA125 level in gastric cancer & diagnosis of peritoneal metastasis in gastric cancer. Objective: This study is an evaluation of serum levels in the tumor markers CA125 in gastric cancer patients in preoperative periods to determine the Relationship of preoperative CA125 level with clinicopathological variables & to predict association of CA125 level with peritoneal dissemination in gastric carcinoma. Methods: A prospective cross sectional study was done of 61 patients diagnosed with gastric cancer treated at a single institution in Bangladesh National Institute of Cancer Research and Hospital, Mohakhali, Dhaka, Bangladesh from July 2010 - December 2011. Analyses were performed to identify patient and tumor-related characteristics and to identify peritoneal metastasis. The sera from 61patients with gastric cancer were measured for CA125 levels using a commercial immunoradiometric assay. All the patients underwent diagnostic imaging with computed tomography (CT) or ultrasound (US) before laparotomy. Peritoneal involvement was confirmed by either ascites diagnosed by USG or CT, direct visualization of metastatic deposits during surgery and detection of cancer cell by peritoneal wash fluid taken after laparotomy. Results: The serum levels of CA125 the cutoff value of 35 U/ml was regarded as positive. Preoperative levels of CA125 were above the cut-off levels in 23% of all cases. A total of 30(49.2%) patients were showed peritoneal involvement. The CA125 level was significantly correlated with the degree of peritoneal dissemination and the existence of malignant ascites. In particular, the serum CA125 levels showed sensitivity 73%, specificity 86%, and the highest odd ratio (18.33 95% CI) for predicting peritoneal metastasis. The positive and negative predictive values of CA125 were 65% and 91%, respectively. So in this study preoperative serum CA125 levels may provide a value in determining depth of invasion, lymph node involvement & metastasis in patients with gastric cancer. CA125 was very sensitive in detecting peritoneal dissemination in gastric carcinoma patients. Conclusion: In this study Preoperative serum Measurement of the serum CA125 titer may be a powerful predictor of peritoneal metastases in patients with gastric carcinoma& may provide a value in determining depth of invasion, lymph node involvement & metastasis in patients with gastric cancer.