Little Clinical Relevance of Ca125, Cea and Ca125/Cea Ratio for the Differential Diagnosis of Ovarian and Non- Ovarian Carcinomatosis

Abstract

Background In women, peritoneal cancer is commonly associated to epithelial ovarian cancer. Ovarian peritoneal carcinomatosis patient survival appears to be better in comparison to other peritoneal Malignancies, e.g., colorectal neoplasms or mesotheliomas. Here, we aim to analyze the value of CA125, CEA, CA125/CEA ratio (CCR) tumor markers as preoperative tools for the diagnosis ovarian cancer. Material and methods: From 2005-2008, we recruit prospectively patients admitted to the Navarre Hospital Complex Gynecological service with peritoneal carcinomatosis and suspicion of ovarian cancer origins. The final diagnosis of ovarian cancer carcinomatosis or other malignancies was obtained through Biopsy or cytology. CA 125, CEA and CCR were determined from preoperative venous blood Samples. We compared the tumor markers values between groups of ovarian cancer carcinomatosis and non-ovarian cancer carcinomatosis and calculate the receiver operating curves (ROC) for CA 125, CEA and CCR. Results From 250 patients with suspicion of having ovarian peritoneal carcinomatosis, only 86.4% of the Cases were finally diagnosis of ovarian cancer. Sensitivities of CA125 > 35 mg/dL, CEA < 5 ngr/mL, and CCR > 25 were 95.5%, 91.9%, and 93.6% with specificities of 4.6%, 40.9% and 40.0%, respectively. ROC displayed poor performance for CA125 and CEA for detecting ovarian peritoneal carcinomatosis patients (area under the curve (AUC): 0.69 and 0.63, respectively) while ROC analysis of CCR showed better results (AUC: 0.74). Conclusions: CCR is somehow useful to differentiate between ovarian and non-ovarian peritoneal carcinomatosis patients in comparison with CA125 and CEA alone, although without sufficient specificity for improving the differential diagnosis.