Elevated CA-125 Levels Research Articles

S3211 Weight Loss, Ascites, and Diarrhea as the Presenting Symptoms for Pseudo-Pseudo Meigs Syndrome

Introduction: Pseudo-pseudo Meigs syndrome (PPMS) is a rare presentation of systemic lupus erythematous (SLE) characterized by ascites, pleural effusion, and elevated CA-125 level. Case Description/Methods: A 30-year-old woman with SLE and history of small bowel obstruction presented with diarrhea, weight loss, anasarca, and alopecia. She was initially tachycardic and hypertensive. Her exam revealed profound anasarca with ascites and bilateral pleural effusions. Labs were notable for Cr=5.65 mg/dL (baseline 0.7 mg/dL), spot protein/creatinine=3.9, ferritin=554.6 ng/ml, ESR=145 mm/Hr, CRP=6 mm/Hr, C3=49 mg/dL, C4=19 mg/dL, unremarkable FSH and LH, +ANA, dsDNA 356 U/ml, and +pANCA/MPO. Outpatient workup showed elevated CA-125 to 260.8 U/mL but ovarian malignancy was ruled out by MRI and CT abdomen/pelvis. Transvaginal ultrasound was normal. Inflammatory bowel disease was ruled out by EGD and colonoscopy during a previous hospitalization. Renal ultrasound showed bilateral hydronephrosis. The patient underwent a paracentesis (SAAG 1.3), and thoracentesis that showed total serum protein 4.2 g/dl, pleural fluid LDH 67 U/L, no serum LDH or pleural protein available. Kidney biopsy demonstrated class IV / V lupus nephritis. She was treated with a three-day course of pulse dose methylprednisolone followed by prednisone, hydroxychloroquine, and furosemide infusion. Her symptoms mostly resolved and CA-125 trended down to 27 U/mL. Discussion: PPMS is a rare condition with few cases reported in the literature. This case illustrates the challenges of evaluating abdominal symptoms and ascites in patients with SLE, and the importance of a kidney biopsy in the evaluation of nephrotic range proteinuria. Due to infrequency and concern for malignancy due to elevated CA-125 level, patients with this syndrome undergo extensive workup. CA-125 has been shown to be elevated due to inflammatory markers enhancing its expression in peritoneal mesothelial cells. Prior publications have shown the correlation of CA-125 with extent of serositis in PPMS. Additionally, our patient has many other clinical features reported in PPMS patients including elevated ferritin, alopecia, and positive pANCA. CT scan of abdomen and pelvis is essential in the workup of this syndrome to rule out ovarian malignancy. Moreover, imaging may exclude mesenteric vasculitis, an uncommon feature of SLE which can be seen as targetoid lesions of the bowel on CT scan. Steroids are the treatment for PPMS.

S3332 An Unusual Case of Aggressive Prostate Cancer With Liver Metastasis in a Patient With Ulcerative Colitis and Total Colectomy

Introduction: Prostate cancer is a relatively slow-growing with 96.8% 5-year survival rate. Less than 7% of patients are found to have aggressive cancer with metastasis to distant sites, such as: bone, lymph nodes, liver and thorax. The incidence of prostate cancer in the 45-54 year age group is merely 7.2% and median age at diagnosis is 67 years. We present a rare case of a 51-year old patient found to have liver metastasis of prostate origin, which was initially thought to be of gastrointestinal origin given elevated Carcinoembryonic Antigen (CEA) and CA 19-9. Case Description/Methods: A 51-year-old male patient with history of ulcerative colitis status post total colectomy thirty years prior, presented with progressive abdominal distension and unintentional twenty pound weight loss over a two month period. Physical exam revealed a mild jaundice, non-tender distended abdomen with palpable hepato-splenomegaly. Routine laboratory revealed normal complete blood count, with liver function elevation: total bilirubin 3.8, direct bilirubin 3, ALP 722, ALT 112, and AST 395. Computed tomography (CT) scan of the abdomen and pelvis without contrast showed findings concerning for metastatic disease with innumerable hepatic mass lesions, and lymphadenopathy. Cancer markers obtained showed normal AFP, however elevated Chromogranin A, CEA and CA 19-9, at 111 ng/mL, 741 ng/mL and 892 ng/mL, respectively. While initially a gastrointestinal origin of cancer was suspected, a liver biopsy was performed which revealed a poorly differentiated adenocarcinoma of prostate origin with positive staining for NKX3.1 and elevated PSA. (Figure) Discussion: Prostate cancer is the second most frequent malignancy in men worldwide and second leading cause of male-cancer related death in the United States, yet has favorable survival rates. The most common tumor marker for prostate carcinoma is serum PSA, however there is no current guideline recommending periodic PSA measurements. Elevated levels of CEA and CA 19-9 in the setting of metastatic prostate cancer have rarely been reported in literature, with merely eight known other cases. Given patient’s underlying history of ulcerative colitis, suspicion for cholangiocarcinoma would have been high on differential and in this case liver biopsy would be contraindicated. Our case highlights a rare presentation of liver metastasis and highlights importance of keeping broad differential. Importantly, liver metastatic burden is of concern and limiting factor when choosing immunotherapy or chemotherapy.Figure 1.: Computed tomography (CT) image of the abdomen, showing innumerable hypodense hepatic mass lesions (white arrows), with the largest in the right hepatic lobe measuring up to 5.4 x 5.0 cm indicated by red arrow.

Prognostic Significance of Clinical Factors Including BRCA Mutation in Epithelial Ovarian, Peritoneal, Fallopian Tube Cancer.

We analyzed the survival outcomes of patients with epithelial ovarian, peritoneal, or fallopian tube cancer with BRCA1/2 mutations and the clinical factors associated with the prognosis of these cancers. We included patients who had been diagnosed with and treated for epithelial ovarian, peritoneal, or fallopian tube cancer and had undergone germline BRCA testing in six hospitals between January 2012 and December 2019. Of the 378 identified patients, 76 (20.1%) carried a BRCA1/2 mutation. Progression-free survival (PFS) and overall survival (OS) did not differ between patients with and without BRCA1/2 mutation. Multivariate analysis for 18 months after the primary treatment showed higher PFS in the BRCA1/2 mutation group (p=0.024). Subgroup analysis in patients with high-grade serous carcinoma showed that BRCA1/2 mutation was an independent favorable prognostic factor for PFS (p=0.035). Subgroup analysis of patients with stage III or IV disease demonstrated an independent gain in PFS in patients with BRCA1/2 mutation (p=0.015). Neoadjuvant chemotherapy as a primary treatment was related to poor PFS (p<0.001) and reduced OS (p=0.005). Having a germline BRCA1/2 mutation improved short-term PFS in patients with epithelial ovarian, peritoneal, or fallopian tube cancer. Elevated initial CA125 level and primary neoadjuvant chemotherapy were related to poor prognosis.

Role of 18F FDG PET/CT in evaluation of post-operative ovarian carcinoma

BackgroundWe evaluated the sensitivity, specificity and accuracy of fluorine-18-fluorodeoxyglucose with positron emission tomography/computed tomography (18F-FDG-PET/CT) in a group of patients with suspicion of ovarian cancer recurrence. It is considered a diagnostic dilemma, particularly in the 2 years following first-line therapy. CA125 serum levels computed tomography (CT) and other modalities are used during routine follow-up. These traditional modalities could provide a significant number of false-negative or equivocal results even in the presence of elevated CA125 levels. So the performance of 18F-FDG-PET/CT is essential for the optimal diagnosis of recurrence and treatment planning.ResultsStudying PET/CT behaviour in the detection of ovarian cancer recurrence, 18F-FDG-PET/CT had an accuracy of 98% with sensitivity and specificity of 98% and 100%, respectively. 18F-FDG-PET/CT had a PPV of 100% and NPV of 83%. While studying the CA125 level (> 35 U/ml) to detect the ovarian cancer recurrence during patient follow-up, the CA125 level had an accuracy of 50% with a sensitivity ratio and specificity ratio of 47% and 80%, respectively. CA-125 level had a PPV of 95% and NPV of 14%. In comparison between conventional CT and PET/CT studies, the PET/CT diagnosed local tumor recurrence in 16 patients (32%), while CT scan diagnosed local tumor recurrence in only 3 patients (6%), and PET/CT detected peritoneal recurrence in 34 patients (68%). CT scan found peritoneal deposits in 11 patients (22%), also the PET/CT showed suspicious abdominal LNS in 22 patients (44%) while, CT scan showed suspicious abdominal LNS in 4 patients (8%), and PET/CT showed suspicious pelvic LNS in 16 patients (32%). CT scan showed suspicious pelvic LNS in 7 patients (14%). PET/CT detected distant organ metastases in 18 patients (36%). CT scan detected distant organ metastasis in only 8 patients (16%). Comparison between CT and PET/CT in 32 follow-up cases for the detection of local tumor recurrence, peritoneal deposits, suspicious abdominal/pelvic LNs and distant organ metastasis. There was a statistically significant difference between CT and PET/CT the end results (p < 0.0001, p = 0.0047, p = 0.001, p = 0.03).Conclusions18F-FDG-PET/CT is more sensitive in detection and localization of ovarian cancer recurrence and more superior than the other imaging modalities.

The impact of endometriosis on embryo implantation in IVF procedures

Embryo implantation is the most important event in the achievement of conception. In the presence of any endometrial disease, this process can be hampered. The endometriosis is linked to causing infertility. It is a chronic uterine disease that is dependent on estrogens and is associated with reduced fecundity. The objective of this study was to investigate the impact of endometriosis on embryo implantation in patients undergoing IVF. This is a case-control study, with case to control ratio of 5:1. The study included 50 patients with endometriosis and 10 patients without endometriosis served as control. The endometriosis was diagnosed by symptoms, pelvic and transvaginal ultrasound examinations. The serum estrogen levels, fertilization rate and implantation rate were determined. Since the presence of a haemorrhagic cyst was suspected at the ultrasonographic finding of masses parallel to the ovaries, measurement of the CA 125 marker was carried out for differential diagnosis. The data were recorded in Excel sheets and analysed using statistical functions of Excel. The significance level was set at 0.05%. Most of the patients in endometriosis group (68%) had elevated CA125 Levels and 56 % had high E 2 level. In the control, only one patient had high E2 level. In the endometriosis group, 31.67% had positive pregnancy test, while 90% patients without endometriosis had positive pregnancy test. These differences were statistically significant. These data reveal that the patients with endometriosis had significantly higher levels of E2 and CA125 marker in blood and had significantly lower implantation rates as compared to those in the control group.

Role of CA 19.9 in the Management of Resectable Pancreatic Cancer: State of the Art and Future Perspectives.

Background: Surgery still represents the gold standard of treatment for resectable pancreatic ductal adenocarcinoma (PDAC). Neoadjuvant treatments (NAT), currently proposed for borderline and locally advanced PDACs, are gaining momentum even in resectable tumors due to the recent interesting concept of “biological resectability”. In this scenario, CA 19.9 is having increasing importance in preoperative staging and in the choice of therapeutic strategies. We aimed to assess the state of the art and to highlight the future perspectives of CA 19.9 use in the management of patients with resectable pancreatic cancer. Methods: A PubMed database search of articles published up to December 2021 has been carried out. Results: Elevated pre-operative levels of CA 19.9 have been associated with reduced overall survival, nodal involvement, and margin status positivity after surgery. These abilities of CA 19.9 increase when combined with radiological or different biological criteria. Unfortunately, due to strong limitations of previously published articles, CA 19.9 alone cannot be yet considered as a key player in resectable pancreatic cancer patient management. Conclusion: The potential of CA 19.9 must be fully explored in order to standardize its role in the “biological staging” of patients with resectable pancreatic cancer.

Study of the level of tumor markers and mutations in the BRCA1/2 genes in breast cancer patients with metachronous tumors.

e12563 Background: Primary multiple malignant tumors are more common in women with breast cancer (BC). However, the difference in the frequency of mutations in the BRCA1/2 genes in metachronous BC tumors has not been fully studied, and there are also conflicting data on the increase in the level of specific tumor markers in this category of patients. Methods: The survey included 58 patients with BC with II-III clinical stages of the disease, of which metachronous tumors in terms of 6 months or more were found in 26 (44.8%) patients, among them metachronous cancer of the second breast - in 14 (53 .8%), cancer of the body of the uterus - in 7 (26.9%) and ovarian cancer - in 5 (19.2%) patients. In the control group of 32 (55.2%) patients with initially diagnosed BC, with the same stages of the disease. Tumor markers were determined in the peripheral venous blood of patients using reagent kits for ELISA analysis produced in Russia. The study of mutations in the BRCA1/2 genes was performed using sequencing on the Illumina MiSeq platform in tumor samples from waxed histological blocks. Library sequencing was performed using MiSeq Reagent Kit v2. Results: ELISA analysis of the level of tumor markers in patients with BC showed that with the development of metachronous cancer, the studied markers were more common than in the control group. In patients with metachronous tumors, elevated levels of CA-125 occurred in 10 (38.5%) patients, CA-15-3 - in 8 (30.8%), CA-19-9 - in 4 (15.4%), AFP - in 5 (19.2%), CEA - in 6 (23.1%). In the control group, CA-125 was found in 6 (18.8%) patients, CA-15-3 - in 5 (15.6%), CA-19-9 - in 2 (6.3%), AFP - in 1 (3.1%), CEA - in 2 (6.3%). Excess levels significant for diagnosis were observed for CA-125 and CA-15-3 in both groups of patients, but in the group of patients with BC with metachronous tumors, these figures were approximately 2 times higher. In the rest of the patients, the oncomarkers under consideration did not reach values significant for diagnosis. The total incidence of patients with clinically significant germline variants in the BRCA1/2 genes in the control group was 5 (15.6%), of which there were predominantly patients with an increased frequency in the population (5382insC, 4154del4, C61G). The total incidence of BC patients with metachronous tumors with germline and somatic variants in the BRCA1/2 genes was 16 (61.5%), with an increased frequency in the same population, mainly in patients with germline mutations. Conclusions: Dynamic study of the level of tumor markers CA-125 and CA-15-3 and CA-19-9 may be useful in the preventive examination of patients with a history of BC as an early diagnosis of the development of metachronous tumors in this category of patients. The most important diagnostic unfavorable factor in the development of metachronous tumors in the examined BC patients was germline mutations in the BRCA1/2 genes.

CA-125 Levels Are Predictive of Survival in Low-Grade Serous Ovarian Cancer—A Multicenter Analysis

Simple SummaryLow-grade serous cancer (LGSC) accounts for approximately 5% of all ovarian cancers. It is characterized by its high resistance to chemotherapy. Cytoreductive surgery, therefore, is the primary treatment modality for this disease and previous studies have shown that complete removal of all visible tumor tissue should be achieved. In this study, 176 women with LGSC were included and most of them had advanced disease stages, where the disease had already spread. CA-125 is a biomarker that has been previously studied in ovarian cancer. We have found that CA-125 level following treatment of LGSC is an important and independent prognostic factor for progression-free and overall survival. It may be a better surrogate for the true amount of residual disease following treatment compared to the gross estimation of visible residual disease during surgery.Objective: Studies on low-grade serous ovarian cancer (LGSC) are limited by a low number of cases. The aim of this study was to define the prognostic significance of age, stage, and CA-125 levels on survival in a multi-institutional cohort of women with pathologically confirmed LGSC. Methods: Women with LGSC were identified from the collaborative Ovarian Cancer Association Consortium (OCAC). Cases of newly diagnosed primary LGSC were included if peri-operative CA-125 levels were available. Age at diagnosis, FIGO stage, pre- and post-treatment CA-125 levels, residual disease, adjuvant chemotherapy, disease recurrence, and vital status were collected by the participating institutions. Progression-free (PFS) and overall survival (OS) were calculated. Multivariable (MVA) Cox proportional hazard models were used and hazard ratios (HR) calculated. Results: A total of 176 women with LGSC were included in this study; 82% had stage III/IV disease. The median PFS was 2.3 years and the median OS was 6.4 years. Age at diagnosis was not significantly associated with worse PFS (p = 0.23) or OS (p = 0.3) (HR per year: 0.99; 95%CI, 0.96–1.01 and 0.98; 95%CI 0.95–1.01). FIGO stage III/IV was independently associated with PFS (HR 4.26, 95%CI 1.43–12.73) and OS (HR 1.69, 95%CI 0.56–5.05). Elevated CA-125 (≥35 U/mL) at diagnosis was not significantly associated with worse PFS (p = 0.87) or OS (p = 0.78) in MVA. Elevated CA-125 (≥35 U/mL) after completion of primary treatment was independently associated with worse PFS (HR 2.81, 95%CI 1.36–5.81) and OS (HR 6.62, 95%CI 2.45–17.92). In the MVA, residual disease was independently associated with PFS (0.022), but not OS (0.85). Conclusion: Advanced LGSC was associated with poor long-term prognosis. FIGO stage and abnormal post-treatment CA-125 level are key prognostic factors inversely associated with PFS and OS. Highlights: 1. Through a multi-center collaborative effort, data from 176 women with low-grade serous ovarian cancer were analyzed. 2. Although low-grade serous ovarian cancer is often considered indolent, the progression-free and overall survival are poor. 3. Elevated post-treatment CA-125 levels are independently associated with poor survival.

Pseudo-pseudo Meig's syndrome presenting as an acute surgical abdomen: A rare entity and review of the literature.

Pseudo-pseudo Meigs' syndrome is a rare entity of systemic lupus erythematosus, which is defined with the combination of pleural effusion, elevated serum CA-125 levels, and ascites. It has similar clinical aspects with gynecological malignancies which may lead gynecologists to perform unnecessary surgeries and lab workouts. This review seeks to point out the importance of diagnosing pseudo-pseudo Meig's syndrome (PPMS) and endeavors to inform gynecologists about the differential diagnoses. This article includes a review of the literature on different cases of PPMS. We searched the PubMed database using the search terms in various combinations "Pseudo-pseudo Meig's syndrome," "Tjalma syndrome," and "SLE." According to the current literature, a majority of internal medicine specialists recognized this clinical condition in the past few years and discussed PPMS as a new onset of systemic lupus erythematosus. PPMS is one of the disregarding entities where gynecologists do not consider it as a differential diagnosis in case of less awareness. When a gynecologist evaluates ascites manifesting as acute abdomen; ectopic pregnancy, ovarian hyperstimulation syndrome, cyst rupture, and malignancy come to mind first. Four-thirds of those patients evaluated by gynecologists were performed hysterectomy leading to unnecessary interventions and economic burden on the health system. Although the mechanism is unrevealed and remains unclear, PPMS has been noticed in the literature for the past few years. In order to prevent unnecessary interventions, this syndrome should be considered as a differential diagnosis.

Portable X-ray fluorescence (pXRF) analysis of heavy metal contamination in church graveyards with contrasting soil types

Human remains have been interred in burial grounds since historic times. Although the re-use of graveyards differs from one country, region or time period to another, over time, graveyard soil may become contaminated or enriched with heavy metal elements. This paper presents heavy metal element soil analysis from two UK church graveyard study sites with contrasting necrosols, but similar burial densities and known burial ages dating back to the sixteenth century and some possibly older than 1,000 years. Portable X-ray fluorescence element laboratory-based analyses were undertaken on surface and near-surface soil pellets. Results show elevated levels of Fe, Pb, Mn, Cr, Cu, Zn and Ca in both necrosols when compared with background values. Element concentration anomalies remained consistently higher than background samples down to 2 m, but reduced with distance away from church buildings. Element concentration anomalies are higher in the clay-rich necrosol than in sandy necrosol. Study result implications suggest that long-used necrosols are likely to be more contaminated with heavy metal elements than similar soil outside graveyards with implications for burial grounds management, adjacent populations and where burial grounds have been deconsecrated and turned to residential dwellings.

Elevated levels of CA125 (MUC16) in metastatic gastric cancer as a strong predictor of poor survival

Introduction: CA125 is an extracellular domain of MUC16 glycoprotein. The clinical significance of serum CA125 has been most extensively studied in ovarian cancer. The significance of serum CA125 in gastric cancer has not been fully elucidated. There is evidence that MUC16 overexpression is associated with poor survival in patients with metastatic gastric cancer. We have not found any research papers on the correlation between the levels of serum CA125 and MUC16 overexpression.Objective: The objective of the study was to assess the effects of elevated CA125 levels in patients with metastatic cancer on the long‑term results (time to disease progression and overall survival).Materials and methods: CA125 was determined in the serum before the start of first‑line chemotherapy in 75 patients (45 males and 30 females) with metastatic gastric cancer. The mean age of the patients was 61,3 (26,7–84,9) years. Synchronous metastases were observed in 85 % of patients: 57,3 % in the peritoneum, 37,3 % in the liver, 5,4 % at other sites. Palliative gastrectomy and metastasectomy were performed in 28 % and 20 % of patients, respectively. Monotherapy, doublet and triplet chemotherapy regimens were used in 6,7 %, 58,7 % and 36,0 % of patients, respectively.Results: the analysis showed that elevated levels of CA125 (&gt; 37 IU/mL) were associated with a significant reduction in median time to progression (3,5 months (CI 2,87–9,53) vs 6,2 months, р = 0.001 (CI 2,02–4,9)) and overall survival (5,1 months (CI 6,07–28,1) vs 17,1 months (CI 3,5–6,67), р = 0.001). One‑factor ANOVA showed that factors with the strongest effects on the survival rates included the location of metastases (peritoneum), tumor histology (adenocarcinoma/signet ring cell carcinoma), the use of palliative gastrectomy and metastasis resection. A multi‑factor ANOVA showed that the only favorable prognostic factors in terms of overall survival rates were normal CA125 levels (HR 0,39 (95 % CI 0,18–0,84), р = 0.001) and the use of palliative gastrectomy (HR 0,23 (95 % CI 0,1–0,58), р = 0.001). The use of triplet chemotherapy regimens allowed to slightly improve the overall survival rates in the group of patients with elevated CA125 levels; however, the differences were not statistically significant (6,7 months vs 4Ю0 months, p = 0.29).Conclusion: Elevated levels of CA125, which reflect MUC16 overexpression to a certain extent, is a strong independent predictor of poor outcome in metastatic gastric cancer. Currently, a possible way to overcome this negative impact is to use more intensive chemotherapy regimens. However, further research should be aimed at finding adequate targets and ways of neutralizing the negative impact of MUC16 overexpression in patients with metastatic gastric cancer.

Clinical Characteristics Predict Recurrence in Borderline Ovarian Tumor Patients with Fertility-Preserving Surgery.

PurposeTo identify prognostic factors in patients with borderline ovarian tumor (BOT) and establish and validate a nomogram predicting recurrence in BOT patients treated with fertility-preserving surgery.Patients and MethodsPatients with BOT who underwent surgery at two institutions between January 2000 and June 2017 were included and categorized into training and validation cohorts. Univariate log rank test and Cox regression analysis were performed in the training cohort to identify prognostic factors, and a nomogram was developed to predict the recurrence rate. The model was validated by calculating the C-index and drawing the calibration curve and receiver operating curve (ROC).ConclusionIn the multivariate Cox regression analysis, practice period, past history of benign ovarian disease, past history of benign breast disease, elevated CA125 levels, elevated CA199 levels, surgical methods, greater omentum resection, FIGO stage, postoperative pregnancy, and re-operation were independently associated with recurrence-free survival (p<0.05). The aforementioned prognostic factors were used to develop a nomogram. The nomogram demonstrated a good ability to predict the risk of recurrence (training cohort C-index: 0.866, validation cohort C-index: 0.920). The calibration curve suggested that the predicted recurrence-free survival was closely related to the actual recurrence. ROC analysis showed that the nomogram had a good discriminatory power with the area under curve between 0.776 and 0.956. The nomogram can predict the 1-, 3-, and 5-year recurrence-free survival of BOT patients undergoing fertility-preserving surgery. The predictive model can help guide surgical plans, postoperative monitoring, and prognostic evaluation of BOT patients.

Measurement of Nineteen Chemical Elements in Thyroid Malignant Nodules and Thyroid Tissue Adjacent to Nodules using Neutron Activation Analysis and Inductively Coupled Plasma Atomic Emission Spectrometry

Thyroid malignant nodules (TMNs) are the most common endocrine cancer and the fifth most frequently occurring type of malignancies. The etiology and pathogenesis of TMNs must be considered as multifactorial. The present study was performed to clarify the role of some chemical elements (ChEs) in the etiology of these thyroid disorders. Thyroid tissue levels of nineteen ChEs were prospectively evaluated in malignant tumor and tissue adjacent to tumor of 41 patients with TMNs. Measurements were performed using a combination of non-destructive and destructive methods: instrumental neutron activation analysis with high resolution spectrometry of short-lived radionuclides and inductively coupled plasma atomic emission spectrometry. Results of the study were additionally compared with previously obtained data for the same ChEs in “normal” thyroid tissue. It was observed that in malignant tissue the mass fractions of Al, B, Ca, Cl, Cu, K, Mg, Mn, Na, P, S, and Si were 3.14, 4.64, 1.79, 2.26, 3.55, 1.57, 1.61, 1.57, 1.24, 2.45, 1.14, and 2.81 times, respectively, higher whereas mass fraction of I was 25.6 times lower than in the normal thyroid. In the “adjacent” group mean mass fractions of Cl and I were approximately 1.6 and 1.7 times, respectively, higher, while mean values of Ba, Ca and Sr content were 55%, 45%, and 70%, respectively, lower than in the “normal” group. In tumor Ca, Cl, Cu, K, and Sr contents were approximately 2.8, 1.4, 1.8, 1.7, and 5.4 times, respectively, higher, while I content was 43 times lower than in “adjacent” group of tissue samples. It was concluded that thyroid tissue adjacent to malignant nodules kept the main function of thyroid gland, while malignantly transformed thyroid cells lost its capacity to accumulate I. It was supposed that the excessive accumulation of Cl and I by thyroid tissue probably precede the TMNs origination and development. It was also supposed that elevated levels of Al, B, Ca, Cl, Cu, K, Mg, Mn, Na, P, S, and Si, as well as drastically reduced level of me in cancerous tissue could possibly be explored for differential diagnosis of benign and malignant thyroid nodules.

Deep muscularis propria tumor invasion without lymph node metastasis as a unique subclassification of stage IB gastric cancer: a retrospective study

BackgroundThe prognosis difference based on the depth of tumor muscularis propria invasion in gastric cancer (GC) was still debated, and therapy strategy for stage IB GC patient required further investigation.MethodsA total of 380 patients with pT2 GC after radical surgery were retrospectively analyzed, including 185 in superficial muscularis propria (sMP) group and 195 in deep muscularis propria (dMP) group.ResultsThe overall survival (OS) was significantly better for patients in sMP group than for patients in dMP group (P = 0.007). In multivariate analysis, depth of tumor invasion, pN stage, age, primary location, positive expression of p53, elevated maximal LDH, elevated initial CA19-9 and AFP level were independent prognostic factors for OS. The sMP group had a significantly better OS than dMP group (P = 0.014) in pN0 stage. After further stratification, the survival outcomes were not significantly different between deep muscularis propria tumor invasion without lymph node metastasis (dMPN0) group (stage IB) and superficial muscularis propria tumor invasion with stage 1–2 lymph node metastasis (sMPN1–2) group (stage II) (P = 0.100). Patients with adjuvant chemotherapy had a statistically better survival than those without in dMPN0 group (P = 0.045) and dMPN0 patients with adjuvant chemotherapy had better OS than sMPN1–2 patients (P = 0.015). In addition, greater postoperative survival could be observed in sMPN0 patients than dMPN0 patients in p53-positive group (P = 0.002), and similar OS could be seen between dMPN0 patients with p53-positive and T2N1–2 patients (P = 0.872).ConclusionAs a unique subclassification of stage IB GC, appropriate adjuvant chemotherapy should be considered for patients with dMPN0 stage. In addition, positive expression of p53, elevated LDH could be potential factors in identifying the different prognoses for stage IB GC patients.

DO HIGH PRE-OPERATIVE CA-125 LEVELS PREDICT EARLY RECURRENCE IN PATIENTS WITH HIGH-GRADE EPITHELIAL OVARIAN CANCER ?

Ponte Academic JournalAug 2022, Volume 78, Issue 8 DO HIGH PRE-OPERATIVE CA-125 LEVELS PREDICT EARLY RECURRENCE IN PATIENTS WITH HIGH-GRADE EPITHELIAL OVARIAN CANCER ?Author(s): Nilufer Bulut ,Tanju KapaganJ. Ponte - Aug 2022 - Volume 78 - Issue 8 doi: 10.21506/j.ponte.2022.8.8 Abstract:Background CA-125 is used as a marker in the diagnosis, treatment, and follow-up of ovarian cancers. High CA-125 levels indicate a high tumor burden, large ascites volume, and advanced stage. In the present study, the predictive value of CA-125 for the prognosis of ovarian cancer patients was determined. Materials-Methods The data of 173 patients diagnosed with ovarian cancer between 2009 and 2021 were analyzed retrospectively. CA-125 values before primary treatment were recorded. All patients underwent neoadjuvant chemotherapy or primary tumor surgery. Patients with normal CA-125 values at the end of treatment, and those with residual tumor, were followed up until the first recurrence. Disease-free and overall survival were analyzed. Results According to the preoperative CA-125 values, the disease-free survival time before treatment in patients with CA-125 levels of 0–40, 41–120, and &gt; 121 U/ml was 73, 59.8, and 54 months, respectively; the differences were not statistically significant (p = 0.174). Patients with a ≥ 3-fold increase in their CA-125 value at recurrence had shorter overall survival (0–40 U/ml: 86 months; 41–120 U/ml: 60 months; &gt; 121 U/ml: 54 months; p = 0.025). For patients without residual tumor after surgery, overall survival was 61 months, but it was significantly shorter (38 months) in those with residual tumor &gt; 1 cm (p=0.001). Conclusion Levels of the tumor marker CA-125 are used to determine the response to treatment, residual tumor, and disease recurrence in ovarian cancer patients. Although elevated CA-125 levels alone do not contribute to the prognosis, patients with values 3-fold higher than before treatment had shorter overall survival. Download full text:Check if you have access through your login credentials or your institution Username Password

Treatment and Long-term outcome of acute cerebral infarction in a patient with high CA125 and endometriosis.

Background: Cancer antigen 125 is a cell surface glycoprotein present in elevated serum levels with certain types of cancer, especially non-mucinous epithelial ovarian cancers. Still, such elevations can also be seen in benign gynecologic conditions such as severe adenomyosis, uterine myomas, and advanced endometriosis. Recently, high serum levels of cancer antigen 125 have also been associated with an increased risk of stroke. Case: This report describes the case of a 48 years-old woman that presented a novel association between ischemic stroke and endometriosis in a patient with extremely high serum levels of cancer antigen 125 and illustrates the long-term management strategy utilized for secondary prevention of ischemic stroke. Conclusion: The role of the cancer antigen 125 level on the pathogenesis of ischemic stroke is yet to be determined. High serum cancer antigen 125 can be seen in ischemic stroke in women of reproductive age. Cancer antigen 125 levels might have some implications on the election of the long-term secondary prevention of IS. Teaching Points: - Elevated serum levels of CA-125 are associated with an increased risk of stroke. - Raised serum levels of CA-125 can be seen in benign gynecologic conditions. - The finding of high CA-125 might have some implications on the election of the long-term management strategy for the secondary prevention of ischemic stroke.

Establishment of an optimized CTC detection model consisting of EpCAM, MUC1 and WT1 in epithelial ovarian cancer and its correlation with clinical characteristics.

ObjectiveEmerging studies have demonstrated the promising clinical value of circulating tumor cells (CTCs) for diagnosis, disease assessment, treatment monitoring and prognosis in epithelial ovarian cancer. However, the clinical application of CTC remains restricted due to diverse detection techniques with variable sensitivity and specificity and a lack of common standards.MethodsWe enrolled 160 patients with epithelial ovarian cancer as the experimental group, and 90 patients including 50 patients with benign ovarian tumor and 40 healthy females as the control group. We enriched CTCs with immunomagnetic beads targeting two epithelial cell surface antigens (EpCAM and MUC1), and used multiple reverse transcription-polymerase chain reaction (RT-PCR) detecting three markers (EpCAM, MUC1 and WT1) for quantification. And then we used a binary logistic regression analysis and focused on EpCAM, MUC1 and WT1 to establish an optimized CTC detection model.ResultsThe sensitivity and specificity of the optimized model is 79.4% and 92.2%, respectively. The specificity of the CTC detection model is significantly higher than CA125 (92.2% vs. 82.2%, P=0.044), and the detection rate of CTCs was higher than the positive rate of CA125 (74.5% vs. 58.2%, P=0.069) in early-stage patients (stage I and II). The detection rate of CTCs was significantly higher in patients with ascitic volume ≥500 mL, suboptimal cytoreductive surgery and elevated serum CA125 level after 2 courses of chemotherapy (P<0.05). The detection rate of CTCEpCAM+ and CTCMUC1+ was significantly higher in chemo-resistant patients (26.3% vs. 11.9%; 26.4% vs. 13.4%, P<0.05). The median progression-free survival time for CTCMUC1+ patients trended to be longer than CTCMUC1− patients, and overall survival was shorter in CTCMUC1+ patients (P=0.043). ConclusionsOur study presents an optimized detection model for CTCs, which consists of the expression levels of three markers (EpCAM, MUC1 and WT1). In comparison with CA125, our model has high specificity and demonstrates better diagnostic values, especially for early-stage ovarian cancer. Detection of CTCEpCAM+ and CTCMUC1+ had predictive value for chemotherapy resistance, and the detection of CTCMUC1+ suggested poor prognosis.

Menopausal Status Combined with Serum CA125 Level Significantly Predicted Concurrent Endometrial Cancer in Women Diagnosed with Atypical Endometrial Hyperplasia before Surgery †.

About 10–66% of patients with atypical endometrial hyperplasia diagnosed before surgery (preoperative-AEH) are found to have concurrent endometrial cancer (EC) at definitive hysterectomy, leading to incomplete primary surgery and delayed adjuvant treatment. This study aims to investigate the potential risk factors of concurrent EC in preoperative-AEH patients in a clinical setting with a gynecological pathology review. All patients diagnosed with AEH by endometrial biopsy or curettage that then underwent definitive hysterectomy from January 2016 to December 2019 in a tertiary hospital were retrospectively analyzed. All diagnoses were reviewed by gynecological pathologists. A total of 624 preoperative-AEH patients were included, 30.4% of whom had concurrent EC. In multivariate analysis, postmenopausal status and CA125 ≥ 35 U/mL significantly correlated with concurrent EC (OR = 3.57; 95% CI = 1.80–7.06; OR = 2.15; 95% CI = 1.15–4.03). This risk was remarkably increased in patients with both postmenopausal status and CA125 ≥ 35 U/mL (OR = 16.20; 95% CI = 1.73–151.44). Notably, concurrent EC seemed to occur more frequently in women with postmenopausal time ≥ 5 years (OR = 4.04, 95% CI = 1.80–5.85). In addition, CA125 ≥ 35 U/mL seemed to be an independent risk factor (OR = 5.74; 95% CI = 1.80–18.27) for concurrent intermediate-high-risk EC. Intermediate-high-risk EC was also more commonly seen in preoperative-AEH women with postmenopausal time ≥ 5 years (OR = 5.52, 95% CI = 1.21–25.19, p = 0.027). In conclusion, preoperative-AEH patients with postmenopausal status or elevated level of CA125 might have a high risk of concurrent EC. Adequate pre-surgical evaluation might be suggested for such patients.

Antígeno carbohidrato 125 (CA125) como marcador pronóstico en ancianos con insuficiencia cardiaca aguda y fracción de eyección preservada

BackgroundCarbohydrate antigen 125 (CA125) has emerged as a new biomarker in heart failure. The objective of the study is to determine whether serum CA125 levels predict total mortality and readmissions at one year in patients >70 years old with acute heart failure (AHF) and preserved ejection fraction (PEF). MethodsMulticenter prospective observational study, which included 359 patients (mean age 81.5 years). The primary endpoint was total all-cause mortality and total readmissions for AHF at 1 year. A negative binomial regression technique was used to evaluate the association between CA125 and both endpoints. ResultsAt one year of follow-up, 87 deaths (24.2%) were registered. The patients in the lower quartile of CA125 had a lower crude mortality rate (14.4%, 26.7, 26.7, 29.2; p=0.09). After multivariate analysis, the CA125 value was positively associated with a higher risk (p=0.009). Such association was also positive but borderline significant for the risk of readmissions (p=0.089). ConclusionsIn a population older than 70 years hospitalized for AHF with PEF, elevated levels of CA125 are associated with an increased risk of death at one year of follow-up. The association with readmission for AHF was more uncertain. Low levels of CA125 identifies a subgroup at low-risk.

Early and late recurrences in lymph node-negative gastric cancer: a retrospective cohort study.

BACKGROUND: Predictors of recurrence in patients with lymph node-negative gastric cancer (GC) who have undergone curative resection have been widely investigated, but not the effects of predictors on timing of recurrence.OBJECTIVE: Determine the factors associated with early and late recurrence in patients with node-negative GC.DESIGN: Retrospective cohort.SETTING: Academic tertiary care center.PATIENTS AND METHODS: The study included patients with node-negative GC after curative resection between 2008 and 2018 at two institutions. Early and late recurrences were determined using a minimum P value approach to evaluate the optimal cutoff for recurrence-free survival (RFS). A competing risk model and landmark analysis were used to analyze factors associated with early and late recurrences.MAIN OUTCOME MEASURES: Recurrence-free survival and factors associated with survival.SAMPLE SIZE: 606.RESULTS: After a median follow-up of 70 months, 50 (8.3%) patients experienced recurrent disease. The optimal length of RFS for distinguishing between early (n=26) and late recurrence (n=24) was 24 months (P=.0013). The median RFS in the early and late recurrence groups was 11 and 32 months, respectively. Diffuse tumors (hazard ratio 3.358, P=.014), advanced T stage (HR 8.804, P=.003), perineural invasion (HR 10.955, P<.001), and anemia (HR 2.351, P=.018) were independent predictors of early recurrence. Mixed tumor location (HR 5.586, P=.002), advanced T stage (HR 5.066, P<.001), lymphovascular invasion (HR 5.902, P<.001), and elevated CA19-9 levels (HR 5.227, P<.001) were independent predictors of late recurrence. Similar results were obtained in the landmark analysis.CONCLUSIONS: Individualized therapeutic and follow-up strategies should be considered in future studies because of distinct patterns in predictors of early and late recurrence.LIMITATIONS: Retrospective design, small sample size.CONFLICT OF INTEREST: None.