Normal CA-125 Levels Research Articles

Postoperative serum CEA and CA125 levels are supplementary to perioperative CA19-9 levels in predicting operative outcomes of pancreatic ductal adenocarcinoma

Carbohydrate antigen (CA19-9) is a well-established marker to monitor disease status after resection of pancreatic cancer. However, few serum markers have been reported to improve the prognostic ability of postoperative CA19-9, especially in patients with normal postoperative CA19-9. A total of 353 patients with pancreatic ductal adenocarcinoma treated by radical resection were reviewed retrospectively, and a prospective cohort including 142 patients with resectable pancreatic head carcinoma was analyzed as a validation cohort. Perioperative CA19-9 and postoperative serum markers (CEA, CA242, CA72-4, CA50, CA125, CA153, and AFP) were investigated. Patients with postoperative normalization of CA19-9 had improved survival times (recurrence-free survival: 11.9months; overall survival: 22.5months) compared with those with decreased but still elevated postoperative CA19-9 (recurrence-free survival: 6.8months, P<.001; overall survival: 13.5months, P<.001) or those with increased postoperative CA19-9 (recurrence-free survival: 3.5months, P<.001; overall survival: 7.9months, P<.001), which was similar to those with consistently normal CA19-9 during perioperative periods (recurrence-free survival: 10.6months, P=.799; overall survival: 24.1months, P=.756). Normal postoperative CA19-9 levels were an independent indicator for a positive outcome after operation, regardless of preoperative CA19-9 levels. Elevated postoperative CEA and CA125 were identified further as independent risk factors for patients with normal postoperative CA19-9, while elevated postoperative CA125 and nondecreased postoperative CA19-9 were independent prognostic markers for patients with elevated postoperative CA19-9. The postoperative monitoring of CEA and CA125 provided prognostic significance to the measurement of CA19-9 in pancreatic cancer after resection.

Preoperative Differentiation Between Malignant and Benign Ovarian Masses in Patients with Normal CA-125 Levels

OBJECTIVE: We aimed to determine the diagnostic values of some clinical and ultrasonographic features for predicting ovarian malignancies in patients with normal serum CA-125 levels.STUDY DESIGN: All of the 84 patients who were diagnosed with ovarian malignancy and 168 patients with benign adnexal mass had normal CA-125 levels, and recruited as study and control groups, respectively. Individual characteristics, ultrasonographic features, and risk of malignancy index (RMI) values of the groups were compared retrospectively.RESULTS: The ages, mean postmenopausal period of the postmenopausal women in the malignant group were significantly higher than the benign group. Nulliparity rates were similar between the two groups. The number of postmenopausal patients was significantly higher in the malignant group. Median cyst diameter and RMI values were significantly higher, and bilaterality and presence of solid area were more frequent in this group. Logistic regression model showed that ovarian cysts larger than 8 cm [Odds ratio (OR): 7.012; p&lt;0.001; 95% Confidence interval (CI): 3.463-14.198], presence of solid area within the cyst [OR: 7.43; p&lt;0.001; 95% CI: 3.799-14.532], and postmenopausal state [OR: 2.893; p=0.027; 95% CI: 1.129-7.412] were found to be significant factors to predict malignancy. CONCLUSION: Ovarian cysts larger than 8 cm, presence of solid area within the cyst, and postmenopausal status are the most important risk factors for ovarian malignancies in these patients with normal CA-125 levels.

Post-adjuvant chemotherapy CA19-9 levels predict prognosis in patients with pancreatic ductal adenocarcinoma: A retrospective cohort study

BackgroundCarbohydrate antigen 19-9 (CA19-9) is a widely used tumor marker for pancreatic ductal adenocarcinoma (PDAC). In addition, several studies have reported the utility of both pre- and postoperative CA19-9 levels as prognostic factors in resectable PDAC. However, little is known about the implications of post-adjuvant chemotherapy (AC) CA19-9 levels. The purpose of this study was to examine the utility of the post-AC CA19-9 level as a prognostic marker for relapse-free survival (RFS) in resectable PDAC. MethodsA total of 119 patients who completed AC were analyzed (normal post-AC CA19-9, n = 79; high post-AC CA19-9, n = 40). The upper limit of the normal (ULN) serum level of CA19-9 was 37 U/mL. ResultsMedian RFS was significantly shorter for patients with high post-AC CA19-9 levels than for those with normal post-AC CA19-9 (10.4 months vs. 29.6 months, respectively; p < 0.001). After adjustment, high post-AC CA19-9 level was an independent predictive factor for short RFS (hazard ratio for RFS, 2.72). Median overall survival was significantly shorter in patients with high post-AC CA19-9 levels than in those with normal postoperative CA19-9 levels (24.7 months vs. 92.1 months, respectively; p < 0.001). The optimal cutoff value of post-AC CA19-9 levels for prediction of early recurrence was >1.5 × UNL (55.5 U/mL), with a 74.2% positive predictive value. ConclusionsThe present results show that high post-AC CA19-9 level is an independent prognostic factor for short RFS in patients with resected PDAC. In addition, it may be useful for predicting early recurrence.

A Rare Case of Primary Peritoneal Psammocarcinoma Presenting as Acute Intestinal Obstruction and Ascites

We report a rare case of primary peritoneal psammocarcinoma (PPP) in a 60year old female patient who presented to surgical emergency with complaints of inability to pass feces and flatus for last 3 days along with pain and distension of abdomen. On clinical examination there were features of acute intestinal obstruction. Contrast CT of abdomen was suggestive of intestinal obstruction along with a stricture at the recto-sigmoid junction. On exploration there was a growth compressing the recto-sigmoid junction from the serosal surface. Anterior resection of the recto-sigmoid was done with negative gross margins. Histopathological examination of the resected specimen led to a diagnosis of primary peritoneal psammocarcinoma because of a solitary peritoneal lesion having abundant psammoma body formation and normal ovaries visualized on radiology and per-operatively. The diagnosis was further confirmed by histochemical tests and immunohistochemistry along with normal CA-125 levels in the patient.

Comparative analysis of resected duodenal and ampullary adenocarcinoma.

362 Background: Duodenal and ampullary adenocarcinomas are rare gastrointestinal cancers that share similar anatomic location and treatment strategy. We report a single-institution experience regarding the association between clinicopathologic features, treatment, and survival outcomes. Methods: A retrospective review of all patients resected with curative intent for duodenal adenocarcinoma (DUO) between 2005-2015 and ampullary adenocarcinoma (AMP) between 2011-2015 at VMMC was performed. For AMP, histologic subtyping into intestinal (IT) and pancreatobiliary (PB) phenotypes was determined. Demographic and clinicopathologic parameters were compared between DUO and AMP patients using Chi-square test. Overall survival was calculated using Kaplan-Meier analysis and prognostic factors were identified by univariate Cox regression. Results: Patients with DUO (n = 44) presented at higher T-stage (p = 0.002) and with larger tumors (4.35cm vs 2.33cm, p &lt; 0.001) than AMP patients (n = 46). DUO patients had a higher rate of surgical complications (68% vs 41%, p = 0.01) with a trend for more pancreatic fistulas (36% vs 20%, p = 0.08). There was no difference in median overall survival between groups. Factors positively influencing survival included Caucasian race (p = 0.02) and normal CA19-9 level at diagnosis (p = 0.01). Tumor factors negatively influencing survival included positive lymph nodes (p = 0.04), lymphovascular invasion (p = 0.001), and perineural invasion (p = 0.02). Within AMP, the PB subtype presented at higher T-stage (p = 0.01) and with more positive lymph nodes (p = 0.03) than IT. There was no difference in survival between subtypes. Majority received adjuvant chemotherapy (88.8% in AMP, 76.3% in DUO), fewer received adjuvant radiotherapy (23.3% in AMP, 30% in DUO), but no survival difference was seen. Conclusions: DUO presents with larger tumors and higher T-stage than AMP and is associated with more surgical complications. The PB phenotype has more advanced pathologic features than IT. No survival difference was seen between anatomic locations or subtypes. Better surgical and chemotherapeutic strategies may be needed to overcome high risk features. Longer follow-up with more patients is needed to confirm these findings.

Palliative Gastrectomy Prolongs Survival of Metastatic Gastric Cancer Patients with Normal Preoperative CEA or CA19-9 Values: A Retrospective Cohort Study.

Background. Palliative gastrectomy has been suggested to improve survival of patients with metastatic gastric cancer, but limitations in study design and availability of robust prognostic factors have cast doubt on the overall merit of this procedure. Methods. The characteristics and clinical outcomes of 173 patients diagnosed between 2008 and 2012 were analyzed to determine the value of palliative gastrectomy and to identify potential prognostic factors. Results. Median overall patient survival was 6.5 months. To attenuate potential selection bias, patients with adequate performance and survival time of ≥ 2 months since diagnosis were included for risk factor analysis (n = 137). The median overall survival was longer for patients who were younger than 60 years, had better performance status (8.7 versus 6.4 months, P = 0.015), received systemic chemotherapy, or had palliative gastrectomy in univariate analyses. Gastrectomy (P = 0.002) remained statistically significant in multivariate analyses. Subgroup analysis showed that patients aged < 60 years, CEA < 5 ng/mL or CA19-9 < 35 U/mL, obtained a survival advantage from palliative gastrectomy. In fact, palliative gastrectomy doubled overall survival for patients who had normal CEA and/or normal CA19-9. Conclusions. Palliative gastrectomy prolongs the survival of metastatic gastric cancer patients with normal CEA and/or CA19-9 level at the time of diagnosis.

Relationship between serum CA19-9 and CEA levels and prognosis of pancreatic cancer.

To explore the relationship between preoperative serum CA19-9 and CEA levels and prognosis of pancreatic cancer (PC). The clinicopathological data of 128 patients with pancreatic adenocarcinoma who were treated in our center between January 2012 and December 2013 were retrospectively analyzed. The relationships between serum CA19-9 and CEA levels and survival were analyzed using Kaplan-Meier method, log-rank test, and Cox regression analysis. The cut-off values for serum CA19-9 and CEA levels were 39 U/mL and 4.7 ng/mL, respectively. Among these 128 patients, the mean age was 62 years, and median survival was 12.2 days. The positive rate of CA19-9 and CEA was 78.1% and 37.5%, respectively. Patients with increased CA19-9 or CEA level suffered a poorer prognosis than those with normal CA19-9 or CEA level (CA19-9: P=0.027; CEA: P=0.036). Cox logistic analysis revealed that lymphatic metastasis, CA19-9 >39 U/mL, and CEA >4.7 ng/mL were independent prognostic factors in patients with pancreatic carcinoma. Preoperative serum CA19-9 and CEA level are closely related with survival time in PC patients and therefore may be used for evaluating the prognosis for PC.

ROLE OF INTEGRATED PET/CT IN DETECTING RECURRENT OVARIAN CANCER IN PATIENTS WITH RISING CA-125 LEVELS

Purpose: The purpose of this study was to assess the sensitivity and diagnostic accuracy of integrated positron emission tomography/computed tomography (PET/CT) in detecting recurrent ovarian cancer in treated patients presenting with rising CA-125 levels during clinical follow-up and compare it with those of CT alone. Materials and Methods: This was a retrospective study. We evaluated 45 patients with pathologically proven ovarian carcinoma who underwent PET/CT during October 2010–November 2013 at our institution for suspected relapse; IRB deemed that approval for this retrospective study was not required. Of these, 35 patients who presented with rising CA-125 levels during clinical follow-up were included in this study. Remaining 10 patients were excluded as they had normal CA-125 levels. At least three previous consecutive CA-125 readings and initial conventional imaging before uorodeoxyglucose-PET/CT were noted. Sensitivity and diagnostic accuracy for tumour detection with PET/CT and CT alone were calculated; histological analysis after biopsy/second look surgery or clinical- radiologic follow-up/response to chemotherapy was taken as reference standard. K statistics (Cohen K) was used for statistical analysis. Results: Of 35 patients with suspected relapse, one patient was lost to follow up. 30 patients were documented to have relapsed, while in four patients, recurrence was not identi ed either on CT or PET-CT and they were proved to be disease free on 2-year follow-up. Amongst these relapsed patients, 10/30 cases were proven histologically, 3 with imaging-guided biopsy and 7 with second-look surgery, whereas 20/30 were con rmed on clinical/radiological follow-up (ranging from 3 to 6 months) or by response to chemotherapy on subsequent imaging. Of 30 patients with relapse, PET-CT highlighted recurrence in 27. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of integrated PET/CT were calculated to be 90%, 75%, 96%, 50%, and 88%, respectively. CT alone detected recurrence in 20 patients. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of CT were calculated to be 73.3%, 100%, 100%, 33%, and 76%, respectively. Conclusion: PET/CT is a highly sensitive and accurate post-therapy surveillance modality for the detection of recurrent ovarian cancer in patients with rising tumour markers as compared to CT alone. Key words: CA125, uorodeoxyglucose, ovarian cancer, positron emission tomography/computed tomography, recurrence

Transmural Rectosigmoid Endometriosis Causing Rectal Bleeding and Partial Colonic Obstruction

Introduction: Intestinal endometriosis occurs in 10% of endometriosis cases. Most patients are asymptomatic while some may experience non-specific gastrointestinal symptoms. Diagnosis is challenging due to lack of characteristic clinical, radiological, and endoscopic findings. Endoscopic biopsies are rarely helpful as intestinal endometriosis frequently involves deeper layers of the bowel wall. We report a rare occurrence of transmural rectosigmoid endometriosis and its unusual presentation as rectal bleeding and partial colonic obstruction. Case Presentation: A 46 year-old-woman presented with six months of severe constipation and hematochezia that worsened monthly, around the time of menstruation. Colonoscopy revealed a circumferential and partially obstructing rectosigmoid lesion which was biopsied, but pathology was non-diagnostic. CT abdomen and pelvis revealed a 3-cm intraluminal mass in the mid-sigmoid colon and a 4-cm well-circumscribed mass in the right adnexa. A pelvic ultrasound confirmed a complex right ovarian cyst, as well as a left hemorrhagic ovarian follicular cyst. Labs revealed normal CBC, CMP, CEA and CA-125 levels. The patient was referred to colorectal and gynecologic oncology surgery, and subsequently underwent robotic-assisted low anterior resection of the rectosigmoid colon with anastomosis, and total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Surgical pathology of the rectosigmoid colon ultimately revealed endometriosis involving the entire thickness of the bowel wall with focal extension into the mucosa. On follow up visits, the patient reported complete resolution of rectal bleeding and constipation. Discussion: Intestinal endometriosis rarely affect the entire thickness of the bowel wall, making endoscopic biopsies typically futile. In cases where mucosal endometriosis was confirmed with endoscopic biopsies, patients were post-menarche women with cyclic gastrointestinal symptoms and hematochezia, similar to our patient. Despite initial non-diagnostic endoscopic biopsies, our patient did prove to have mucosal involvement of the colon on surgical pathology. Symptomatology of cyclic rectal bleeding and severe constipation in post-menarche women may be an indication of transmural involvement of intestinal endometriosis and should be considered in the differential diagnosis. Moreover, these patients may benefit from more thorough endoscopic sampling which may improve the diagnostic yield of endoscopy.Figure 1Figure 2

Primary Peritoneal Carcinoma: A Case Report of Primary Peritoneal Papilary Serous Adenocarcinoma in a 59 Year Old Postmenopausal Woman

Primary peritoneal carcinoma is rare and may present with symptoms similar to epithelial ovarian carcinoma which has some histological similarities. This is a case report of a 59 year old woman Para 2 who presented with massive ascites, abdominal pain, difficulty in breathing, abdominal mass and weight loss of three months duration. No conclusive diagnosis could be made after an ultrasound scan and CT-scan investigations showed the ovaries were of normal size but serum CA125 level was markedly elevated. No organ including the ovaries was identified as primary source of the tumour at an initial laparatomy. Specimens were however taken from multiple areas including the peritoneum and the omentum for histopathology. Reports of cytology and histology specimens indicated papillary serous adenocarcinoma with likely primary source being the ovary. Two cycles of neo-adjuvant chemotherapy was administered followed by re-laparatomy where total abdominal hysterectomy plus bilateral salpingoophorectomy, omectomy and surgical reduction of tumour seedlings. Final histopathology ruled out papillary serous adenocarcinoma of the ovary which has similar histological features with papillary serous adenocarcinoma of the peritoneum. Four cycles of adjuvant platinum plus paclitaxel based chemotherapy was then administered and serum CA 125 declined from 214u/ml to 49.5u/ml with no clinical signs of residual disease on completion of chemotherapy. The patient is now on followed-up. Conclusion: Primary peritoneal carcinoma though rare, should be suspected if the peritoneum is involved in a malignancy of an unknown primary source. Management of primary peritoneal carcinoma should involve surgical debulking and appropriate chemotherapy as in ovarian carcinoma.

The Significance of Normal Pretreatment Levels of CA125 (

Objective:To assess the association between normal CA125 levels at diagnosis of epithelial ovarian carcinoma (EOC) with prognostic factors and with outcome.Methods:The study group consisted of histologically confirmed EOC patients with normal pretreatment CA125 levels, and the controls consisted of EOC patients with elevated (≥35 U/mL) pretreatment CA125 levels, diagnosed and treated between 1995 and 2112. Study and control group patients fulfilled the following criteria: 1) their pretreatment CA125 levels were assessed; 2) they had full standard primary treatment, i.e. cytoreductive surgery and cisplatin-based chemotherapy; and 3) they were followed every 2–4 months during the first two years and every 4–6 months thereafter.Results:Of 114 EOC patients who fulfilled the inclusion criteria, 22 (19.3%) had normal pretreatment CA125 levels. The control group consisted of the remaining 92 patients with ≥35 U/mL serum CA125 levels pretreatment. The proportion of patients with early-stage and low-grade disease, with optimal cytoreduction, and with platin-sensitive tumors was significantly higher in the study group than in the control group. The progression-free survival (PFS) and overall survival (OS) were significantly higher in the study group than in the control group on univariate analysis but not on multivariate analysis.Conclusion:It seems that a normal CA125 level at diagnosis in EOC may also be of prognostic significance for the individual patient.

Cholangiocarcinoma with a paraneoplastic leukemoid reaction mimicking a pyogenic liver abscess

Cholangiocarcinoma with a paraneoplastic leukemoid reaction mimicking a pyogenic liver abscess

Predictive value of CA125 in peritoneal metastasis and prognosis of patients with gastric carcinoma

To investigate the predictive value of serum CA125 in peritoneal metastasis, and to examine the association of CA125 with the prognosis. Clinical data of 1285 gastric cancer patients admitted to the Qilu Hospital from March 2003 to September 2008 were retrospectively reviewed. The sensitivity, specificity and accuracy of serum CA125 for peritoneal metastasis were analyzed. Clinicopathological characteristics and survival were compared between patients with normal serum CA125 level(≤35 μg/L) and patients with elevated serum CA125 level(>35 μg/L). The specificity, sensitivity and accuracy of serum CA125 for peritoneal metastasis were 96.0%, 13.8% and 81.2%, respectively. A significantly higher incidence of peritoneal metastasis was observed in the patients with elevated serum CA125 level as compared to those with normal serum CA125 level(43.2% vs. 16.5%). CA125 was an independent predictor of peritoneal metastasis(RR=3.475, 95% CI:2.124-5.685). The 5-year overall survival rate in patients with elevated serum CA125 level was 13.5%, which was significantly lower than that of patients with normal serum CA125 level (49.8%, P<0.01). CA125 was an independent prognostic factor of gastric cancers(HR=2.049, 95%CI:1.355-2.873). Serum CA125 is useful in predicting peritoneal metastasis and prognosis of gastric cancer, which should be used as a routine examination of gastric cancer patients.

Esophagitis Dissecans Superficialis as a Rare Clinical Manifestation of a Praneoplastic Syndrome

Introduction: Esophagitis dissecans superficialis (EDS) is a rare finding that may present as part of a paraneoplastic syndrome. A 66-year-old female with no significant PMHx presented with new onset of ascites. Ascitic fluid was diagnostic for stage IV adenocarcinoma of unknown primary. Cancer markers were ordered and were notable for an elevated CA125 level with normal CEA and CA19-9 levels. Upper endoscopy was performed to rule out gastrointestinal malignancy. Upper endoscopy demonstrated normal stomach and duodenum. Endoscopic examination of the esophagus revealed active linear sloughing of the superficial mucosa of the entire esophagus, consistent with EDS (Figure 1). The patient denied any signs of dysphagia, odynophagia, GERD, or dyspepsia. Findings of EDS in this patient may represent a paraneoplastic syndrome from an occult malignancy. EDS is a rare endoscopic finding characterized by sloughing of large fragments of esophageal mucosal lining. Typical causes include medications (e.g. bisphosphonates, NSAIDs, potassium chloride), hot beverages, chemical irritants, celiac disease, collagen diseases and autoimmune bullous dermatoses. Close review of our patient’s social and medical history does not reveal any of the aforementioned precipitating factors. A review of the published literature brought up rare cases of paraneoplastic causes of EDS. The pathophysiology seems to be similar to that of paraneoplastic pemphigus. This case may represent as paraneoplastic EDS from occult malignancy.Figure 1: Esophagitis dissecans superficialis.

Abstract 4712: Personalized ovarian cancer surveillance and detection of a therapeutic drug target in circulating tumor DNA

Abstract Retrospective studies have demonstrated that nearly 50% of ovarian cancer patients with normal CA125 levels have persistent disease; however, prospectively distinguishing between patients is currently impossible. Here we demonstrate that for one patient, with the first reported FGFR2 fusion transcript in ovarian cancer, circulating tumor DNA (ctDNA) is a more sensitive and specific biomarker than CA125 and it can also inform on a candidate therapeutic. Over a four year period, during which the patient underwent primary debulking surgery and chemotherapy, tumor recurrences and multiple chemotherapeutic regimens, blood samples were longitudinally-collected and stored. Whereas post-surgical CA125 levels were elevated only three times over 28 measurements, the FGFR2 fusion ctDNA biomarker was readily detectable by qtRT-PCR in all of these same blood samples and in the tumor recurrences. Given the persistence of the FGFR2 fusion, we treated tumor cells derived from this patient and other with the FGFR2 inhibitor BGJ398. Only tumor cells derived from this patient were sensitive to FGFR2 inhbitor treatment. Using the same overall approach, ctDNA is demonstrated in other patients and the results compared to CA125. Taken together, we demonstrate that a relatively inexpensive, PCR-based ctDNA surveillance assay can outperform CA125 in identifying occult disease. To our knowledge, this use of a personalized biomarker represents the first example in ovarian cancer demonstrating the presence of continuous occult disease in the face of negative clinical, radiologic and biochemical examination. Moreover, the recent identification of FGFR fusions in other solid cancers suggests a broader application of this strategy beyond ovarian cancer. Citation Format: John A. Martignetti, Olga Camacho-Vanegas, Nolan Priedigkeit, Catalina Camacho-Vanegas, Elena Pereira, Li Lin, Bojan Losic, hardik Shah, Jun Liao, Jian Ma, Pratik Lahiri, Mark Chee, Eric Schadt, Peter Dottino. Personalized ovarian cancer surveillance and detection of a therapeutic drug target in circulating tumor DNA. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4712. doi:10.1158/1538-7445.AM2014-4712

726P - Natural History of Untreated Patients Who Had Metastatic Biliary Tract Cancer (Btc) with Good Performance Status (Ps)

ABSTRACT Aim: Although chemotherapy is widely recommended for patients with metastatic biliary tract cancer (BTC), the natural course of these patients, especially those with good performance status (PS) who are indicated for chemotherapy, is not known. Methods: We retrospectively reviewed patients with metastatic or locally advanced BTC who were examined between January 2005 and September 2013 at six cancer centers. Patients were eligible if they had good PS (Eastern Cooperative Oncology Group score 0-2) and no history of any treatment for cancer. The primary objective was to evaluate the survival time of patients with advanced BTC with good PS who were untreated. Results: Of the 1,677 screened patients, 204 met the inclusion criteria. The median age was 70.1 years and median overall survival (OS) was 7.1 months. OS by disease location was 4.7 months for intrahepatic, 9.7 months for extrahepatic, 4.4 months for gallbladder, and 11.2 months for ampulla of Vater cancer. In subgroup analysis, OS of locally advanced BTC was 13.8 months and that of patients with normal CEA/CA 19-9 was 10.6 months. In multivariate analysis, variables that were associated with poor prognosis were disease extent (metastatic disease) [HR 2.19 (95% CI 1.39-3.45 p = 0.001)], high baseline CEA level (defined as > 4.0 ng/mL) [HR 1.51 (95% CI 1.06-2.17 p = 0.024)], and high baseline CA 19-9 level (defined as > 100 U/mL) [HR 1.93 (95% CI 1.33-2.91 p = 0.001)]. Conclusions: Metastatic BTC with good PS showed modest survival without any treatment for primary cancer. Furthermore, subgroup analysis showed that patients with normal CA19-9 or CEA level or locally advanced status had favorable survival. Further studies comparing the outcome of chemotherapy with that of best supportive care in patients with unresectable BTC are warranted. Disclosure: All authors have declared no conflicts of interest.

Abnormal CA-125 levels in menopausal women without ovarian cancer

ObjectiveTo determine if an abnormal CA-125 level in a menopausal female without ovarian cancer is associated with an increase in mortality. MethodsThe Prostate, Lung, Colorectal, and Ovarian Cancer Screening Randomized Controlled (PLCO) Trial is a large multicenter prospective trial conducted by the National Cancer Institute (NCI). Over 78,000 healthy women aged 55–74 were randomized to a screening arm versus a usual medical care arm to evaluate the efficacy of screening in reducing mortality due to ovarian cancer. Women in the screening arm underwent annual screening for ovarian cancer with transvaginal ultrasound and CA-125 levels. There were 38,818 patients without ovarian cancer that had at least one CA-125 level drawn; 1201 (3.09%) had at least one abnormal level. The current study compares mortality in patients that had one or more abnormal CA-125 levels without ovarian cancer versus those with all normal levels. ResultsPatients with one or more abnormal CA-125 levels, without ovarian cancer, had a significantly higher mortality than patients with all normal CA-125 levels in the PLCO screening trial (p<0.0001). This increased risk extended throughout the follow-up period. Analysis of cause of death listed on the death certificate showed an excess mortality attributable to lung cancer, digestive disease, and endocrine, nutritional, and metabolic disease. ConclusionMenopausal females with an elevated CA-125 and without ovarian cancer are exposed to an increased risk of premature mortality.

Prognostic Role of CA-125 in Patients Undergoing Cardiac Transplantation.

INTRODUCTION: Carbohydrate antigen 125 (Ca125) is a well-established biomarker for monitoring ovarian cancer growth. Recent studies have suggested that Ca125 serum levels are remarkably elevated in patients with heart failure (HF), being an independent predictor of mortality and heart transplantation (HT). However, its long-term prognostic role in patients undergoing a HT has not been investigated yet. METHODS: We retrospectively studied all patients who underwent a HT in our Advanced HF Unit, and had a previous determination of Ca125, since 2003 until 2012. Decompensated patients at the moment of the blood extraction and those whose survival was less than 1 month after HT were excluded. Pre-HT clinical, haemodynamical and follow-up data were analyzed. RESULTS: Of 173 patients who underwent a HT, 64 could be included in our study. When divided this population into normal or elevated Ca125 levels (>35U/mL, n=25), no significant differences were found according to their Baseline Characteristics. Survival was significatively inferior in the “Elevated Ca125” group.Figure: No Caption available.Furthermore, “Elevated Ca125” group presented a clearly negative tendency to Graft Rejection. There were no differences according to Infections, Tumours or Graft Vascular Disease. CONCLUSSIONS: In our population, non-congestive patients with high levels of Ca125 had an inferior long-term survival after Heart Transplantation than those with normal levels. A tendency to less Graft Rejection existed in this group, too.

Gene expression profiles of high-grade serous ovarian cancers in patients with normal CA-125 levels at the time of recurrence

Gene expression profiles of high-grade serous ovarian cancers in patients with normal CA-125 levels at the time of recurrence

Osteopoikilosis: A Benign Condition With the Appearance of Metastatic Bone Disease

Case Report A 37-year-old woman with a history of migraines and gastritis presented to the emergency department with 1 day of right adnexal pain. A computed tomography (CT) scan of the pelvis performed to evaluate the pelvic pain showed a fluid-filled structure in the right adnexa, indicating a possible tubo-ovarian abscess. The patient was subsequently admitted to the hospital for treatment with antibiotics. Incidentally found on CT imaging were diffuse sclerotic foci (Fig 1) throughout the visualized spine and pelvis, suggesting asymptomatic metastatic disease. Physical examination was only significant for right lower quadrant tenderness, corresponding to the CT findings. There was no lymphadenopathy, mass, or obvious tenderness of her spine and pelvis. Initial laboratory results showedanormalcompletebloodcountandserumchemistries, including calcium of 9.8 mg/dL, and alkaline phosphatase of 63 U/L, and normal CA125 level. CT imaging of the chest showed diffuse blastic-appearing lesions throughout the skeleton without notable lymphadenopathy or mass. A nuclear bone scan was found to be normal, without evidence of any blastic metastatic lesions (Fig 2). The patient was ultimately given the diagnosis of osteopoikilosis, a rare benign condition of the bone.