Preoperative Serum CA-125 Levels Research Articles

Postoperative lymph node metastasis status and related factors in patients with early-stage, low-risk endometrial cancer assessed by the Mayo criteria

Objective: To investigate the postoperative lymph node metastasis status and related factors of patients with early-stage low-risk endometrial cancer evaluated by the Mayo criteria in order to make the preoperative evaluation more accurate. Methods: A total of 172 patients with early-stage low-risk endometrial cancer who underwent surgery in Sichuan Provincial Cancer Hospital from 2009 to 2018 and were evaluated as early low-risk according to the "Mayo criteria" were retrospectively enrolled, and were divided into lymph node metastasis group (7 cases) and non-metastasis group (165 cases) according to the results of postoperative pathological examination. The postoperative pathological examination results and prognosis of all patients were collected. The lymph node metastasis of the two groups was analyzed. The multiple logistic regression model was used to analyze the related factors of lymph node metastasis, and the area under the curve (AUC) of the relevant factors was calculated by using the receiver operating characteristic curve to predict the postoperative lymph node metastasis of patients. Results: The age of 172 patients was (53.0±8.6) years, and the follow-up [M(Q1,Q3)] was 64.1 (46.2, 91.4) months, among whom 2 relapsed and 1 died. Among the 7 patients with lymph node metastasis, 5 cases had pelvic lymph node metastasis, 1 case had pelvic lymph union and abdominal para-aortic lymph node metastasis, 1 case had isolated abdominal para-aortic lymph node metastasis, 3 cases had two lymph node metastases, and 4 cases had intrailiac lymph nodes being the most common metastasis site. Multivariate analysis showed that preoperative serum cancer antigen (CA) 125 was the relevant factor for postoperative lymph node metastasis, with an OR value (95%CI) of 1.022 (1.001-1.043) (P=0.042), with AUC (95%CI) of CA125 predicting lymph node metastasis of 0.850 (0.761-0.939) (P=0.002), and the optimal cut-off value of CA125 was 29.305 U/ml with the sensitivity of 85.7% and the specificity of 80.6%. Conclusions: When CA125>29.305 U/ml, patients with early-stage low-risk endometrial cancer assessed by the Mayo criteria, had an increased risk of lymph node metastasis. Therefore, adding preoperative serum CA125 level as an evaluation index on the basis of the classic "Mayo criteria" may help conduct more accurate preoperative evaluation and better identify early-stage low-risk EC patients.

Correlation between pre-operative platelets count and serum cancer antigen-125 level in epithelial ovarian carcer

Cancer antigen 125 (Ca-125) is currently used as an adjunct to ovarian cancer diagnosis, prognosis, and monitoring. Platelet (PLT) count and Ca-125 levels are both prognostic markers in ovarian cancer that are linked to inflammation and immune evasion.To determine the relationship between pre-operative platelet count and serum Ca-125 level, and their diagnostic accuracy for the prediction of stage IV epithelial ovarian cancer.The study included forty-two women with histologic diagnosis of epithelial ovarian cancer managed at the University of Port Harcourt Teaching Hospital between January 1, 2016, and December 31, 2020. Following informed consent, a data collection form was used to obtain socio-demographic and clinical characteristics. Pretreatment levels of Cancer Antigen 125 (Ca-125) and Platelets count (PLT) were determined from blood samples. The Spearman correlation coefficient was used to determine the relationship between PLT and Ca-125, and the Receiver Operating Characteristic (ROC) curve analysis was used to assess the predictive accuracy of PLT count alone and PLT-Ca-125. The sample median platelet count was 308 (307) x 10/L and median Ca-125 was 286µ/ml (397). Pre-operative platelets count was significantly associated with Ca-125 (rho= 0.28 p-value = 0.03). Ca-125 had a statistically significant relationship with ovarian cancer histology (X2:19.522; p-value 0.001). PLT-Ca-125 (0.51) and PLT only (0.29) had a statistically significant positive correlation with ovarian cancer stage (p 0.001). Since it had an area under the curve (AUC) greater than 0.7, PLT-Ca-125 can be used as a predictive model to correctly stage patients with epithelial ovarian cancer. Ca-125 level (z:-2.24; p-value = 0.025) was significantly associated with thrombocytosis in ovarian cancer patients.Platelet count and Ca-125 levels do correlate in blood samples taken from ovarian cancer patients prior to treatment. Furthermore, PLT-Ca-125 levels could be used to predict advanced stage disease.

BRCA Mutation Patients: Are There Other Predisposing Factors for Ovarian Cancer Occurrence? A Multicenter Retrospective Study

Objectives: The objective of this multicenter retrospective study aimed to evaluate the association of clinical variables and the incidence of ovarian cancer in patients with BRCA 1–2 mutation carriers who underwent risk-reducing salpingo-oophorectomy (RRSO). Design: Patients with a pathogenic mutation of BRCA 1–2 genes and with no evidence of disease are considered eligible. The exclusion criterion was the refusal to undergo the surgery. The retrospective study included all RRSO performed from May 2015 to April 2022 in the three gynecological Institutions of Southern Italy for were included in this retrospective study. Participants/Materials, Setting, Methods: Age, menarche age, BMI, menopause at time of RRSO, breast cancer first- and second-degree relatives, ovarian cancer first- and second-degree relatives, estroprogestin use, pregnancy normal full-term delivery, history of endometriosis, previous breast cancer and histologic type, previous abdominal/pelvic surgery, BRCA 1 or BRCA 2 status, preoperative serum CA-125 levels (IU/mL), age at time of RRSO and histological analysis were collected. Results: 184 were recruited. One was excluded. To assess cancer risk, the outcome variable was classified into three classes: no event, cancer, and other conditions excluding cancer. 14 women presented ovarian cancer and tubal intraepithelial carcinoma (STIC) on histopathologic final report. Ovarian cancer was found in 8 patients, whereas the presence of STIC was found in 6 of them. Limitations: The low incidence of patients diagnosed with ovarian cancer or STIC compared with the total number of patients undergoing RRSO is a potential bias. Conclusions: Our study did not demonstrate a correlation between clinical features and the occurrence of precancerous or cancerous lesions in BRCA mutation carrier patients.

Identifying tumor markers-stratified subtypes (CA-125/CA19-9/carcinoembryonic antigen) in cervical adenocarcinoma.

There is a lack of research evaluating the effect of tumor markers for prognosis in cervical adenocarcinoma. We aimed to develop and validate a preoperative tumor-marker-based model including clinicopathological factors to clarify the prognostic value of endocervical adenocarcinoma. A total of 572 patients with cervical adenocarcinoma who were staged at the International Federation of Gynecology and Obstetrics (FIGO) IA-IIA were reviewed retrospectively. Preoperative serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA)-125 and CA19-9 levels were measured. The survival and recurrence patterns were analyzed according to the tumor-marker-related stratification. The predictive values of biomarkers and clinical variables were assessed with Cox regression and competing risk models. Patients with elevated preoperative tumor markers had evidently poor overall survival and recurrence-free survival. The triple-elevated tumor marker (TETM) subgroup had the worst overall survival and progression-free survival than the triple-negative tumor marker (TNTM) subgroup and the single-elevated tumor marker (SETM) subgroup. The most important predictors for overall survival were elevated tumor markers, FIGO-stage, tumor differentiation, lymphovascular space invasion (LVSI) and lymph nodes metastasis. The most important predictors for recurrence-free survival were elevated tumor markers, FIGO-stage, tumor differentiation, LVSI and deep stromal invasion. Stratified analysis showed that elevated CA-125 and CA19-9 were significantly associated with postoperative distant metastasis. A decision curve analysis confirmed that a combination of tumor markers as predictors significantly outperformed the other common predictors used (FIGO-stage, intermediate and high-risk factors, tumor differentiation, lymph nodes). Elevated preoperative serum CEA, CA-125, and CA19-9 levels exhibited poor overall survival and recurrence-free survival in cervical adenocarcinoma patients. Combined preoperative serum CA-125 and CA19-9 independently predicted distant metastasis in patients with endocervical adenocarcinoma.

Predictive impacts of peritoneal washing cytology for surgical resection-intended pancreatic cancer cases: Establishment of planned staging laparoscopy criteria.

Staging laparoscopy (SL) has been advocated for pancreatic cancer, mainly to evaluate the peritoneal washing cytology (CY) status, which seems to impact the prognosis of pancreatic cancer. To establish an optimal treatment strategy for CY positive (CY+) pancreatic cancer cases, real-world clinical data about CY status-depending surgical outcomes should be accumulated. Peritoneal washing samples were collected from 183 consecutive patients who could be classified as either resectable or borderline resectable (BR) pancreatic cancer between January 2012 and December 2020. Correlations between the CY status and other clinicopathological parameters with the recurrence patterns and survival outcomes were examined. In addition, we analyzed several risk factors for the CY+ status and attempted to identify the patient population that may benefit most from SL. A total of 24 of the 183 patients were CY+. Peritoneal recurrence occurred more frequently in CY+ cases than in CY- cases (29% vs. 6%, p < .001) and median survival time after surgery was significantly shorter in CY+ cases than in CY- cases (28.5 months vs. 67.5 months; p < .001). In detail, almost all CY+ patients among curative resection-intended cases had either elevated preoperative serum CA19-9 levels (≥250 U/mL) or DUPAN-2 levels (≥150 U/mL). Significant predictive factors of CY positivity were BR status (p = .028) and serum CA19-9 level exceeding 250 U/mL (p = .008). CY status was identified as an independent prognostic factor, and SL examination should be recommended, especially for patients with risk factors for CY positivity, such as BR cancer and elevated serum CA19-9 levels.

Early recurrence after complete mesocolic excision for right-sided colon cancer with D3 lymphadenectomy: pattern, risk factors, prognostic impact, and individualized follow-up.

The definition of early recurrence (ER) for right-sided colon cancer patients after complete mesocolic excision (CME) with D3 lymphadenectomy remains unclear. This study aimed to define the optimal time for ER and clarify risk factors for ER and post-recurrence survival (PRS). A total of 578 right-sided colon cancer patients who underwent CME with D3 lymphadenectomy were included. The minimum p value method was used to evaluate theme optimal time of recurrence-free survival to discriminate between ER and late recurrence (LR). Risk factors for ER were determined by a logistics regression model. The PRS was compared between ER and LR. The optimal time to define ER was 15months (P = 1.8697E-7). 93 patients developed tumor recurrence, 46 patients had ER (≤15months) and 47 patients had LR (>15months). Preoperative serum CA19-9 > 37U/mL (OR = 3.185, P = 0.001), pathological N+ stage (OR = 3.042, P = 0.027), and lymphovascular invasion (OR = 2.182, P = 0.027) were identified as independent risk factors associated with ER. Age > 75years (HR = 1.828, P = 0.040), pathological N2 stage (HR = 1.850, P = 0.009), multiple sites of recurrence (HR = 1.680, P = 0.024), and time to recurrence ≤15months (HR = 2.018, P = 0.043) were significantly associated with worse PRS in patients with recurrence. 15months was the optimal time to distinguish ER and LR. ER was associated with a poor PRS. Elevated preoperative serum CA19-9 level, pathological N+ stage, and lymphovascular invasion were significantly predictive of ER.

Prognostic significance of serum CA125 in the overall management for patients with gastrointestinal stromal tumors

BackgroundCarbohydrate antigen 125 (CA125) is elevated as a tumor marker in many carcinomas, but its association with gastrointestinal stromal tumor (GIST) has received less attention. This study intends to evaluate whether CA125 level can predict tumor progression and overall survival (OS) of GIST patients.MethodsWe retrospectively analyzed the clinical data and follow-up records of GIST patients who underwent surgical resection in Nanjing Drum Tower Hospital from August 2010 to December 2020. All patients were classified according to serum CA125 level. The relationship between CA125 and clinical outcomes was then examined.ResultsA total of 406 GIST patients were enrolled in this study, among which 46 patients had preoperative elevated serum CA125 level and 13 patients with high CA125 level both preoperative and postoperative were observed. Preoperative CA125 concentration was significantly related to rupture status, resection style, tumor site, tumor size, mitotic index, NIH risk grade and c-kit exons. According to Kaplan–Meier curve analysis, high expression of postoperative CA125 was significantly correlated with worse progression-free survival (PFS) and OS among patients with preoperative elevated CA125 level. Ultimately, Cox proportional regression model analysis revealed that increase of preoperative and concurrent postoperative CA125 concentration was an independent predictive factor for PFS.ConclusionsThe concurrent abnormality of serum CA125 before and after operation was an independent risk factor for GIST progression, suggesting its significance as a serum biomarker in the overall management of GIST patients.

Frozen/Section Sonuçları ile Postoperatif Patoloji Sonuçları Arasındaki Uyumsuzluğu Öngören Faktörler: Tersiyer Merkez Sonuçları

FACTORS PREDICTING INACCURACY BETWEEN FROZEN SECTION ANALYSIS AND POSTOPERATIVE PATHOLOGY RESULTS: A TERTIARY CENTER EXPERIENCE ABSTRACT Objective: To evaluate the diagnostic accuracy and to identify the factors determining the inaccuracy between FS analysis and postoperative pathology results in our hospital. Materials and Methods: This study included 1435 patients with pelvic masses who underwent surgical intervention and FS consultation. Results: On univariate analysis, menopausal state, abnormal uterine bleeding, preoperative serum Ca125 level, preoperative leukocyte value, preoperative neutrophil value, tumor size, presence of cystic component, pathological findings in Doppler USG, ascites and cell type were found to have statistical significance for benign / borderline / malign discrimination. Menopausal state (p&amp;lt;0.0001), preoperative serum Ca125 level (p&amp;lt;0.0001) and tumor size (p&amp;lt;0.0001) were identified as independent predictors for determining inaccuracy between intraoperative and postoperative pathological evaluation. Inconsistency increased 2.5 times with a serum Ca125 &amp;gt; 35 IU/ml, 3.8 times with tumor size&amp;gt; 79 mm and 5 times in postmenopausal patients. For the discrimination of benign / borderline / malign definitions, FS results and final pathology results were compatible in 1250 (87%) patients while it was not in 185 (13%) patients. Conclusions: Increased preoperative serum Ca125 level was a predictor for inaccuracy between FS examination and postoperative pathology results. Also, tumor size ≥80 mm and menopausal state were related to misdiagnosis in FS results. Maximal effort should be done to minimize preventable errors during intraoperative FS analysis. Keywords: Frozen section, Pelvic mass, Inaccuracy, Borderline tumors

Preoperative serum CA19-9 predicts postoperative pancreatic fistula in PDAC patients: retrospective analysis at a single institution

BackgroundPostoperative pancreatic fistula (POPF) is a critical complication of pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC). Recent papers reported that serum carbohydrate antigen (CA)19-9 levels predicted long-term prognosis. We investigated whether preoperative serum CA19-9 levels were associated with POPF in PDAC patients.MethodsThis cohort study was conducted at a single institution retrospectively. Clinicopathologic features were determined using medical records.ResultsAmong of 196 consecutive patients who underwent pancreatectomy against PDAC, 180 patients whose CA19-9 levels were above the measurement sensitivity, were registered in this study. The patients consisted of 122 patients who underwent pancreaticoduodenectomy and 58 patients who underwent distal pancreatectomy. Several clinicopathological factors, including CA 19-9 level, as well as surgical factors were determined retrospectively based on the medical records. Patients with high CA19-9 levels had a significantly higher incidence of POPF than those with low levels (43.9 vs. 13.0%, P < 0.0001). The receiver operating characteristic curves calculated that the cutoff CA19-9 value to predict POPF was 428 U/mL. CA19-9, BMI, curability, and histology were statistically significant risk factors for POPF by univariate analysis. Multivariate analysis showed that CA19-9 and BMI levels were statistically significant independent risk factors for POPF. CA19-9 levels were correlated with both histology and curability. Disease free survival and overall survival of patients with higher levels of CA19-9 were significantly shorter than that of patients with lower levels of preoperative serum CA19-9.ConclusionsIn patients undergoing pancreatectomy for PDAC, higher preoperative CA19-9 levels are a significant predictor for POPF.

Clinicopathological Characteristics and Surgical Findings of Epithelial Ovarian Carcinoma

Introduction: Ovarian cancer was the third most common gynecological cancer globally in 2020. The objective of this study was to delineate clinicopathological characteristics and surgical findings of epithelial ovarian carcinoma in our context.&#x0D; Methods: This is a descriptive cross-sectional study conducted at Bhaktapur Cancer Hospital, from March, 2023 to May, 2023. Ethical approval was obtained from Institutional Review Board (Ref. No. 773/2079/80). Data pertaining patient characteristics, initial symptoms, pre-operative CA-125 level, risk of malignancy index, stage, histology, type and extent of surgery and residual disease were evaluated in 35 cases of epithelial ovarian carcinoma. Data were analyzed using SPSS version 16.0.&#x0D; Results: Among 35 cases of epithelial ovarian carcinoma, majority occurred in postmenopausal women (57.1%) with mean age 53 years. The most common presentation was abdominal distension (51.4%). Majority of patients had raised preoperative serum CA-125 level (94.2%) and RMI score (91.4%). Most of them presented in advanced stage III and IV (85.7%) with histology type high grade serous 2 carcinoma (82.8%). Eleven patients (31.4%) underwent primary cytoreductive surgery and 24 (68.5%) patients received neoadjuvant chemotherapy with three to six cycles of Carboplatin and Paclitaxel and underwent interval cytoreductive surgery. At surgery, majority had no residual disease (R 0 94.2%).&#x0D; Conclusions: Majority of epithelial ovarian carcinoma occurred in postmenopausal women with abdominal distension. Most of them presented in advanced stage III-IV with histology high grade serous carcinoma. They underwent interval cytoreductive surgery more than primary cytoreductive surgery. At surgery, majority had no residual disease.

Misdiagnosed appendiceal mucinous neoplasms and primary ovarian mucinous tumors present with different pre- and intraoperative characteristics.

ObjectiveTo identify the differences between the pre- and intraoperative characteristics in misdiagnosed appendiceal mucinous neoplasms (AMNs) and those in primary ovarian mucinous tumors (POMTs) and to establish an effective model for differentiating AMNs from pelvic mucinous tumors.MethodsThis study enrolled 70 AMN patients who were misdiagnosed with ovarian tumors and 140 POMT patients who were treated from November 1998 to April 2021 at Peking Union Medical College Hospital. The clinical features and operative findings of the two groups of patients were collected and compared.ResultsThere were significant differences in age and menopausal status, but no difference in the patients’ clinical manifestations between the two groups. The preoperative serum CA125 and CA199 levels were not different between the two groups. The CEA level (31.04 ± 42.7 vs. 7.11 ± 24.2 ng/ml) was higher in the misdiagnosed AMN group (P < 0.001). The AMNs were smaller than the POMTs that were measured preoperatively by ultrasonography (US) (P<0.05) and measured at surgery (P<0.05). Furthermore, the patients with AMNs more commonly had multinodularity and ascites noted on the preoperative US (P<0.001), on CT (P<0.001), and at surgery (P< 0.001). The two groups also differed in the presence of bilateral disease, in the appendiceal appearance and peritoneal dissemination. Subsequently, a prediction model was developed using multivariable logistic regression, which was evaluated through internal validation.ConclusionsThe suspicion of a nongenital organs originated tumor especially origing from appendiceal should be considered in a patient who is older, tumor size less than 12cm, multinodular, presence of mucinous ascites, and elevated serum CEA levels. Bilateral ovarian involvement, peritoneal dissemination, and an abnormal appendiceal appearance found during surgery were the typical features associated with AMNs.

Systemic therapy and perioperative management improve the prognosis of pancreatic ductal adenocarcinoma: A retrospective cohort study of 2000 consecutive cases

ObjectiveThis study aimed to explore patterns of the treatment strategies of pancreatic ductal adenocarcinoma based on 2000 consecutive cases of a prospective database since 2012 to obtain new insights for future directions. MethodsAmong 2000 patients enrolled in this study, 210 patients were excluded, and 710, 521, and 559 patients were treated between 2012 and 2015 (group 1), between 2016 and 2017 (group 2), and between 2018 and 2019 (group 3), respectively. Patient clinicopathologic and biological factors, and perioperative outcomes were used to assess the prognostic factors. ResultsThe median survival for all patients with pancreatic ductal adenocarcinoma was 21.7 months (1-year survival, 75.0%; 2-year survival, 43.7%; 5-year survival, 19.7%). Group 3 had a better survival outcome than groups 1 and 2 (median survival time: 23 versus 20.5 and 21.1 months). The proportion of patients younger than 65 gradually increased over time, as did the use of systemic chemotherapy and postoperative adjuvant radiotherapy. The tendency for early diagnosis (lower CA19-9 and CEA levels, smaller size, and earlier N stage), use of chemotherapy and radiotherapy, early recovery (lesser hospital stay and Clavien-Dindo grade <3), absence of abdominal pain, younger age, length of operation ≤3 h, and pathological factors (absence of lymphovascular invasion, peripancreatic fat infiltration and neural invasion, higher differentiation) were related to patients' survival. Multivariable analysis for prognosis revealed that tumor biological factors (increased preoperative serum CA19-9 level, tumor size, tumor differentiation, N stage, and presence of lymphovascular invasion and neural invasion), chemotherapy, radiotherapy, abdomen pain, operation period, length of stay, and length of operation correlated with patients’ survival. ConclusionsSystemic therapy, including chemotherapy and radiotherapy, has gradually improved the prognosis after operative resection for pancreatic ductal adenocarcinoma. Neoadjuvant therapy is also beneficial to improve the prognosis to a certain extent. The enhanced recovery after surgery (ERAS) policies and the specific assessment of postoperative pancreatic fistula (POPF) risk may be related to reduced hospital stays and the reduction of serious complications. These advancements show that the concept of systemic therapy has been accepted and actively applied by Chinese medical institutions.

Prognosis and fertility outcomes of patients with borderline ovarian tumors after fertility-sparing surgery

Objective: To explore the clinical prognosis and fertility outcomes in patients with borderline ovarian tumors (BOT) who underwent fertility-sparing surgery, and evaluate the related risk factors. Methods: The study examined the clinicopathological characteristics of 280 patients diagnosed with BOT from Qilu Hospital of Shandong University between January 2009 and December 2019. According to the surgery plan, the patients were divided into the fertility-sparing group (167 cases) and the radical surgery group (113 cases). The information of the patients' age, preoperative serum CA-125 level, surgery method, pathological type, FIGO stage (2014), tumor location, and whether focal canceration combined were collected. The Kaplan-Meier method was used to compare disease-free survival (DFS) between the fertility-sparing surgery group and the radical surgery group. The univariate and multivariate Cox proportional hazard regression analysis was used to explore high-risk factors associated with DFS. Results: A total of 280 BOT patients were identified in the study, with a median age of 35.0 (26.0, 51.0) years old. The median follow-up time was 55.2 (34.7, 79.3)months. 25 patients (15.0%) developed recurrence in the fertility-sparing surgery group, 11 patients (8.7%) developed recurrence in the radical surgery group. There was no significant difference in 5-year DFS rate between the two groups (84.4% vs 90.1%, P=0.223). Only FIGO stage was found to be related to DFS through the univariable and multivariable Cox proportional hazard regression analysis, and patients with FIGO Ⅱ/Ⅲ had higher risk of recurrence [HR (95%CI) 2.872(1.283-6.431)] (P=0.010); Fertility-sparing surgery does not increase the recurrence risk of BOT patients (P=0.116). Pregnancies were reported in 39 patients (54.2%), among whom 37 patients gave birth successfully, and 2 patients selected to terminate pregnancy. Conclusions: The fertility-sparing surgery does not increase the risk of recurrence in BOT patients, and patients who underwent the fertility-sparing surgery have a favorable outcome. FIGO stage is the independent risk factor of DFS in BOT patients.

Correlation of Preoperative Level of Serum Ca125 with Surgical Staging of Ovarian Cancer

Background: Ovarian cancer is one of the leading cause of mortality and morbidity of gynaecological malignancies. Lack of early demonstration of symptoms and lack of effective screening tests, ovarian tumours are usually diagnosed at an advanced stage. Different studies shows the association of pre-operative serum CA125 level with the surgical staging of ovarian cancer. Objective: To find out the correlation of pre-operative level of serum CA 125 with the surgical staging (FIGO-2014) of ovarian cancer. Methodology: This cross sectional study was carried out among 81 subjects in the department of gynaecological oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from August 2018 to September 2019. Sampling technique was purposive. All consecutive patients admitted at department of gynaecological oncology, BSMMU with diagnosed ovarian cancer were included in this study. Data were collected and documented on a preformed and pretested structured questionnaire. Clinical examinations and relevant investigations were done and recorded accordingly. Result: Mean age of the study subjects was 45.7 ± 15.2 years with a range of 13-75 years. Mean BMI was 23.3 ± 3.0 kg/m2 and mean age of marriage was 16.1 ± 2.8 years. Maximum study subjects had stage III (44.4%) followed by stage II (23.5%), stage I (21.0%) and stage IV (11.1%). Preoperative CA-125 was &gt;35 U/ml in 90.1% cases. Serum CA-125 was elevated at the advanced stage of ovarian cancer. Maximum study subjects had serous tumors (70.4%) followed by mucinous tumors (11.5%), endometrioid adenocarcinoma (7.4%), malignant teratoma (4.9%) and clear cell tumors (3.7%). Serum CA-125 had significant positive correlation with surgical stages of ovarian epithelial cancer. Conclusion: Surgical stage of epithelial ovarian cancer significantly correlates with CA-125. Bangladesh Med Res Counc Bull 2021; 47(2): 110-117

Endocan-microvascular Density in Primary Ovarian Carcinoma.

Background:Epithelial ovarian cancer is among the leading causes of death in women and is driven by angiogenesis. Microvascular density (MVD) can be used to evaluate angiogenesis in carcinomas and thus it can be used as a potential biomarker for ovarian cancer. This study is aimed to establish the association between endocan-MVD with clinicopathological factors in primary epithelial ovarian cancer. Methods:The clinicopathological characteristics were acquired from the medical records filed between January 2008 and December 2018 of 89 epithelial ovarian cancer cases in Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Sectioned samples were analyzed for endocan through immunohistochemistry followed by the quantification of MVD. The association between clinicopathological characteristics and endocan-MVD was analyzed using the Pearson chi-square test and Fischer’s exact test. Results:All cases of epithelial ovarian carcinomas were positive for endocan. The mean ± standard deviation value of endocan-MVD level was 21.6±14.60 microvessels per 200x field. A total of 53 (59.6%) cases had low and 36 (40.04%) had high endocan-MVD values. High endocan-MVD level had a significant association with the older age group (p-value = 0.009), smaller tumor size (p-value<0.001), type II tumor (p-value<0.001), high-grade tumor (p-value<0.001), advanced FIGO stage (p-value=0.002), and presence of tumor recurrence (p-value=0.017). No significant association was found between endocan-MVD and the other clinicopathological characteristics such as race, pre-operative serum CA-125 level, presence of diabetes mellitus, endometriosis, lymph node involvement, distant metastasis, and family history of malignancy. Conclusion:Endocan-MVD showed a significant association with age, tumor size, tumor type, tumor grade, FIGO stage, and recurrence in primary epithelial ovarian cancer. Thus, endocan-MVD could be implemented as a reliable marker to predict prognosis in epithelial ovarian cancer in the future.

Para-aortic lymph node dissection in left-sided colorectal cancer: Risk factors, prognostic impact, and therapeutic value.

This study aimed to clarify risk factors, prognostic impact, and the therapeutic value of para-aortic lymph node (PALN) dissection in left-sided colorectal cancer. One hundred and fifty-four patients who underwent primary tumor resection and PALN dissection for left-sided colorectal cancer were included. Logistic regression analysis was used to identify risk factors for PALN metastasis. Cox regression analysis was performed to identify risk factors for overall survival (OS). PALN metastasis was pathologically confirmed in 47 patients (30.5%). Postoperative complications occurred in 42 patients (27.3%). Pathological N stage (OR = 4.661, p = 0.034) and inferior mesenteric artery LNs metastasis (OR = 6.048, p = 0.003) remained to be independently associated with PALN metastasis, the 5-year OS rate and median survival in patients with PALN metastasis was 37.7% and 24 months. Elevated preoperative serum CA19-9 level (HR = 1.006, p = 0.007), number of positive LNs > 7 (HR = 7.263, p = 0.001), and mucinous adenocarcinoma or signet ring cell carcinoma (HR = 6.511, p = 0.001) were independently associated with OS in patients with PALN metastasis. PALN dissection in addition to primary tumor resection have acceptable postoperative complications and may be oncologically beneficial in selected left-sided colorectal cancer patients with clinically suspicious PALN metastasis.

Treatment Planning for Resectable Pancreatic Cancer Based on Prediction of Postoperative Early Recurrence

Background: Resectable pancreatic cancer (R-PC) often recurs early after radical resection, which is associated with poor prognosis. Predicting early recurrence preoperatively is useful for determining the optimal treatment. Methods: 178 patients, diagnosed with R-PC on the CT image and undergoing radical resection at our institution from 2005 to 2019 were retrospectively analyzed. Patients with recurrence within six months after resection formed the early recurrence (ER) group, while other patients constituted non-early recurrence (Non-ER) group. Early recurrence prediction score was developed using preoperative parameters. Results: ER was observed in 45 patients (25.3%). The ER group had significantly higher preoperative CA19-9 (p=0.03), serum SPan-1 (p=0.006), and CT tumor diameter (p=0.01) compared with Non-ER group. The ROC curve analysis identified cut-off values for CA19-9 (133 U/mL), SPan-1 (78.2 U/mL), and preoperative tumor diameter (23 mm). When the parameter exceeded the cut-off level, 1 point was given, and the total score of the three factors was defined as the early recurrence prediction score. Multivariate analysis for ER-related perioperative and surgical factors identified the score of 3 (odds ratio [OR], 4.63 [95% CI, 1.82–11.78], p=0.0013) and R1 resection (OR, 3.20 [1.01–10.17], p=0.049) as independent predictors of ER. Conclusions: For R-PC, ER could be predicted by the scoring system using preoperative serum CA19-9 and SPan-1 levels and CT tumor diameter, which may have great significance in identifying patients with poor prognoses and determining the optimal treatment strategy.

Correlation of Preoperative Serum and Intraoperative Peritoneal Lavage Fluid Ca-125 Levels with Postoperative Tumor Histology in Patients with Endometrial Cancer: A Prospective-Controlled Study

Background The role of Ca-125 in endometrial cancer is not fully known. Some authors have reported high Ca-125 levels in patients with recurrent or advanced endometrial cancer, whereas others have stated that Ca-125 levels and the advance of the disease were not correlated in endometrial cancer. This makes it inevitable for clinicians to search for different measurement methods or interpretation of the present tumor markers. The aim of this study was to evaluate the relationship between Ca-125 values of the serum and abdominal lavage fluid and postoperative histopathological parameters in patients with endometrial carcinoma. Methods The study included patients who were diagnosed with endometrial cancer in the Gynecology Clinic and were planned to undergo surgery. The correlations of clinicopathological parameters with preoperative values of Ca-125 measured from serum and abdominal lavage fluid were investigated. The Spearman correlation test was applied in the analysis of correlations of serum and abdominal lavage fluid Ca-125 values with postoperative tumor characteristics. Results The serum Ca-125 values were determined to be positively correlated with surgical stage, tumor diameter, and lymph node involvement (p = 0.03; p = 0.04; and p = 0.01, respectively). No correlation was determined between tumor grade and serum Ca-125 level. The level of Ca-125 in the abdominal lavage fluid was observed to be correlated with surgical stage and tumor grade, but not with tumor diameter or lymph node involvement (p = 0.01, p = 0.04, respectively). Conclusions The value of Ca-125 in the abdominal lavage fluid has a positive correlation with the surgical stage and tumor grade in patients with endometrial carcinoma.

Preoperative Serum CA-125 Levels in Patients with Ovarian Cancer.

Introduction: A noteworthy proportion of patients with stage I disease have usual preoperative serum levels, and not all cell types rapid the antigen. Our aim of this study was to predict preoperative serum CA-125 levels in patients with ovarian cancer. Material &amp; Methods: This cross-sectional study was carried out at the Department of Gynecological Oncology, Department of Gynae &amp;amp; Obstetric, Ashiyan Medical College Hospital, Barua Khilkhet, Dhaka, Bangladesh during the period from January 2015 to December 2015. A total of 100 patients were selected using purposive sampling technique for this study. Data were collected and documented on a preformed and pretested structured questionnaire. Clinical examination and relevant investigation were done and recorded accordingly. Data were processed and analyzed with the help of computer software SPSS 22. Results: Mean age of the study subjects was 45.7 ± 15.2 years with a range of 13-75 years. Table II shows education status of the study subjects. It was observed that half of the study subjects had education up to primary level, 26% had studied up to secondary level, 19% up to higher secondary level and only 5% were graduate. Mean BMI was 23.3± 3.0 kg/m2, mean age of marriage was 16.1± 2.8years and mean CA-125 level was 547.02± 478.74. Maximum study subjects had stage III (44.0%) followed by stage II (24.0%), stage I (21. 0%) and stage IV (11.0%). Also, most of the study subjects had serous tumors (70.0%) followed by mucinous tumors (11.0%), endometrioid adenocarcinoma (8.0%), clear cell tumors (4.0%), malignant tertoma (5.0%), Brenner (1.0%) and dysgerminoma (1.0%). Endometrioid adenocarcinoma was found in elderly study subjects and clear cell tumor was found in young aged study subjects. Histopathological type according to grading of ovarian tumor describes, all stage IV tumors were serous, all clear cell and Brenner tumors were stage I, and all endometrioid adenocarcinoma tumors were stage III. Serum CA-125 was elevated at the advanced stage of ovarian cancer. Conclusion: Serum CA-125 had significant positive correlation with surgical stage of ovarian cancer in epithelial cancer patients of this study. But in case of germ cell ovarian cancer, it showed a negative correlation

Factors associated with the involvement of lymph nodes in low‐grade serous ovarian cancer

Evaluating nodal metastases in low-grade serous ovarian cancer (LGSOC) patients. Women with LGSOC who had undergone primary cytoreductive surgery comprising systematic pelvic-paraaortic lymphadenectomy were included. Data were obtained retrospectively from 12 oncology centers. One hundred and forty-eight women with LGSOC who had undergone comprehensive surgical staging were included. Seventy-one (48.0%) patients had metastatic lymph nodes. Preoperative serum CA-125 levels of ≥170 U/ml (odds ratio [OR]: 3.84; 95% confidence interval [CI]: 1.22-12.07; p = 0.021) and presence of lymphovascular space invasion (LVSI) (OR: 13.72; 95% CI: 3.36-55.93; p < 0.001) were independent predictors of nodal metastasis in LGSOC. Sixty (40.5%) patients were classified to have apparently limited disease to the ovary/ovaries. Twenty (33.3%) of them were upstaged after surgical staging. Twelve (20.0%) had metastatic lymph nodes. Presence of LVSI (OR: 12.96; 95% CI: 1.14-146.43; p = 0.038) and preoperative serum CA-125 of ≥180 U/ml (OR: 7.19; 95% CI: 1.35-38.12; p = 0.02) were independent predictors of lymph node metastases in apparent Stage Ⅰ disease. Clinicians may consider to perform a reoperation comprising systematic lymphadenectomy in patients who had apparently limited disease to the ovary/ovaries and had not undergone lymphadenectomy initially. Reoperation may be considered particularly in patients whose preoperative serum CA-125 is ≥180 U/ml and/or whose pathological assessment reported the presence of LVSI.