Serum Cancer Antigen 125 Levels Research Articles

Preoperative Predictors of Optimal Tumor Resectability in Patients With Epithelial Ovarian Cancer.

BackgroundSeveral studies have shown that whether complete tumor resection can be achieved during debulking surgery depends on various patient-related factors. However, none of these studies was conducted among patients with epithelial ovarian cancer (EOC) in sub-Saharan Africa. In this study, we aimed to determine the preoperative predictors of optimal tumor resectability (OTR) during primary debulking surgery (PDS) in patients with EOC.MethodologyIn this study, we reviewed all patients with histologically diagnosed EOC who underwent PDS between January 2011 and December 2020. We included 83 patients with complete clinical records for subsequent data analysis. Descriptive statistics were computed for patients’ data, and binary logistic regression analysis was used to assess the strength of associations between patients’ preoperative characteristics and OTR.ResultsThe overall rate of OTR was 53.0%, while the rate in advanced EOC patients was 36.1%. In the univariate analyses, pleural effusion, ascites, tumor bilaterality, size of the largest tumor, retroperitoneal lymph nodes, omental caking, peritoneal thickening, significant extrapelvic tumor, serum cancer antigen-125 (CA-125) levels, and hemoglobin levels were recorded as the predictors of OTR. However, after adjusting for covariates in the final multivariate models, we found that the absence of moderate-to-large pleural effusion (odds ratio (OR) = 5.60; 95% confidence interval (CI) = 1.32, 23.71) and having serum CA-125 levels of ≤370 U/mL (OR = 6.80; 95% CI = 1.19, 38.79) were the overall independent predictors of OTR while not having any preexisting comorbidity (OR = 18.21; 95% CI = 2.40, 38.10), and the absence of pleural effusions (OR = 13.75; 95% CI = 1.80, 24.85) or enlarged retroperitoneal lymph nodes (OR = 11.95; 95% CI = 1.35, 16.07) were predictors of OTR in advanced EOC patients.ConclusionsWe demonstrated that the radiological absence of pleural effusions and enlarged retroperitoneal lymph nodes and having no preexisting medical morbidity and serum CA-125 levels of ≤370 U/mL were the independent predictors of OTR during PDS. The preliminary data generated from this study can be used to develop variables for a prediction model in a future validation study.

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.

Identification of Effective Model for Prediction of Ovarian Malignancy Risk using Models like Risk of Malignancy Index, Logistic Regression, International Ovarian Tumour Analysis- Simple Rules

Introduction: Ovarian tumour is not a single entity it is a spectrum of neoplasm involving variety of histological tissues. Use of mathematical formula as malignancy index which is based on logistic model, menopausal status, serum levels of Cancer Antigen 125 (CA-125) and ultrasound findings in a score system is not so popular which can be a useful predictor for diagnosing and monitoring the progression of ovarian malignancy. Aim: To determine the effectiveness of the three models i.e., Risk of Malignancy Index (RMI-1,2,3 and 4), Logistic Regression 2 (LR-2), International Ovarian Tumour Analysis (IOTA) - simple rules in predicting ovarian malignancy. Materials and Methods: This prospective cohort observational study was conducted in Department of Obstetrics and Gynaecology at Saveetha Medical College and Hospital, Tamil Nadu, India, from June 2017 to July 2018. The study included a total of 70 female subjects with ovarian mass. Information obtained by investigations, ultrasound was used to predict the risk of malignancy by using the three models {Risk of Malignancy Index (RMI-1,2,3 and 4), Logistic Regression 2 (LR-2), International Ovarian Tumour Analysis (IOTA)- simple rules}. CA-125 level was considered as primary outcome variable. Study group histopathology impression (malignant Vs benign) was considered as primary explanatory variable. The result from the above models was compared with the postoperative histopathological report. The sensitivity and specificity of each model was also identified. Results: Majority of the study participants 49 (70%) were in premenopausal status and only 21 (30%) were in menopausal status. The mean CA-125 level was 108.82±233.13 in the study population (95% CI: 53.23-164.41). Among the 70 study subjects, 53 (75.70%) patients were RMI-1 benign and only 17 (24.30%) were RMI-1 malignant. Majority of the study participants 42 (60%) were IOTA impression benign and only 28 (40%) were IOTA malignant. The difference in the proportion of IOTA-simple rules between histopathology impression was statistically significant (p-value <0.001). The sensitivity of IOTA-simple rules in predicting malignant histopathology was 92%, Specificity was 90.48%, diagnostic accuracy was 91.04%. Conclusion: For early risk stratification of adnexal masses, IOTAsimple rules can be used as a screening tool due to its high sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy.

CORRELATION BETWEEN CORPUS LUTEUM VOLUME USING 2D ULTRASOUND AND COLOR-DOPPLER STUDY OF CORPUS LUTEUM VASCULATURE WITH MATERNAL SERUM CA-125 LEVEL IN PROGNOSIS OF FIRST TRIMESTER THREATENED ABORTION

Background: Threatened miscarriage is a common complication in the first trimester of pregnancy and is often associated with anxiety regarding pregnancy outcome. Approximately, 20% of pregnant women have symptoms of threatened abortion in the first trimester of pregnancy. A single serum cancer antigen 125 (CA-125) level determination is valuable in women with imminent abortion presenting with abdominal pain, vaginal bleeding or both rather than serial measurements. Objective: To evaluate the prognostic value of correlating the corpus luteum volume measured by two-dimensional ultrasound, and color doppler blood flow changes in the corpus luteum together with the results of serum CA-125 at the time of initial presentation with pregnancy outcome in patients with first trimesteric threatened abortion. Patients and methods: This prospective controlled study was held during the period from May 2015 to May 2018 on 100 women on their first trimester of pregnancy, 50 women having normal uncomplicated pregnancy and 50 women with clinical diagnosis of threatened abortion. The latter group was further subdivided into: group of patients who aborted (14 patients), and another group who continued their pregnancy and proceeded into the second trimester (36 patients). Results: It was found that the mean corpus luteum peak systolic velocity (CL PSV) for the threatened abortion (aborted) group was 30.68 ± 18.9 cm/sec, while for the threatened abortion (continued) group was 22.03 ± 12.9 cm/sec, and for the control group was 21.58 ± 13.77 cm/sec. The difference was statistically significant between threatened abortion (aborted) group and each of the threatened abortion (continued) group and the control group. The difference was statistically non-significant between the threatened abortion (continued) group, and the control group. The cut-off value of CL PSV at which there was a high probability of termination of pregnancy in threatened abortion cases, reached 17.785 cm/sec with a sensitivity of 63.6% and specificity of 54.4%. Conclusion: Serum CA-125 level determination was valuable in the women with symptoms of threatened abortion with a cut-off limit of 31.85 IU/ml of CA-125 level which carried a sensitivity of 86.4% and specificity of 80.7%. The study suggested that CA- 125 may be a cheap, sensitive and specific method in prediction of the cases of threatened abortion.

Role of serum VEGF-A biomarker for early diagnosis of ovarian cancer instead of CA-125.

To assess the significance of serum vascular endothelial growth factor-A (VEGF-A) as a potential biomarker for the diagnosis of ovarian cancer instead of cancer antigen-125 (CA-125). The case-control study was conducted at the obstetrics departments of Sir Ganga Ram Hospital and Jinnah Hospital, Lahore, Pakistan, from April to September 2018, and comprised cases of epithelial ovarian tumour and healthy female controls. Serum VEGF-A and CA-125 levels were evaluated using Luminex multi-analyte profiling technology and enzyme immunoassays technique. Age, stage, grading, metastasis and ascites of ovarian cancer patients were investigated and compared with serum VEGF-A and CA-125 levels. Data was analysed using SPSS 20. Of the 89 subjects, 44(49.4%) were cases and 45(49.6%) were controls. Among the cases, 13(29.5%) were benign and 31(70.5%) were malignant. The mean serum VEGF-A values were inversely proportional to the stages of ovarian cancer i.e. stage I, II, III and IV showed 762.2pg/ml, 267.3pg/ml, 233.1pg/ml and 125.5pg/ml VEGF-A levels respectively. A steady increase in the mean serum CA-125 values with the progression of the disease was observed i.e. in stage I, II, III and IV the levels of CA-125 were 146.2U/ml, 268.5U/ml and 477.2U/ml and 844.4U/ml respectively. The detection of high concentrations of serum VEGF-A level supported its use as one of the diagnostic parameters in the timely investigation of ovarian cancer.

Therapeutic Efficacy of Catheter-directed Ethanol Sclerotherapy and Its Impact on Ovarian Reserve in Patients with Ovarian Endometrioma at Risk of Decreased Ovarian Reserve: A Preliminary Study

To investigate the therapeutic efficacy of catheter-directed ethanol sclerotherapy (CDS) and its effect on ovarian reserve in patients with endometrioma at risk of decreased ovarian reserve. Retrospective study. Teaching hospital. We evaluated 18 patients with ovarian endometrioma measuring ≥3 cm and preprocedural serum antimüllerian hormone (AMH) levels of <2 ng/mL. An 8.5-F catheter was inserted either transabdominally or transvaginally into the endometrioma. After aspiration, sclerotherapy with 99% ethanol was performed, with a subsequent 20-minute ethanol retention. Ultrasonography was performed preprocedurally and 6 months after CDS to evaluate any recurrence or changes in cyst size. Furthermore, serum AMH levels, cancer antigen 125 (CA-125) levels, and the visual analog scale scores for dysmenorrhea were obtained to analyze the ovarian reserve and treatment efficacy, preprocedurally and at 6 months after CDS. The mean cyst size on ultrasonography and serum CA-125 levels decreased 6 months after CDS (p <.001 and p = .001, respectively). All patients reported a decreased visual analog scale score for dysmenorrhea (p <.001). However, the difference in serum AMH levels before and after CDS was statistically insignificant (p = .875). CDS was efficacious in reducing pain and serum CA-125 levels in patients with low AMH levels without adversely affecting their ovarian reserve.

Clinical usefulness of cancer antigen 125 biomarker for tuberculosis diagnosis: experience in Cali, Colombia

Introduction: Diagnosing extra-pulmonary tuberculosis (EPTB) is a challenge for physicians. It has been suggested that cancer antigen 125 (CA-125), which is produced by mesothelial cells, may be an EPTB diagnostic biomarker. Objective: To describe serum CA-125 levels behavior in patients with TB treated in a referral university hospital located in Cali, Colombia. Materials and methods: A cross-sectional study was conducted in 99 TB patients with CA-125 measurements (U/mL) made before TB treatment was started, and treated at Fundación Valle del Lili between 2007 and 2016. Cases were classified as pulmonary TB (PTB) (n=33) or EPTB (n=66). A bivariate analysis was performed to compare the variables of interest (sociodemographic, clinical, and laboratory findings data) between EPTB and PTB groups, and to determine differences between patients with CA-125 positive results and those with negative results in relation to mortality. Results: Elevated CA-125 levels were reported in 55 patients (55.56%). Positive CA-125 results (&gt;35 U/mL) were more frequent in the EPTB group (59.09% vs. 48.48%). In the EPTB group, positive results were found in tuberculous serositis cases (100% pericardial TB, 68.42% peritoneal TB and 66.66% pleural TB), and in 66.66% of miliary TB and TB of the spine cases, respectively. Also, 15 TB infection-related deaths were reported in the follow-up period (n=66), of which 13 had a CA-125 positive result, finding a significant difference with those with negative results (p=0.021), however 47.05% of the surviving patients also had a positive result. Conclusions: Most of tuberculous serositis, miliary and TB of the spine cases showed elevated CA-125 levels before starting TB treatment. CA-125 may prove to be useful for prognostic purposes in these patients.

CA19-9-producing esophageal adenocarcinoma originating from the esophageal cardia of the mid-thoracic esophagus: a case report

BackgroundAlthough there are many studies on primary esophageal adenocarcinoma arising from Barrett's esophagus or ectopic gastric mucosa, reports on adenocarcinoma arising from esophageal cardiac glands are extremely rare. Herein, we report a case of mid-thoracic cancer antigen 19-9 (CA 19-9)-producing primary esophageal adenocarcinoma, which presumably originated from the cardiac glands.Case presentationA 74-year-old man was referred to our department with advanced esophageal cancer, which initially presented with dyspepsia. Serum levels of cancer antigen 19-9 (CA 19-9) were elevated (724.89 U/ml). Upper gastrointestinal endoscopy revealed a type 2 tumor on the posterior wall of the mid-thoracic esophagus approximately 29–32 cm from the incisor. Mucosal biopsy was consistent with a diagnosis of adenocarcinoma. Contrast-enhanced computed tomography showed a circumferential wall thickening in the mid-thoracic esophagus without enlarged lymph nodes or distant metastasis. Positron emission tomography–computed tomography showed accumulation in the primary tumor, but no evidence of lymph node or distant metastasis. According to these findings, the adenocarcinoma was staged as cT3N0M0, thereby, requiring subtotal esophagectomy with lymph node dissection. Postoperative course was uneventful. Histopathologic analysis revealed a 50 × 40 mm moderately differentiated adenocarcinoma with invasion to the thoracic duct and lymph node metastasis at #108(1/4), #109R(1/3), and #109L(1/3). After surgery, the stage was revised to moderately differentiated pT4apN2pM0 (pStage III). Immunostaining revealed expression of CA19-9 and suggested esophageal cardiac gland origin of the tumor. Three months after the surgery, the patient showed no recurrence and is undergoing outpatient observation.ConclusionsWe experienced a case of mid-thoracic CA19-9-producing primary esophageal adenocarcinoma, which was presumed to have originated in the esophageal cardiac glands. Due to the scarcity of studies regarding this condition, specific management needs to be further clarified.

A clinical observational study on the efficacy of subcutaneous etonogestrel implants for adenomyosis in 20 patients

Objective: To evaluate the efficacy of subcutaneous etonogestrel implants for adenomyosis. Methods: We conducted a clinical observational study of 20 patients suffering from adenomyosis treated with subcutaneous etonogestrel implants from August 2015 to July 2017 and followed up for 36 months. We evaluated the efficacy of subcutaneous etonogestrel implants primarily based on the following indicators: the pictorial blood loss assessment chart (PBAC) for menstrual blood volume, changes in bleeding patterns, the visual analog scale (VAS) pain score for dysmenorrhea, uterine volume, serum cancer antigen 125 (CA125) levels, hemoglobin levels and side effects. Results: During the 3 years of follow-up, subcutaneous etonogestrel implants were removed from six patients, among whom one was diagnosed with endometrial cancer, four had an increased menstrual blood volume, and one entered menopause. In total, 14 patients were treated with subcutaneous etonogestrel implants for 3 years. Among these patients, the number of patients with heavy menstrual bleeding and high PBAC and VAS scores and serum CA125 levels was significantly decreased after implantation compared with that before implantation. In the eight patients with anemia, hemoglobin levels increased gradually. However, the uterine volumes did not significantly change. Bleeding patterns were changed but were tolerable. Conclusion: Subcutaneous etonogestrel implants represent a new option for the clinical treatment of adenomyosis for patients who refuse surgery.

Effect of Taoren-Quyu decoction on endometriosis in rats

Purpose: To study the effect of traditional Chinese Medicine formula Taoren-Quyu decoction (TQD) on endometriosis.&#x0D; Method: Fifty female Wistar rats were randomly separated into five groups (10 rats/group): normal control, model (untreated) group, positive control (danazol), 200 mg/kg/day (low dose) or 400 mg/kg/day (high dose). All rats were prepared into endometriosis except for normal control rats. TDQ groups rats were orally administered of TQD for 5 weeks. After treatment, the rats were sacrificed by cervical dislocation. The number of total endometriotic lesions were counted. Serum levels of cancer antigen 125 (CA-125), interleukin 13 (IL-13), interleukin 18 (IL-18) and peritoneal fluid tumor necrosis factoralpha (TNF-α) were measured by ELISA kits.&#x0D; Result: Compared with control rats, TQD reduced the number of total endometriotic lesions significantly (12.7 ± 1.2, p &lt; 0.01), as well as serum levels of CA-125 (6.4 ± 1.2 U/mL), IL-18 (118.6 ± 7.4 pg/mL), IL13 (6.3 ± 0.8 pg/mL) and peritoneal fluid TNF-α (231.5 ± 11.7 pg/mL) (p &lt; 0.01).&#x0D; Conclusion: The results reveal that TQD exerts anti-endometriotic effect in rats by inhibiting inflammatory factors. Therefore, TQD has potentials for use in the treatment of endometriosis.

Primary ovarian serous carcinomas with extensive squamous differentiation: a case report and literature review

BackgroundPrimary ovarian serous carcinomas (OSC) with extensive squamous differentiation is a rare, and histological diagnostic criteria and biological behavior have not been fully established. We present an extremely rare case of primary OSC of the ovary with squamous differentiation.Case presentationA 58-year-old (gravidity 3, parity 2) female was admitted complaining of abdominal distention for 6 months. No apparent tumor in the cervix was found by a physical examination. Serum levels of cancer antigen 125 (CA125) was elevated (2723.0 IU/L). Macroscopically, a 7 cm tumor of the left uterine adnexa, a 5 cm tumor of the right adnexa, and a 3 cm tumor of the omentum were found. Histological and immunochemical tests confirmed a diagnosis of OSC with squamous differentiation. Debulking surgery with tumor resection was performed. The patient was subsequently received postoperative chemotherapy.ConclusionsIn summary, OSC with extensive squamous differentiation is a rare, and the inter- and intratumor heterogeneity may be the reason for this phenomenon. Histological diagnostic criteria and biological behavior have not been fully established because of the limited data.

Predictive effects of preoperative serum CA125 and AFP levels on post-hepatectomy survival in patients with hepatitis B-related hepatocellular carcinoma.

The association between the serum levels of cancer antigen 125 (CA125; also termed MUC16) and the prognosis of patients with hepatocellular carcinoma (HCC) has not been widely reported to date. The aim of the present study was to determine the association between preoperative serum CA125 levels and prognosis of patients with hepatitis B virus (HBV)-related HCC after hepatectomy. The study included 306 patients with HBV-related HCC who underwent liver resection and were classified into four subgroups based on their baseline CA125 and α-fetoprotein (AFP) levels. The perioperative clinical data were compared and analyzed. Kaplan-Meier and Cox regression analyses were performed to determine the associations between patient clinicopathological characteristics and survival. The results revealed that the median follow-up time was 35 months. Patients with low preoperative serum CA125 levels presented with improved 3-year disease-free survival (DFS) (79.3 vs. 75.7%; P=0.278) and overall survival (OS) (84.4 vs. 77.1%; P=0.001) rates compared with those among patients with high preoperative serum CA125 levels. High preoperative serum CA125 levels were a risk factor associated with short DFS and OS rates in all patients. In patients with baseline AFP levels >100 ng/ml, low preoperative serum CA125 levels were significantly associated with prolonged DFS and OS rates (log-rank test P=0.002 and P=0.005, respectively). In patients with AFP levels ≤100 ng/ml, no significant differences were observed in DFS or OS rates between the high and low preoperative serum CA125 groups. Patients with high preoperative serum CA125 and AFP levels exhibited the worst prognosis (low DFS and OS rates). In conclusion, high baseline CA125 levels may be associated with a poor prognosis in patients with HBV-related HCC.

Serum levels of cancer antigen 125 before hormone replacement therapy are not associated with clinical outcome of frozen embryo transfer in women with adenomyosis.

AimThis retrospective study aimed to evaluate the predictive value of serum cancer antigen 125 (CA125) levels before hormone replacement therapy on pregnancy outcomes in women with adenomyosis undergoing frozen embryo transfer.MethodsA total of 509 women with adenomyosis were screened and 84 patients receiving a total of 114 cycles of frozen embryo transfer were included, based on the inclusion and exclusion criteria. Patients were divided into two groups based on their CA125 levels (≤ or >35 IU/mL) before hormone replacement therapy. The basic characteristics and main outcomes of the two groups were compared. Receiver operating characteristic curve and subgroup analyses were also conducted.ResultsThere were no significant differences in clinical outcomes of frozen embryo transfer cycles in patients with different serum CA125 levels before hormone replacement therapy. Receiver operating characteristic curve analysis demonstrated that CA125 levels before hormone replacement therapy were not predictive of clinical pregnancy outcomes.ConclusionsSerum CA125 levels before hormone replacement therapy are not associated with the clinical outcomes of frozen embryo transfer among women with adenomyosis.

Derivation and validation of a nomogram model for pulmonary thromboembolism in patients undergoing lung cancer surgery.

BackgroundA specific risk-stratification tool is needed to facilitate safe and cost-effective approaches to the prophylaxis of acute pulmonary thromboembolism (PTE) in lung cancer surgery patients. This study aimed to develop and validate a simple nomogram model for the prediction of PTE after lung cancer surgery using readily obtainable clinical characteristics.MethodsA total of 14,427 consecutive adult patients who underwent lung cancer surgery between January 2015 and July 2018 in our institution were retrospectively reviewed. Included in the cohort were 136 patients who developed PTE and 544 non-PTE patients. The patients were randomly divided into the derivation group (70%, 95 PTE patients and 380 non-PTE patients) and the validation group (30%, 41 PTE patients and 164 non-PTE patients). A nomogram model was developed based on the results of multivariate logistic analysis in the derivation group. The cut-off values were defined using Youden’s index. The prognostic accuracy was measured by area under the curve (AUC) values.ResultsIn the derivation group, multivariate logistic analysis was carried out to evaluate the risk score. The risk assessment model contained five variables: age [95% confidence interval (CI): 1.008–1.083, P=0.016], body mass index (95% CI: 1.077–1.319, P=0.001), operation time (95% CI: 1.002–1.014, P=0.008), the serum level of cancer antigen 15-3 (CA15-3) before surgery (95% CI: 1.019–1.111, P=0.005), and the abnormal results of compression venous ultrasonography before surgery (95% CI: 2.819–18.838, P<0.001). All of them were independent risk factors of PTE. To simplify the risk assessment model, a nomogram model was established, which showed a good predictive performance in the derivation group (AUC 0.792, 95% CI: 0.734–0.853) and in the validation group (AUC 0.813, 95% CI: 0.737–0.890).ConclusionsA high-performance nomogram was established on the risk factors for PTE in patients undergoing lung cancer surgery. The nomogram could be used to provide an individual risk assessment and guide prophylaxis decisions for patients. Further external validation of the model is needed in lung cancer surgery patients in other clinical centers.

The role of D-dimer with beta-human chorionic gonadotropin, progesterone and cancer antigen-125 as markers for miscarriage

Background/Aim Miscarriage is defined as pregnancy termination before the 20th week of gestation or if a baby’s birth weight is more than 500 g. Approximately 10–12% of all gestations worldwide end with a miscarriage. We aimed in this study to evaluate the role of serum level of D-dimer along with beta-human chorionic gonadotropin (β-HCG), progesterone, and cancer antigen-125 (CA-125) in the prediction of first trimetric miscarriage. Patients and methods A total of 400 pregnant women from the Centre of Excellency Clinic, National Research Centre, Egypt, were recruited in this study at the fifth week of gestational age. Patients were divided into two groups: group 1 included patients whose pregnancy was completed (n=356), and group 2 included patients who had miscarriage (n=44). Serum level of D-dimer was measured by enzyme-linked fluorescence assay, whereas serum levels of β-HCG, progesterone, and CA-125 were measured by using an enzyme-linked immunosorbent assay technique at the fifth week and 13th week of gestation for all participants, and then they underwent follow-up until 20 weeks of pregnancy. Results Pregnancy was completed in 356 women (group 1), whereas miscarriage occurred in 44 women (group 2). At the fifth week and 13th week of gestation, the serum level of D-dimer in the fifth week was insignificant, but it became significant in the 13th week. β-HCG and progesterone were found significantly lower, whereas the level of CA-125 was found higher in women who aborted (group 2). Conclusion During the first trimester, maternal serum markers such as D-dimer with β-HCG, progesterone, and CA-125 levels represent early, noninvasive techniques to predict miscarriage.

Adenocarcinoma Arising From a Gastric Duplication Cyst With Lymph Node Metastasis

Gastric duplication cysts (GDCs) are a relatively rare congenital anomalies and are mostly diagnosed in the early years of life. Herein, we report a very rare surgical case of adenocarcinoma arising from a GDC with lymph node metastasis. A 78-year-old woman was referred to our hospital because of elevated serum levels of cancer antigen (CA) 19-9. Endoscopic ultrasound, contrast fistulography, and computed tomography showed a cystic lesion communicating with the lesser curvature of the stomach. The serum levels of CA 19-9 were high, and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging demonstrated a slightly enlarged lymph node with high FDG uptake after four months. The size of the cyst was unchanged. It was diagnosed as a GDC. The enlarged lymph node was highly likely to be malignant. Hence, we performed a distal gastrectomy involving the origin of entry and whole body of the GDC with en bloc regional lymphadenectomy. The postoperative pathology was consistent with GDC with moderately differentiated adenocarcinoma and lymph node metastasis. Adjuvant chemotherapy with tegafur-gimeracil-oteracil potassium (S-1) was administered for 12 months. At present, the patient is alive, with no recurrence of the lesion even four years after the operation. GDCs in adults are rare and may predispose to malignancy. Early diagnosis and prompt surgical intervention are important for favorable outcomes.

Inflammatory signals induce MUC16 expression in ovarian cancer cells via NF-κB activation.

Cancer antigen 125 (CA125), encoded by the mucin 16 cell surface associated (MUC16) gene, has been widely used as a biomarker for ovarian cancer (OC) screening. However, it has yet to be elucidated as to why its levels increase with tumor progression as well as with certain other non-malignant conditions. Based on our knowledge of the inflammatory microenvironment (IME) in OC, HEY cells were treated with several inflammation-associated factors as well as their antagonists, and it was observed that inflammation-associated factors upregulated MUC16 gene expression. Considering the role of nuclear factor (NF)-κB in the inflammatory signaling network and our previous research on OC, chromatin immunoprecipitation was performed, and it was observed that activated NF-κB bound to the MUC16 gene promoter and enhanced its expression, thereby elevating secreted CA125 levels. These findings demonstrated that IME and MUC16 gene expression were associated in OC, partly elucidating the role of IME in tumor progression, explaining the elevated serum CA125 levels in some non-malignant conditions, and confirming IME as a potential target for OC therapy.

Value of preoperative neutrophil-lymphocyte ratio and human epididymis protein 4 in predicting lymph node metastasis in endometrial cancer patients.

To investigate the value of pretreatment neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), serum cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in predicting lymph node metastasis in patients with endometrial cancer. A retrospective analysis of 145 patients with endometrial cancer who were treated at the Peking University Cancer Hospital and Institute between October 2010 and November 2013 was performed. Preoperative NLR, PLR, serum CA125 and HE4 were assessed. Clinicopathological parameters were evaluated for LN metastasis using logistic regression. Receiver operating characteristic (ROC) curves were plotted and the optimal cut-off values of NLR, PLR, CA125 and HE4 were calculated for predicting lymph node metastasis. The levels of NLR, PLR, serum CA125 and HE4 were significantly higher in patients with lymph node metastasis than those without lymph node metastasis. Multivariate analysis showed that only the higher NLR and HE4 were independent predictors for lymph node metastasis (odds ratio, OR = 3.509, P = 0.016; OR = 1.446, P = 0.016). The optimal cut-off values of NLR and HE4 for predicting lymph node metastasis were 2.50 (area under the curve, AUC = 0.809) and 80.4 pmol/L (AUC = 0.713). The sensitivity and specificity were 75.0% and 84.9% for NLR, 86.7% and 73.8% for HE4, respectively. When HE4 was combined with NLR to predict lymph node metastasis, the sensitivity and specificity were significantly improved. Preoperative higher NLR and serum HE4 are predictors of lymph node metastasis in endometrial cancer, and the predictive value was superior to that of serum CA125.

Preoperative Differentiation of Benign and Malignant Non-epithelial Ovarian Tumors: Clinical Features and Tumor Markers.

To evaluate the role of clinical features and preoperative measurement of cancer antigen 125 (CA125), human epididymis protein (HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. One hundred and nineteen consecutive women with germ cell, sex cord-stromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, among malignant, four were immature teratomas. The most common tumors in the sex cord-stromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign and malignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant cases were diagnosed at initial stages with good prognosis. The measurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.

Serum Levels of Cancer Antigen 15.3 and Estrogen in a Samples of Iraqi Women with Breast Cancer Treated with Anastrazole.

Serum Levels of Cancer Antigen 15.3 and Estrogen in a Samples of Iraqi Women with Breast Cancer Treated with Anastrazole.