Serum Cancer Antigen Research Articles

Vascular endothelial growth factor in tumor cells in platinum-containing chemotherapy of advanced ovarian cancer

Aim. Study of the relationship of vascular endothelial growth factor expression in tumor cells of ascites and primary tumor in patients with ascitic form of ovarian cancer undergoing neoadjuvant chemotherapy according to the AP scheme (doxorubicin + cisplatin).
 Methods. The level of vascular endothelial growth factor messenger ribonucleic acid (mRNA) was assessed using PCR-RT in epithelial cells of ascites and primary tumor tissue obtained intraoperatively after 2–4 courses of neoadjuvant chemotherapy according to the AP scheme from 25 patients with a verified diagnosis of ovarian cancer (serous adenocarcinoma) at stage III–IV according to the International Federation of Gynecology and Obstetrics. Processing of the results was performed using the software package Statistica 10.
 Results. An increase in the expression of vascular endothelial growth factor mRNA in epithelial cells of ascites in 60% of samples was established. In the intraoperatively obtained tumor tissue after 2–4 courses of neoadjuvant chemotherapy according to the AP scheme, vascular endothelial growth factor expression was increased in 73% of the samples. At the same time, the increase of relative expression in the tumor after neoadjuvant chemotherapy did not depend on the degree of therapeutic pathomorphosis but was related to early relapse and increased level of cancer antigen-125 (CA-125). Median of relapse-free survival in vascular endothelial growth factor-positive ovarian cancer was less than 5 months.
 Conclusion. Neoadjuvant chemotherapy according to the AP scheme increases the expression of vascular endothelial growth factor in the tumor tissue in advanced ovarian cancer; the degree of vascular endothelial growth factor overexpression in ovarian tumor is related to the presence of early relapse and an increase in the serum CA-125 level.

Comparison of serum biochemical markers in patients with mesothelioma and pleural plaques versus healthy individuals exposed to environmental asbestos.

In this study, we aimed to compare serum biochemical markers in patients with malignant pleural mesothelioma and pleural plaques versus healthy individuals exposed to environmental asbestos. Between September 01, 2010 and March 31, 2011, a total of 540 participants (354 males, 186 females; mean age 61.4 years; range, 35 to 89 years) were included in the study. The participants were divided into four groups as follows: (1) patients with pleural plaques (n=277); (2) healthy individuals with normal chest X-rays who were exposed to environmental asbestos (n=121); (3) healthy individuals with normal chest X-rays who were not exposed to environmental asbestos (n=118); and (4) patients with malignant pleural mesothelioma (n=24). Serum levels of carcinoembryonic antigen, cancer antigen 125, 15-3, 19-9, free T3, free T4, thyroidstimulating hormone, vitamin B12, folate, and ferritin were measured. Serum cancer antigen 125, 15-3, folic acid, vitamin B12, and ferritin levels were higher with lower free T3 levels in Group 4 than the other groups. The areas under the curve for cancer antigen 125 and 15-3 were 0.78 and 0.67, respectively in the differential diagnosis of mesothelioma from other pathologies (p<0.001 for both). Optimal limits of these biomarkers were 13.63 and 18.43 ng/mL, respectively with 83% and 75% sensitivity and 69% and 48% specificity, respectively. The combination or individual use of serum cancer antigen 125, 15-3, folic acid, vitamin B12, and ferritin levels may be helpful for early diagnosis and treatment of malignant pleural mesothelioma.

Treatment of symptomatic adenomyosis with the levonorgestrel-releasing intrauterine system.

To determine the long-term effects of using the levonorgestrel-releasing intrauterine system (LNG-IUS) to treat symptomatic adenomyosis. A prospective longitudinal study was conducted among 1100 women who received the LNG-IUS at a tertiary teaching hospital in China between December 10, 2006, and December 24, 2014. All participants had symptomatic adenomyosis (visual analogue scale [VAS] ≥7 and/or pictorial blood loss assessment chart [PBAC] score >100) diagnosed by transvaginal sonography. Follow-up was at 3, 6, 12, 24, 36, 48, and 60months after LNG-IUS placement. The primary outcome was symptom relief. Secondary outcomes included LNG-IUS retention status; changes in uterine volume; serum levels of cancer antigen 125 (CA125); menstruation pattern; and adverse events. In all, 374 (33.7%) participants completed 60months of LNG-IUS treatment. The VAS, verbal rating scale, PBAC score, hemoglobin level, uterine volume, and serum CA125 level all showed marked improvements at this time point when compared with baseline (P<0.05 for all comparisons). The cumulative retention rate of LNG-IUS was 56.2%. Changes in menstruation pattern at 60months included amenorrhea (n=97, 25.9%) and shortened periods (n=82, 21.9%). The incidence of adverse events was <10% and not considered notable. Long-term use of LNG-IUS was effective and acceptable for the treatment of symptomatic adenomyosis. Registered at clinicaltrials.gov (NCT03027648).

Clinical Value of Serum Cancer Antigen 19-9 as a Tumor Screening Marker among Healthy Individuals

Background: Serum tumor markers are convenient, non-invasive, acceptable to patients and play an important role as an ancillary tumor diagnostic tool. CA 19-9 has become a common tumor marker, specific for digestive system tumors. The study was carried out to determine the value of CA 19-9 as a tumor screening marker among healthy individuals.&#x0D; Materials and Methods: This study had been carried in Dhaka Medical college Hospital from January 2016 to January 2018. The serum CA 19-9 level was detected using a microsome luminescence method. Individuals with high CA 19-9 levels underwent further examination, including routine fecal testing, thoracic and abdominal computed tomography (CT) scan, gastroscopy, and colonoscopy. These individuals had regular follow-up examinations.&#x0D; Results: Over a 3-year period, the serum CA19-9 levels of 960 healthy individuals were estimated. The CA 19-9 level of 15 individuals was positive (positive rate: 1.56%), including 7 men (7/699; 1.001%) and 8 women (8/261; 3.06%). There was a significant difference between males and females (p&lt;0.01), The overall tumor detection rate was 0.72% (7/960) including 6/699 men (0.85%) and 1/261 women (0.38%).&#x0D; Conclusion: Therefore, elevated CA 19-9 level can be used to assist in the diagnosis malignancy.&#x0D; J MEDICINE JUL 2019; 20 (2) : 92-94

Magnetic resonance imaging in categorization of ovarian epithelial cancer and survival analysis with focus on apparent diffusion coefficient value: correlation with Ki-67 expression and serum cancer antigen-125 level

BackgroundTo determine whether magnetic resonance (MR) imaging features combined with apparent diffusion coefficient (ADC) values could be used as a tool for categorizing ovarian epithelial cancer (OEC) and predicting survival, as well as correlating with laboratory tests (serum cancer antigen 125, serum CA-125) and tumor proliferative index (Ki-67 expression).Methods and materialsMRI examination was undertaken before invasive procedures. MRI features were interpreted and recorded on the picture archive communication system (PACS). ADC measurements were manually performed on post-process workstation. Clinical characteristics were individually retrieved and recorded through the hospital information system (HIS). Cox hazard model was used to estimate the effects of both clinical and MRI features on overall survival.ResultsBoth clinical and MRI features differed significantly between Type I and Type II cancer groups (p < 0.05). The mean ADC value was inversely correlated with Ki-67 expression in Type I cancer (ρ = − 0.14, p < 0.05). A higher mean ADC value was more likely to suggest Type I ovarian cancer (Odds Ratio (OR) = 16.80, p < 0.01). Old age and an advanced International Federation of Gynecology and Obstetrics (FIGO) stage were significantly related to Type II ovarian cancer (OR = 0.22/0.02, p < 0.05). An advanced FIGO stage, solid components, and old age were significantly associated with poor survival (Hazard Ratio (HR) = 23.54/3.69/2.46, p < 0.05). Clear cell cancer type had a poorer survival than any other pathological subtypes of ovarian cancer (HR = 13.6, p < 0.01).ConclusionsMR imaging features combined with ADC value are helpful in categorizing OEC. ADC values can reflect tumor proliferative ability. A solid mass may predict poor prognosis for OEC patients.

Clinical Evaluation of CA72-4 for Screening Gastric Cancer in A Healthy Population: A Multicenter Retrospective Study.

Early detection is important for improving the survival rate of patients with gastric cancer (GC). Serum tumor markers have been widely used for detecting GC. However, their clinical values remain controversial. This study aims to investigate the role of serum cancer antigen 72-4 (CA72-4) in the diagnosis of GC in a healthy population. A total of 7757 adults who underwent upper gastrointestinal endoscopy and serum CA72-4 level measurement in multicenters in Taiwan from January 2006 to August 2016 were recruited in this retrospective study. Risk factors for GC, serum tumor markers, and esophagogastroduodenoscopy (EGD) findings were evaluated. High serum levels of CA72-4 were found in 7.2% of healthy adults. CA72-4 level showed lower sensitivity (33.3%) but higher specificity (92.8%); however, the positive predictive value was quite low (0.18%). After adjustment of clinical risk factors for GC using EGD findings, gastric ulcer (adjusted odds ratio (aOR) = 2.11), gastric polyps (aOR = 1.42), and atrophic gastritis (aOR = 1.27) were significantly associated with high serum CA72-4 levels. Furthermore, both age (OR = 1.01) and Helicobacter pylori infection (OR = 1.44) exhibited a significant association with high serum CA72-4 levels. These results indicate that routine screening of CA72-4 levels for diagnosing GC in asymptomatic patients may be ineffective due to low sensitivity and low positive predictive value. The clinical utility of EGD findings along with serum CA72-4 level for screening healthy individuals with GC is warranted.

Does risk of malignancy algorithm (ROMA) discriminate more efficiently than HE4 OR CA125 in the diagnosis of pelvic masses?

To evaluate the diagnostic accuracy of serum cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in the prediction of malignant ovarian masses then to analyze the effect of personal criteria and medical diseases on this accuracy.This prospective study was performed in Zagazig University Hospital. The eligibility criteria for inclusion were; consecutive women, at any age ≥18 years, with established diagnosis of ovarian mass based on symptoms, signs, and imaging techniques. All patients underwent personal and medical history taking, preoperative serum CA125 and HE4 (cutoff 35 IU/mL and 150 pmol/L, respectively) assessment then postoperative histopathologic examination of lesions as a reference standard.Among the included 140 patients, 62 were confirmed to have ovarian malignancy and 78 had benign lesions. Serum CA125 ≥35 IU/mL was associated with ovarian malignancy at sensitivity 91.9%, specificity 53.8%, and accuracy 70.7%. Raising its cutoff to 67.5 IU/mL decreased the sensitivity 83.9%, increased the specificity 80.7% with accuracy 82.1%. The combination of HE4 and CA125 showed sensitivity 75.8%, specificity 93.5%, and accuracy 85.7%. Women suffering from both diabetes mellitus and hypertension showed a significant decrease in CA125 concentration P = 0.02 with false negative results in (5/11) of them, making its sensitivity 54.5% in this condition.The performance of CA125 in cancer ovary prediction can be improved by increasing its cutoff or by combining CA125 with HE4. Diabetes mellitus and hypertension can influence CA125 performance while HE4 is independent on these factors. This can be an additional value of the introduction of HE4 in cancer ovary prediction protocols.

Serum tumor marker levels at the development of intracranial metastasis in patients with lung or breast cancer

Intracranial metastasis (IM) is observed in various cancers, including in lung and breast cancer, and its timely diagnosis is required for successful patient treatment. Various tumor serum markers, such as carcinoembryonic antigen (CEA), pro-gastrin-releasing peptide (ProGRP), neuron-specific enolase (NSE), and cancer antigen 15-3 (CA15-3), serve not only as prognostic indicators in lung and breast cancer but also as risk factors for IM development. This study is the first to assess a subgroup of cancer patients with IM that did not show elevated serum tumor marker levels. This retrospective study included 53 patients with lung or breast cancer in which IM was detected by enhanced brain magnetic resonance imaging between January 2013 and December 2018. IM was classified into three types [parenchymal metastasis (PM), leptomeningeal metastasis and dural metastasis]. Serum CEA level was measured using an electrochemiluminescence immunoassay (ECLIA) or chemiluminescent immunoassay. Plasma ProGRP level was measured using a chemiluminescent enzyme immunoassay (CLEIA), and the serum NSE level was measured using ECLIA. The serum CA15-3 level was measured using CLEIA. Univariate and multivariate analyses were performed using Pearson's χ2 test and logistic regression analysis, respectively. Among the total 53 patients, 15 patients (28.3%) did not show elevated serum tumor marker levels. Univariate analysis showed that the patients with PM only significantly correlated with no increasing tumor marker level compared with other IM types (P=0.030), as well as female patients and patients without symptoms (P=0.010 and 0.046, respectively). Multivariate showed that the patients with PM only and female patients significantly correlated with no increasing tumor marker level (P=0.038 and 0.014, respectively). Our findings describe a subgroup of lung and breast cancer patients with IM that do not show elevated tumor marker levels, indicating the need for the identification of novel indicators for IM or increased monitoring of these patients.

SAT-586 Primary Fallopian Tube Carcinoma Metastasizing to the Thyroid Gland: A Rare Cause of Hypothyroidism

Background: Primary fallopian tube carcinoma (PFTC) has been considered to account for only about 0.1-0.5% of all gynecologic cancers. It is notorious for metastasis to the ovaries, omentum, and uterus but has never been reported to present with hypothyroidism as a metastatic thyroid nodule. Case: A 53-year-old female presented with fatigue, generalized weakness and constipation for the last 4 months. Her past medical history was significant for stage IV poorly differentiated PFTC status post total abdominal hysterectomy, omentectomy and tumor debulking due to the local spread of the PFTC. She also underwent multiple cycles of chemotherapy with paclitaxel, cisplatin, doxorubicin and bevacizumab and was declared in remission by her oncologist. On examination, her vital signs were stable. Thyroid examination showed palpable nodules in the right and left lobes. Her laboratory investigation revealed normal liver and renal function tests, but the blood chemistry was significant for raised TSH levels of 68.8 mcIU/ml and decreased T3 and T4 levels of 45 ng/dL and 0.54 ng/dL respectively. Thyroid Peroxidase Antibody level was less than 3 IU/ml (reference range <6 IU/ML). Thyroid ultrasound showed a 2.3 x 0.7 x 2 cm solid nodule in the medial lower pole of the right lobe with and a 1.9 x 0.8 x 1.1 cm solid nodule in the medial lower pole of left lobe with increased vascularity. The fine needle aspiration cytology revealed groups of highly atypical cells showing enlarged, irregular, crowded nuclei which were intermixed with scattered bland follicular cells and macrophages. These atypical cells were identical to the serous carcinoma cells seen on previous PFTC specimens, confirming the hematogenous spread of PFTC to the thyroid gland. This diagnosis was further substantiated by immunohistochemical staining, which showed two different populations of cells, thyroid cells stained positive for TTF-1 (Thyroid transcription factor-1) while other cells were positive for WT-1 immunohistochemical stain strongly suggestive of metastatic serous carcinoma. Her serum cancer antigen 125 (CA 125) was also found to be elevated at 395 U/ml (normal range 0-35 U/ML) suggesting recurrence of PFTC. Niraparib chemotherapy was initiated. She was also started on 75 mcg of Levothyroxine per day. TSH levels after two months were 4.2 mcIU/ml. Conclusion: PFTC can be diagnosed early in its course using transvaginal Doppler ultrasound to detect areas of neovascularization within the fallopian tube. PFTC has histological and clinical resemblance with ovarian and uterine primaries and hence can be challenging to diagnose. It is incredibly uncommon to suspect thyroid metastasis from the residuals of PFTC as a possible etiology of hypothyroidism. Thus, physicians should keep a very high index of suspicion in appropriate clinical settings. Prognosis remains poor as most patients present with metastatic disease.

Diagnostic Performance of Serum Human Epididymis Protein 4 (HE4) for Prediction of Malignancy in Ovarian Masses

Background:Early diagnosis of ovarian cancer is essential for long term disease control and mortality reduction. This has been achieved using tumor markers like cancer antigen 125 (CA-125) which is elevated in malignant as well as non-malignant conditions. This dilemma led to efforts towards development of newer markers like serum human epididymis secretory protein E4 (HE4). Present study aimed to evaluate role of HE4 in diagnosing ovarian cancers and comparing it with CA-125. Methods:Serum samples from 67 patients with ovarian cancer, 42 with benign ovarian masses and 26 healthy controls were collected preoperatively and tested for serum HE4 levels and CA-125 levels. Diagnostic performance of both tumor markers (HE4/CA-125) to diagnose malignancy in ovarian masses was calculated and compared to each other. Results:Mean CA-125 and HE4 levels were significantly higher in patients with ovarian cancer than in those with benign disease (p<0.001) or healthy controls (p< 0.001). Serum HE4 levels significantly increased in epithelial ovarian cancers when compared to non-epithelial ovarian cancers (p<0.01). Using benign control as comparison, receiver operating characteristic curve (ROC) was generated to predict a cut-off value for diagnosing malignancy for serum HE4 and CA-125. Compared to CA-125, HE4 had a similar sensitivity (83.6% vs. 85.10%) and higher specificity (100% vs. 90.48%); combination of serum HE4 and CA-125 improved the sensitivity to detect ovarian cancer to 92.54%. Sensitivity of HE4 to detect early stage ovarian cancer was superior to CA-125 (92.61% vs. 63.41%). Conclusion:Serum HE4, a novel tumor marker, discriminated epithelial ovarian cancer from benign ovarian masses. HE4 levels were related to the stage and histological types with the lowest levels in mucinous epithelial ovarian cancer and non-epithelial malignancy. Measuring serum HE4 levels alongwith CA-125 may provide higher accuracy for detecting epithelial ovarian cancer particularly in the early stages.

Assessment of the diagnostic value of using serum CA125 and GI-RADS system in the evaluation of adnexal masses.

Cancer antigen 125 (CA125) is a valuable tumor marker for ovarian cancer. Gynecology Imaging Reporting and Data System (GI-RADS) is proved to be effective at identifying the adnexal masses. We investigated whether the combination of these two methods can improve the diagnostic accuracy of ovarian cancer.We retrospectively analyzed preoperative data of 325 patients diagnosed with suspected adnexal mass, 196 patients with benign ovarian masses and 129 with malignant ovarian cancer (stage I: 34, II: 16, III: 61, IV: 18). CA125 was analyzed using the ARCHITECT system, GI-RADS was evaluated according to the International Ovarian Tumor Analysis consensus nomenclature and definitions. Sensitivities and specificities were also calculated for GI-RADS, CA125 and the combinations.The sensitivity, specificity and accuracy of CA125, GI-RADS were 75.97%, 79.59%, 78.15%, and 90.70%, 90.82%,90.77%, the combination data were 94.79%, 96.00%,95.53%. The AUC of combined diagnostic methods was the largest and significantly better compared with each method alone, P < .001). For stage I-II malignancy, GI-RADS as a single method was superior to CA125.Combined use of serum CA 125 and GI-RADS system improved the identification of adnexal masses at high risk of malignancy and could be used for clinical decision-making.

Evaluation of serum cancer antigen 125, resistin, leptin, homocysteine, and total antioxidant capacity in rat model of endometriosis treated with Curcumin.

Endometriosis is one of the most common reproductive diseases of women, with some important biochemical changes in the serum. Curcumin was reported to have anti‐endometriosis, anti‐inflammatory and antioxidant activity. This study explores the changes of serum levels of Cancer Antigen 125 (CA125), leptin, resistin, homocysteine, and total antioxidant capacity (TAC) in a rat model of endometriosis and the effect of curcumin treatment on these factors. Fifty female Sprague‐Dawley rats (220–250 gr body weight) were randomly divided into control (received 0.3 mL of the vehicle), sham(stress of surgery + 0.3 mL of the vehicle) and three endometriosis groups as danazol treatment (7.2 mg/kg BW, IP), curcumin treatment (48 mg/kg BW, IP) and test (received 0.3 mL of the vehicle). Endometriosis was induced by surgically auto‐transplantation of uterine tissue to the abdominal wall and intestinal mesentery. The animals were treated for 4 weeks. On the last day, the blood sample was collected by heart puncture, and the above‐mentioned factors were measured in the sera. Leptin in the curcumin treatment group was markedly higher than all of the studied groups, except the danazol group, while there were no significant differences between other groups (P < 0.05). Level of resistin in endometriosis groups did not show significant differences with the control group (P < 0.05). There was no significant difference in the serum levels of homocysteine and CA 125 between all of the studied groups (P > 0.05). The serum levels of TAC in the control group were significantly higher than all of the studied groups (P < 0.05). Curcumin could prevent the growth of endometriosis, while there was no significant alteration on measured factors in the serum of rat with induced endometriosis. Hence follow up of these parameters in serum may not be a proper indicator to evaluate the status of endometriosis in the rat model.

Prediction effects of serum CA125 decrease ratio during different cycles in relapsed ovarian cancer.

To investigate the prognostic value of serum cancer antigen 125 (CA125) levels during chemotherapy in relapsed epithelial ovarian cancer (EOC) and to identify cut-off values that distinguish patients who relapse beyond 12 months from those who relapse within 12 months. About 93 relapsed EOC patients who received cytoreductive surgery and adjuvant chemotherapy at Obstetrics and Gynecology Hospital of Fudan University between January 2003 and March 2015 were selected. Univariate regression analysis was used to determine the significant prognostic factors. The Kaplan-Meier method was used to calculate the overall survival (OS) rate. The CA125 decrease ratio of more than 97.6% after the fourth chemotherapy cycle was significantly associated with relapse time (P = 0.044). The sensitivity was 70.0%, and the specificity was 76.9%. Moreover, in all relapsed patients, the group with the CA125 decrease ratio after the fourth chemotherapy cycle of more than 97.6% had a significantly better OS than any other group (P = 0.0019). The CA125 decrease ratio of less than 97.6% after the fourth chemotherapy cycle can be a predictive factor for relapse within 12 months. Patients without a significant decrease in CA125 after four cycles of chemotherapy should have a more frequent follow-up and more active re-examination.

Diagnostic accuracy of CA125 and HE4 in ovarian carcinoma patients and the effect of confounders on their serum levels

ObjectivesTo evaluate the diagnostic accuracy of serum cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in the prediction of malignant ovarian masses then to analyze the effect of personal criteria and medical diseases on this accuracy. Study DesignThis prospective study was performed in Zagazig University Hospital. The eligibility criteria for inclusion were; consecutive women, at any age ≥18 years, with established diagnosis of ovarian mass based on symptoms, signs, and imaging techniques. All patients underwent personal and medical history taking, preoperative serum CA125 and HE4 (cutoff 35 IU/mL and 150 pmol/L, respectively) assessment then postoperative histopathologic examination of lesions as a reference standard. ResultsAmong the included 140 patients, 62 were confirmed to have ovarian malignancy and 78 had benign lesions. Serum CA125 ≥35 IU/mL was associated with ovarian malignancy at sensitivity 91.9%, specificity 53.8%, and accuracy 70.7%. Raising its cutoff to 67.5 IU/mL decreased the sensitivity 83.9%, increased the specificity 80.7% with accuracy 82.1%. The combination of HE4 and CA125 showed sensitivity 75.8%, specificity 93.5%, and accuracy 85.7%. Women suffering from both diabetes mellitus and hypertension showed a significant decrease in CA125 concentration P = 0.02 with false negative results in (5/11) of them, making its sensitivity 54.5% in this condition. ConclusionsThe performance of CA125 in cancer ovary prediction can be improved by increasing its cutoff or by combining CA125 with HE4. Diabetes mellitus and hypertension can influence CA125 performance while HE4 is independent on these factors. This can be an additional value of the introduction of HE4 in cancer ovary prediction protocols.

Assessment of Elevated Serum Tumor Markers Carcinoembryonic Antigen (CEA) and Cancer Antigen 15-3 (CA15-3) among Patients with Different Subtypes of Metastatic Breast Cancer

Background: Cancer antigen 15-3 and carcinoembryonic antigen are used in clinical and laboratory diagnosis of metastatic breast cancer. Previous studies have noted conflicting results about the association between carcinoembryonic antigen and cancer antigen 15-3 in metastatic breast cancer. The present study examined serum tumor marker levels of carcinoembryonic antigen and cancer antigen 15-3 among patients with different subtypes of metastatic breast cancer.Methods: In this cross-sectional study, we assessed metastatic breast cancer patients diagnosed between 2005 and 2012 who referred to academic Hospitals affiliated with Mashhad University of Medical Sciences. The patients were selected by systematic randomization sampling. Demographic, clinical, pathological, and therapeutic data were collected from patients’ hospital records. Statistical analyses were performed by Statistical Package for the Social Sciences version 16.0 software.Results: A total of 298 eligible patients enrolled in the study. Patients’ median age was 48.39±12.57 years. Elevated serum levels of carcinoembryonic antigen were identified in 65.17% of patients and cancer antigen 15-3 in 57.29% of patients. Based on molecular subtype categorization, 109 (39.5%) patients were human epidermal growth factor receptor 2 negative and 105 (38.0%) patients were in the luminal group. There was no significant correlation between serum carcinoembryonic antigen and cancer antigen 15-3 with subtypes of the tumor. The most common sites for metastasis were bones and liver, respectively. However, there was no significant correlation between serum carcinoembryonic antigen and cancer antigen 15-3 with the site of metastasis. There was a significant association between serum carcinoembryonic antigen level and stages IIA and IV.Conclusion: One of the most significant findings of the current study was the increased serum carcinoembryonic antigen and cancer antigen 15-3 levels in most metastatic breast cancer participants. We postulate that regular measurement of serum cancer antigen 15-3 and carcinoembryonic antigen could be useful for earlier detection and prediction of outcomes.

Comparison between Serum HE4 and CA125 as Tumor Markers in Premenopausal Women with Benign Pelvic Mass

The aim of the study was to evaluate the role of human epididymal secretory protein (HE4), cancer antigen 125 (CA125), and the Risk of Ovarian Malignancy Algorithm (ROMA) in diagnosing benign pelvic masses in premenopausal women. Serum was collected from 391 premenopausal women with benign pelvic mass prior to surgery and from 45 healthy individuals. Serum HE4 and CA125 levels and ROMA scores were evaluated separately. Among the 391 women with benign pelvic mass, 2.3% (9/391) had elevated HE4 levels (> 70 pmol/L), while 37.1% (145/391) had elevated CA125 levels (> 35 U/mL) (p < 0001). Endometriosis provided false-positive results for CA125 levels in more than half of the cases but resulted in no significant change for HE4 level. In 13 gravid women with a mass, 30.8% (4/13) and 38.5% (5/13) had elevated HE4 and CA125 levels, respectively; however, the difference was not significant (p > 0.05). Moreover, serum levels and patient percentages for CA125 elevation significantly increased with increase in mass diameter, whereas those for HE4 did not. CA125 elevation showed random results for benign pelvic masses, while HE4 elevation showed a higher specificity. Thus, serum HE4 testing is a better approach than CA125 testing for diagnosing benign pelvic masses in premenopausal women.

Clinical risk profile associated with ovarian cancer

Background. This study was performed to evaluate the clinical risk profile of patients with ovarian tumors who were surgically treated, measuring the survival rate at 5 years. Method. The medical records of 237 women between ≤30 and ≥60 years old, from the surgery and obstetrics and gynecology clinics of “St. Andrew the Apostle” County Emergency Clinical Hospital, Constanţa, Romania, were analyzed, taking into account the following variables: age, parity, menarche and menopause precocity, gynecological pathology association, serum cancer antigen (CA) 125 marker, and tumor, lymph node and metastasis (TNM) staging and surgical treatment. Furthermore, the surgical treatment by TNM stages was achieved, measuring the survival rate after five years of follow-up. Results. In our study, the highest prevalence of malignant ovarian cancer was seen at ages ≥60 years old (55.69%). Most of the patients with malignant disease were multiparous (81.85%) and the menarche seemed to appear more earlier (i.e., between 10 and 12 years) in about 58.22% of patients. Moreover, from 161 menopausal patients, the higher prevalence was seen at the group between 45 and 55 years old, not being dependent on the earlier appearance. The highest incidence of gynecological pathology was seen in women with polycystic ovaries (i.e., 5.48%). Regarding serum CA125 tumoral marker, higher values were noticed in the majority of patients (89.51%). Most of the patients were diagnosed in stage III TNM (36.58%), followed by stage II (26.58%) and stage IV (20.67%). The highest prevalence of surgical treatment in the first and second stages was represented by total hysterectomy with bilateral anexectomy, omentectomy and peritoneal lavage, and for the third and fourth stages, total hysterectomy, bilateral anexectomy, omentectomy, peritonectomy and lymphadenectomy, with a better survival rate at five years seen in patients under the age of 30 years old. Conclusions. Thus, our study shows the need to create a screening for patients at risk for ovarian cancer which present higher age, multiparity, early menarche, polycystic ovaries association, and higher serum CA126 marker values. The survival rate at five years of folow-up shows a higher incidence of survival in patients under 30 years old, probably due to the earlier stages detected.

Serum and Salivary Cancer Antigen 125 in Non-Hodgkin Lymphoma Patients Received Chemotherapy

Serum and Salivary Cancer Antigen 125 in Non-Hodgkin Lymphoma Patients Received Chemotherapy

Ultrasonic and Laboratory Predictors of Pregnancy Loss in Patients with Threatened Miscarriage: A Three-Year Observational Study

Objectives: The aim of this study was to assess the relation between different abnormalities of the yolk sac, serum level of Cancer Antigen 125 (CA-125) and serum level of Beta Human Chorionic Gonadotropin (β –HCG) as early predictors of first trimester pregnancy loss in patients with threatened miscarriage. Methods: This prospective observational study was conducted on 292 pregnant women between six to 13 weeks of gestation who were suffered threatened miscarriage. Visualization of yolk sac and diameter were recorded by transvaginal ultrasound . Maternal serum CA-125 and β HCG were also measured. Pregnancy outcome was the main outcome measure. Data was collected and tabulated. Results: There was highly Significant relation between YS size and pregnancy outcome (P<0.001). CA-125 and β-HCG were good predictors of miscarriage with accuracy 88%and 81.5% respectively. Conclusions: Yolk sac size and maternal serum CA-125 and β-HCG are good predictors of pregnancy outcome in first trimester threatened miscarriage.

Treatment strategies for patients with advanced ovarian cancer undergoing neoadjuvant chemotherapy: interval debulking surgery or additional chemotherapy?

ObjectiveTo treat advanced ovarian cancer, interval debulking surgery (IDS) is performed after 3 cycles each of neoadjuvant chemotherapy (NAC) and postoperative chemotherapy (IDS group). If we expect that complete resection cannot be achieved by IDS, debulking surgery is performed after administering additional 3 cycles of chemotherapy without postoperative chemotherapy (Add-C group). We evaluated the survival outcomes of the Add-C group and determined their serum cancer antigen 125 (CA125) levels to predict complete surgery.MethodsA retrospective chart review of all stage III and IV ovarian, fallopian tube, and peritoneal cancer patients treated with NAC in 2007–2016 was conducted.ResultsAbout 117 patients comprised the IDS group and 26 comprised the Add-C group. Univariate and multivariate analyses revealed that Add-C group had an equivalent effect on progression-free survival (PFS; p=0.09) and overall survival (OS; p=0.94) compared with the IDS group. Multivariate analysis revealed that patients who developed residual disease after surgery had worse PFS (hazard ratio [HR]=2.18; 95% confidence interval [CI]=1.45–3.28) and OS (HR=2.33; 95% CI=1.43–3.79), and those who received <6 cycles of chemotherapy had worse PFS (HR=5.30; 95% CI=2.56–10.99) and OS (HR=3.05; 95% CI=1.46–6.38). The preoperative serum CA125 cutoff level was 30 U/mL based on Youden index method.ConclusionsAdministering 3 additional cycles of chemotherapy followed by debulking surgery exhibited equivalent effects on survival as IDS followed by 3 cycles of postoperative chemotherapy. Preoperative serum CA125 levels of ≤30 U/mL may be a useful predictor of achieving complete surgery.