Serum Tumor Marker Levels Research Articles

Mastocheck: Notable plasma protein biomarker for diagnosis of breast cancer in the real clinical practice by using multiple reaction monitoring-based mass spectrometry.

3044 Background: Breast cancer is the most frequently diagnosed cancer and the most leading cause of cancer-related deaths among women worldwide. Although screening mammography is available, there is an ongoing interest in improved early detection and prognosis. And also, serum tumor marker levels, such as CA 15-3 and others, may reflect disease progression and recurrence, they have not proven to be sensitive for early disease detection. Research investigating biomarkers for early detection, prognosis and the prediction of treatment responses in breast cancer is rapidly expanding. However, no validated biomarker currently exists for use in routine clinical practice, and breast cancer detection and management remains dependent on invasive procedures We aimed to develop biomarker for diagnosis of breast cancer in the real clinical practice by using proteomics technology. Methods: Based on our previous studies, we performed verification and validation of 124 candidate proteins by using proteomics approach. Among these 124 candidate proteins, the three proteins (neural cell adhesion molecule L1-like protein, apolipoprotein C-1, carbonic anhydrase-1) with highest statistical significance were selected. We created the performance algorithm of the 3-protein diagnostic model to predict of the breast cancer. We performed several experiments for establishment and validation of cut-off value. Furthermore we conducted test for acquisition of sample stability and more experiments to achieve the reproducibility and level of evidence, compared with other cancers (colon, thyroid, ovary, pancreas and lung cancer) and established effect of anesthesia. Results: Total 1226 samples (532 patients of breast cancer, 562 healthy women and 100 sample of other cancers) was analyzed. The sensitivity, specificity and accuracy from confirmation experiment was 71.58%, 85.25% and AUC 0.8323, respectively. The result of comparison with other cancers, there are no statistical significant difference and no relevance with effects of anesthesia. With these results, we recently got permission it to use for in vitro diagnostic use from Korea Food and Drug Administration. Conclusions: In this study, we developed a plasma protein biomarker that may help to diagnosis of breast cancer in the real clinical practice. By using MRM approach, the 3-protein biomarker was validated in an independent cohort with acceptable accuracy for early diagnosis of breast cancer.

Curative effect analysis of 3DCRT combined with thalidomide and GEMOX regimen in advanced intrahepatic cholangiocarcinoma

Objective To investigate the efficacy and adverse reaction of three-dimensional conformal radiotherapy (3DCRT) combined with thalidomide and GEMOX regimen (gemcitabine + oxaliplatin) in patients with advanced intrahepatic cholangiocarcinoma. Methods A total of 100 patients with advanced intrahepatic cholangiocarcinoma in 901 Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army from March 2015 to June 2018 were divided into chemotherapy group (n=50) and combination group (n=50) by random number table method. The chemotherapy group was treated with thalidomide and GEMOX regimen, and the combined group was treated with 3DCRT on the basis of the chemotherapy regimen. The levels of serum tumor markers, clinical efficacy and adverse reactions of patients in the two groups were compared before and after treatment. Results The levels of serum carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and carbohydrate antigen 19-9 (CA19-9) in the combined group were (8.76±2.69) μg/L, (76.17±10.12)×103 U/L and (169.85±78.97)×103 U/L respectively, which were significantly lower than those of (12.46±3.47) μg/L, (104.56±14.38)×103 U/L, (312.45±71.36)×103 U/L in the chemotherapy group, with statistically significant differences (t=5.959, P<0.001; t=11.416, P<0.001; t=9.474, P<0.001). The clinical benefit rate and the total effective rate of the combined group were respectively 64.0% (32/50) and 88.0% (44/50), which were higher than those of 42.0% (21/50) and 72.0% (36/50) in the chemotherapy group, with statistically significant differences (χ2=4.857, P=0.028; χ2=4.000, P=0.046). The incidences of leukopenia, nausea and vomiting, constipation and alopecia of patients in the combined group were 20.0% (10/50), 24.0% (12/50), 30.0% (15/50) and 12.0% (6/50) respectively, which were 14.0% (7/50), 16.0% (8/50), 24.0% (12/50) and 8.0% (4/50) respectively in the chemotherapy group, with no statistically significant differences (χ2=0.638, P=0.424; χ2=1.000, P=0.317; χ2=0.457, P=0.499; χ2=0.444, P=0.505). Conclusion 3DCRT combined with thalidomide and GEMOX regimen can significantly reduce the levels of serum tumor markers in patients with advanced intrahepatic cholangiocarcinoma, enhance the short-term efficacy without significantly increasing and aggravating adverse reactions. Key words: Bile duct neoplasms; Antineoplastic combined chemotherapy protocols; Three-dimensional conformal radiotherapy technology; Thalidomide

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.

Comprehensive analysis of serum tumor markers and BRCA1/2 germline mutations in Chinese ovarian cancer patients.

BackgroundThe serum tumor markers has been widely used in ovarian cancer diagnosis. BRCA1/2 germline mutations are the most common predisposing factors for ovarian cancer development. This study aimed to comprehensively investigate serum tumor markers and BRCA1/2 germline mutations and analyze their associations with ovarian cancer.MethodsLevels of 11 serum tumor markers were examined in ovarian cancer patients and controls with benign gynecologic diseases. By integrating multiplex PCR and next‐generation sequencing technologies, BRCA1/2 germline mutations were analyzed and confirmed by Sanger sequencing. The discriminative models with serum tumor markers and BRCA1/2 mutation status were constructed for ovarian cancer detection and patient stratification.ResultsAmong 11 markers, six of them were significantly elevated and only beta‐human chorionic gonadotropin (β‐HCG) was significantly reduced in ovarian cancer patients. A total of 54 (23.3%) ovarian cancer patients were found to harbor BRCA1/2 deleterious mutations, and BRCA1/2 mutations were significantly associated with Hereditary Breast and Ovarian Cancer‐related tumors and family history of cancer. Carbohydrate antigen 125 showed a good performance in ovarian cancer detection as a single marker (AUC = 0.799), while a panel of eight markers showed a good performance in BRCA1 mutation detection with an AUC value of 0.974. In addition, a panel of five serum tumor markers combined with BRCA1/2 mutation status showed a good performance in lymph node metastasis prediction (AUC = 0.843).ConclusionsWe found the association between BRCA1/2 germline mutation status and serum tumor marker levels, and identified discriminative models that combined serum tumor markers with BRCA1/2 mutation status for ovarian cancer detection and patient stratification.

The Role of Serum CEA and CA19-9 in Efficacy Evaluations and Progression-Free Survival Predictions for Patients Treated with Cetuximab Combined with FOLFOX4 or FOLFIRI as a First-Line Treatment for Advanced Colorectal Cancer.

Background Previously, it was demonstrated that serum levels of tumor markers, CEA and CA19-9, correlated with chemotherapy. Consequently, it has been hypothesized that dynamic monitoring of changes in these markers may predict the shrinkage or growth of colorectal cancers. To test this hypothesis, we analyzed CEA and CA19-9 serum levels in patients with advanced colorectal cancer who received cetuximab in combination with chemotherapy. These levels were evaluated at various time points to identify their potential to serve as early efficacy predictors during treatment and early predictors of disease progression. Patients and Methods Measurements of tumor markers, CEA and CA 19-9, in patients with metastatic colorectal cancer (n = 73) who received cetuximab plus folinic acid, fluorouracil, and oxaliplatin or irinotecan (FOLFOX4/FOLFIRI) as a first-line treatment at our center were retrospectively analyzed. These levels were also compared with objective responses according to the World Health Organization criteria. Initially, 65 patients had elevated CEA levels (>5 ng/ml), and 59 patients had elevated levels of CA19-9 (>37 U/ml). A total of 172 cycles and 165 cycles of computed tomography/magnetic resonance imaging observations were available for review from these two patient groups. Results After completing three cycles of treatment, the best diagnosis of cetuximab resistance was achieved when CEA increased by 35% (efficacy, 83.33%; sensitivity, 75.41%) and when CA19-9 increased by 28% (efficacy, 80.00%; sensitivity, 84.31%). Next, the efficacy of cetuximab at the time of diagnosis (at the first imaging examination/after three cycles of treatment) was evaluated after the first cycle of chemotherapy. When CEA decreased by 60% from its baseline level, the best effective rate and sensitivity were observed (63.64% and 80.95%, respectively). Similarly, when CA19-9 was 45% lower than its baseline level, the best effective rate and sensitivity were observed (84.21% and 93.18%, respectively). To evaluate progression-free survival (PFS), levels of both CEA and CA19-9 were evaluated after the third cycle of chemotherapy. Increases of 35% and 28%, respectively, resulted in a shorter PFS period compared with the other patients (3.15 months vs. 9.10 months, respectively; P < 0.0001). Conversely, when the evaluation was performed after the first cycle of chemotherapy, patients exhibiting a 60% decrease in CEA and a 45% decrease in CA19-9 had a longer PFS period (11.13 months vs. 8.10 months, respectively; P = 0.0395). Conclusions CEA and CA19-9 are useful indicators of therapeutic curative effect from cetuximab combined with first-line chemotherapy. These markers also helped assess cetuximab resistance and served as early predictors of initial treatment effectiveness. Furthermore, a simultaneous increase or decrease in the levels of both indicators was consistent with the observed differences in PFS.

Analysis of uterine corporeal mesenchymal tumors occurring after menopause

ObjectiveBecause it is difficult to diagnose accurately whether uterine corporeal mesenchymal tumors are benign or malignant before surgery, an understanding of the characteristics of patients with uterine sarcomas occurring in the postmenopausal period is required.MethodsWe retrospectively reviewed the cases of women who underwent surgery for uterine mesenchymal tumors at our hospital.ResultsAmong 487 operated cases, 447 tumors occurred in the premenopausal period and 40 occurred in the postmenopausal period. Uterine sarcomas were observed in 5 cases (1.1%) during the premenopausal period and in 11 cases (28%) during the postmenopausal period. Among the postmenopausal patients, age, age at menopause, body mass index (BMI), tumor size, incidence of abnormal vaginal bleeding, serum tumor marker levels (cancer antigen 125, carbohydrate antigen 19–9, and carcinoembryonic antigen), and serum lactate dehydrogenase values were not significantly different between patients with benign tumors and those with malignant tumors. On the other hand, the incidence to have abnormal signal on MRI was significantly higher in patients with malignant tumors than in patients with benign tumors.ConclusionIn our hospital, the incidence of malignant tumors in women with uterine corporeal mesenchymal tumors was much higher in postmenopausal patients than in premenopausal patients. Because it is generally not easy to diagnose uterine sarcomas before surgery, surgery should be positively considered when uterine sarcomas cannot be ruled out for patients in the postmenopausal period.

Mass-forming mucosa-associated lymphoid tissue lymphoma of the cecum treated by laparoscopy-assisted bowel resection

Colonic mucosa-associated lymphoid tissue (MALT) lymphoma is very rare, especially those which form a mass. Although the characteristics and treatment methods of gastric MALT lymphomas are well established, those of colonic MALT lymphomas have been insufficiently described. Here, we report a case of mass-forming cecal MALT lymphoma that was successfully treated by laparoscopy-assisted bowel resection. A 60-year-old woman with right lower abdominal pain and a palpable tumor was referred to our hospital. Colonoscopy showed a smooth elevated submucosal tumor-like lesion in the cecum. Histological and immunochemical findings were consistent with MALT lymphoma. Serum tumor marker levels were within normal range. Enhanced abdominal computed tomography showed a large tumor 55mm in diameter in the cecum and edema of a few paracolic lymph nodes. The tumor was diagnosed as cecal MALT lymphoma classified as stage II1 by Lugano classification, and laparoscopy-assisted ileocecal resection was performed. The postoperative course was uneventful and the patient underwent eradication therapy for Helicobacter pylori. A year after the operation she has had no recurrence. In patients with mass-forming colonic MALT lymphoma without dissemination, surgical resection may be a feasible treatment.

Role Of Serum Levels Of Tumor Markers In The Prognosis Of Patients With Carcinoma Gall Bladder And Their Correlation With Its Staging

Role Of Serum Levels Of Tumor Markers In The Prognosis Of Patients With Carcinoma Gall Bladder And Their Correlation With Its Staging

Neutrophil-to-lymphocyte ratio and platelet count as prognostic factors in ovarian malignancies.

The objectives of the present study were to demonstrate the influence of neutrophils, platelets, and neutrophil-lymphocyte ratio (NLR) in the ovarian cancer prognosis and to compare these parameters with benign ovarian neoplasms. Records of patients underwent surgery for ovarian cysts were evaluated. There were 72 malignant neoplasms and 213 benign neoplasms. Age, parity, histologic type, tumor stage, type of surgery performed, chemotherapy, disease-free survival, serum levels of tumor markers, neutrophils, lymphocytes, platelets, and NRL were recorded. The Mann-Whitney, the Chi-square test and multiple linear regression were used. A P-value < 0.05 was established as the significance level. Higher values of platelets, neutrophils, and NLR were found in malignant tumors (P = 0.0132, P = 0.0208, and P < 0.0001, respectively), while lymphocytes values were higher in benign group (P < 0.0001). Preoperative platelet count 300,000/mm3 was related to less aggressive histological types (P = 0.0148). NLR <3 was related to the initial stages (P = 0.0053), and patients with disease-free survival >24 months had most often neutropenia during chemotherapy (P = 0.0482). After multivariate analysis, platelets, NLR, and serum levels of CA15.3 were considered independent variables related to tumor staging (P = 0.028, P = 0.028, and P = 0.035, respectively). NLR and serum levels of platelets may represent potential prognostic factors in ovarian cancer, and they may also serve as therapeutic targets in the future treatment strategies.

Clinical Value of Serum HE4, CA125, CA72-4, and ROMA Index for Diagnosis of Ovarian Cancer and Prediction of Postoperative Recurrence.

Ovarian cancer is one of the most common cancers among women. With cancer, early detection is paramount to saving lives. However, early detection of ovarian cancer has been fraught with difficulty. The diagnostic performance of HE4, CA125, ROMA index, and CA72-4 was evaluated for ovarian cancer. This was a diagnostic study enrolling 97 patients with pelvic masses who had been scheduled for surgery and 33 healthy women. Serum levels of tumor markers, including human epididymis protein 4 (HE4), carbohydrate antigen 125 (CA125), and carbohydrate antigen 72-4 (CA72-4) were detected in each patient and analyzed using the risk of ovarian malignancy algorithm (ROMA) index for sensitivity, specificity, positive predictive values, negative predictive values, and accuracy. ROC curve analysis was conducted to compare the diagnostic performances of serum HE4, CA125, CA72-4, and ROMA index in ovarian cancer. The dynamic changes of these biomarkers were analyzed in patients with ovarian cancer after operation. HE4 had the best specificity, CA72-4 had the lowest sensitivity, and ROMA index had the best diagnostic efficiency among these biomarkers for diagnosis of ovarian cancer. CA125 had better specificity in the post-menopausal group than in non-menopausal group. The kinetic changes of HE4, CA125, and ROMA index in patients with ovarian cancer were consistent with the remission and recurrence of the disease. HE4 and ROMA index which reference intervals are established according to the menopausal status have important clinical significance in the diagnosis of ovarian cancer. Regular detection of serum HE4, CA125, and ROMA index can help predict postoperative recurrence of ovarian cancer.

Antitumor activity of Cuphea ignea extract against benzo(a)pyrene-induced lung tumorigenesis in Swiss Albino mice.

Lung cancer has one of the highest mortality rates among various types of cancer and is the most frequent cancer in the world. The incidence of lung cancer is increasing rapidly, in parallel with an increased incidence of smoking. Effective chemoprevention may be an alternative strategy to control the incidence of lung cancer. Thus, the objective of current work was to ascertain the possible preventive and therapeutic efficacies of Cuphea ignea extract in a mouse model of lung tumorigenesis and its cytotoxicity toward the A549 human lung cancer cell line. Lung tumorigenesis was induced by the oral administration of benzo(a)pyrene (50 mg/kg b.w.) twice per week to Swiss albino mice for 4 weeks. Benzo(a)pyrene-treated mice were orally administered C. ignea (300 mg/kg body weight, 5 days/week) for 2 weeks before or 9 weeks after the first benzo(a)pyrene dose, for a total of 21 weeks. At the end of the administration period, various parameters were measured in the serum and lung tissues. The results revealed that the oral administration of benzo(a)pyrene resulted in increases in relative lung weight, serum levels of tumor markers (ADA, AHH, and LDH), and the inflammatory marker NF-κB, and a decreased total antioxidant capacity compared with the control. In addition, decreased levels of enzymatic and non-enzymatic antioxidants, with a concomitant increase in lipid peroxidation, metalloproteinases (MMP-2 and MMP-12), and the angiogenic marker VEGF were detected in lung tissues. Moreover, benzo(a)pyrene administration induced the upregulation of PKCα, COX-2, and Bcl-2 expression, with the downregulation of BAX and caspase-3 expression. C. ignea treatment alleviated all alterations in these parameters, which was further confirmed by the histopathological analysis of lung tissues. The findings of the current work provide the first verification of the preventive and therapeutic potentials of C. ignea extract against benzo(a)pyrene-induced lung tumorigenesis in mice.

Perspectives of usak university faculty of medicine and dentistry students to biochemistry course

Aim: In this study, we aimed to share our experiences about patients with miscellaneous non-specific malign stromal tumors of testis. We report the demographic and clinical characteristics and the long-term results in patients with non-specific malign stromal tumors of testis.Material and Methods: 234 patients with testicular cancer between June 1994 and January 2019 have been evaluated retrospectively. Eleven patients (Dedifferentiated liposarcoma, Diffuse large B-cell lymphoma, Embryonal rhabdomyosarcoma, Adenocarcinoma of the epididymis, Ewing’s sarcoma of the testis, Testicular leiomyosarcoma, Well-differentiated liposarcoma, Paratesticular high grade sarcoma and Paratesticular malignant mesothelioma) whose data were reached, are taken into the study. Patients’ age, scrotal localization of symptoms, clinical examination findings, serum tumor marker levels, pathology results and follow-up period were recorded. Results:The mean age at diagnosis was 43.7 years (range, 18 to 79). 54.5% of the lesions were localized to the right hemiscrotal area and of 45.4% to the left hemiscrotal area. None of patients had a history of unilateral undescended testis in medical history or testicular cancer in familial history. Serum tumor markers were normal in all patients. The mean scrotal mass lesion at diagnosis was 59.9 mm3 (range, 33 to 138 mm3). 3 or 4 cyles of chemotherapy protocols were administered in necessary cases. Mean follow-up period was 80.6 months (range, 12 to 297 months). Tumor recurrence was occured in only two patients (Dedifferentiated liposarcoma and Adenocarcinoma of the epididymis) during the follow-up.Conclusion: Miscellaneous non-specific malign stromal tumors of the testis should be kept in mind especially in middle age group patients presented with malign scrotal lesions. Surgical treatment should be aggressive and additional specific treatment according to pathology result should be planned without delay. Follow-up protocols are recommended to be tumor specific.

Epidermoid Cyst of the Testis 5-Year Follow-Up Results in Adults

Background: In this study, we aimed to share our experiences in patients with epidermoid cyst of the testis. We report the demographic and clinical characteristics and the long term results in patients with epidermoid cysts. Materials and Methods: Thirteen patients with epidermoid cyst of the testis treated between June 2000 and January 2018 were retrospectively evaluated. Ten patients with available data were included in the study. Patients’ age, scrotal localization of symptoms, physical examination findings, serum tumor marker levels, pathology results and follow-up periods were recorded. Results: The current cohort consisted of 10 patients. The mean age at diagnosis was 29.7 years (range, 20 to 53 years). Eighty percent of the lesions were localized to the left hemiscrotum and 20% to the right hemiscrotum. One patient had a history of unilateral undescended testis. Serum tumor markers were normal in all patients. The mean scrotal mass lesion volume at diagnosis was 28 mm3 (range, 13 to 51 mm3). The mean follow-up period was 66.9 months (range, 12 to 216 months). Conclusions: Epidermoid cyst of the testis should be kept in mind, particularly in patients with lesions negative for tumor markers and radiological findings typical of epidermoid cysts. Annual follow-up is not required.

Transarterial radioembolization with Iodine-131-Lipiodol for hepatic metastases from gastrointestinal malignancies - Experience in tertiary care oncology center in India.

Context:Unresectable colorectal hepatic metastases can be treated with radioembolization.Aims:The aim of this study is to analyze the response and survival benefits of transarterial radioembolization (TARE) with Iodine-131 (131I) Lipiodol for hepatic metastases from gastrointestinal malignancies.Settings and Design:Retrospective study of 20 patients with pathologically proven hepatic metastases from primary gastrointestinal malignancies referred for palliative therapy with TARE.Subjects and Methods:At baseline, standard laboratory and imaging data were recorded. All patients fulfilling the inclusion/exclusion criteria underwent TARE with 131I Lipiodol. Post procedure, the patients were reviewed after 1 month with follow-up positron emission tomography–computed tomography and tumor marker levels to evaluate treatment response with continued follow-up till December 2016 and overall survival calculated.Statistical Analysis Used:Data were analyzed using a statistical analysis package (Social sciences, version 15.0 for Windows; SSPS Inc.). Survival data were plotted using Kaplan–Meier survival curves.Results:At the end of follow-up period, 15 of 20 patients were alive. The mean and median survival was 38.88 ± 5.0 months (95% confidence interval [CI], 29.03–48.74 months, P = 0.17) and 49.3 ± 12.4 months (95% CI, 25.0–73.7 months, P = 0.17), respectively. 66 months survival was 75%. Response evaluation in 10 patients showed partial response in 3 (30%), stable disease in 2 (20%) and progressive disease in 5 (50%) patients. All patients with partial response showed a reduction in serum tumor marker levels.Conclusions:TARE with 131I-Lipiodol is highly effective with a significant survival benefit in refractory cases of hepatic metastases from gastrointestinal malignancies.

Non-specific malign stromal tumors of testis

Aim: In this study, we aimed to share our experiences about patients with miscellaneous non-specific malign stromal tumors of testis. We report the demographic and clinical characteristics and the long-term results in patients with non-specific malign stromal tumors of testis. Material and Methods: 234 patients with testicular cancer between June 1994 and January 2019 have been evaluated retrospectively. Eleven patients (Dedifferentiated liposarcoma, Diffuse large B-cell lymphoma, Embryonal rhabdomyosarcoma, Adenocarcinoma of the epididymis, Ewing’s sarcoma of the testis, Testicular leiomyosarcoma, Well-differentiated liposarcoma, Paratesticular high grade sarcoma and Paratesticular malignant mesothelioma) whose data were reached, are taken into the study. Patients’ age, scrotal localization of symptoms, clinical examination findings, serum tumor marker levels, pathology results and follow-up period were recorded. Results:The mean age at diagnosis was 43.7 years (range, 18 to 79). 54.5% of the lesions were localized to the right hemiscrotal area and of 45.4% to the left hemiscrotal area. None of patients had a history of unilateral undescended testis in medical history or testicular cancer in familial history. Serum tumor markers were normal in all patients. The mean scrotal mass lesion at diagnosis was 59.9 mm3 (range, 33 to 138 mm3). 3 or 4 cyles of chemotherapy protocols were administered in necessary cases. Mean follow-up period was 80.6 months (range, 12 to 297 months). Tumor recurrence was occured in only two patients (Dedifferentiated liposarcoma and Adenocarcinoma of the epididymis) during the follow-up. Conclusion: Miscellaneous non-specific malign stromal tumors of the testis should be kept in mind especially in middle age group patients presented with malign scrotal lesions. Surgical treatment should be aggressive and additional specific treatment according to pathology result should be planned without delay. Follow-up protocols are recommended to be tumor specific.

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.

TUMOR MARKERS

Object: Analysis of serum tumor markers CA-125, CEA, AFP, &amp; ß-HCG in patientswith ovarian malignant tumors and correlation of their serum levels with histological types. StudyDesign: Institution based descriptive and prospective study. Place &amp; Duration: Department ofPathology, Liaquat University of Medical &amp; Health Sciences, Jamshoro from January 2009 toJune 2011. Material &amp; Methods: One hundred cases, diagnosed as ovarian malignant tumor onH&amp;E staining were selected for study &amp; measurement of serum CA-125, CEA, AFP, &amp; ß-HCGpreoperatively and postoperatively in each case. Results: Out of 100 ovarian cancers diagnosedon H&amp;E stain 33 were serous cystadenocarcinoma, 29 mucinous adenocarcinoma, 19 germ celltumors and 15 sex-cord stromal tumors, 1 endometroid carcinoma, 1 brenner tumor, 1 clear cellcarcinoma and 1 case of NHL. Increased level of CA-125 was seen preoperatively in 33/33 casesof serous cystadenocarcinoma and 24/29 cases of mucinous adenocarcinoma. Surprisinglyincreased levels were also seen in 10/19 germ cell tumor and 8/15 in sex-cord stromal tumors.CEA is raised in mucinous tumors. AFP &amp; ß-HCG were raised in germ cell tumors &amp; sex cordstromaltumors. Serum tumor marker levels were declined following appropriate therapy of thetumors. Conclusions: Serum tumor markers are useful and important for the detection of ovariantumors. They may also help in assessment of response to specific treatment, prognosis &amp; followup of patient.

Verification of the diagnostic strategy for anterior mediastinal tumors.

For thymic epithelial tumors (TETs), the National Comprehensive Cancer Network guideline has suggested that complete excision of the tumor should be performed without a preoperative biopsy when resectable. However, little evidence has been provided to support this strategy. The purpose of this study was to review our diagnostic process and to evaluate the validity of radical resection of anterior mediastinal masses (AMMs) without pathological confirmation. A total of 254 patients underwent surgical resection for AMMs between 2004 and 2015. This study included 181 patients with likely TETs according to clinical features, serum levels of tumor markers and autoimmune-antibodies, and radiological findings. In addition, AMMs likely TETs were classified into resectable or unresectable tumors. We retrospectively reviewed the diagnostic process of those patients and validated surgical resection of AMMs without a definitive diagnosis. Among 254 patients, 181 were suspected of having a TET based on the serum levels of tumor markers and autoimmune-antibodies and the radiological findings. Of them, 157 patients were deemed resectable and underwent surgical resection without histological confirmation, and 144 (92%) were diagnosed with TETs in the final pathological examinations. In 13 patients with non-TETs, the tumors were difficult to differentiate from TETs by imaging and clinical findings alone. A total of 92% of patients suspected of having a TET and who underwent complete resection without pathological confirmation were accurately diagnosed and properly treated. Surgical resection without a definitive diagnosis was feasible in patients suspected of having a TET when they were considered resectable.

Efficacy of Huaier granule in patients with breast cancer.

Huaier extract has been demonstrated to exhibit potent anti-tumor effects in various types of cancer cells. However, the clinical benefit of Huaier granule in breast cancer has not been reported. In this study, we aimed to evaluate the efficacy of Huaier granule in breast cancer patients. Our study included 284 breast cancer patients treated with or without Huaier granule between January 2005 and October 2016 at Qilu Hospital, Shandong University, Jinan, China. Retrospective data obtained included demographics, clinicopathological characteristics, disease-free survival (DFS), serum concentrations of tumor markers, the Karnofsky performance scale (KPS), and incidences of emotional symptoms. DFS was the main outcome measure. Of the patients included, 144 were classified into the control group and 140 into the Huaier group. Baseline characteristics were well balanced between the study arms. Median DFS was 91.43months for control group and 112.61months for Huaier group (hazard ratio (HR) = 2.97, 95% confidence interval (CI) = 1.57-5.61, p < 0.01). After Huaier granule treatment, the serum levels of tumor markers could be reduced to the normal range. In addition, breast cancer patients with Huaier granule treatment had higher KPS scores and less emotional symptoms. Our data demonstrated that patients orally administrated Huaier granule got longer DFS. Furthermore, Huaier granule could reduce serum tumor markers, improve the functional status, and decrease the incidences of emotional symptoms in breast cancer patients. Therefore, Huaier granule was an effective therapy for women with breast cancer.

913P - The prognostic value of DNA damage level in peripheral blood lymphocytes in germ cell cancer patients

Background: Germ cell tumors (GCTs) are extraordinarily sensitive to cisplatin (CDDP)-based chemotherapy. DNA damage represents one of the most important factors contributing to the toxic effects of CDDP-based chemotherapy. Previously, in a pilot study, we observed prognostic value of the DNA damage level in peripheral blood lymphocytes (PBLs) from chemo-naïve GCT patients. This study was aimed to validate the prognostic value of the DNA damage level in PBL in chemo-naïve, as well as chemotherapy pre-treated GCT patients. Methods: PBLs isolated from 123 GCT patients (101 chemotherapy-naïve and 22 chemotherapy pre-treated) baseline and before 2nd cycle of chemotherapy were included into this prospective study. The DNA damage levels in PBLs were evaluated by the Comet assay and scored as percentage of DNA in tail by the Metafer-MetaCyte analyzing software. The DNA damage level in PBL was categorized as ‘low’ or ‘high’ according to the cut-off level of the mean. Results: The mean ± SEM (standard error of the mean) of the endogenous DNA damage level was 5.25 ± 0.64. Chemotherapy-naïve patients with “low” DNA damage levels at baseline had significantly better progression-free survival (PFS) (hazard ratio [HR] = 0.05 95%CI (0.02 – 0.17), P = 0.0001) and overall survival (OS) (HR = 0.00, P = 0.0002, no death occurred in patients with “low” DNA damage level) compared to patients with “high” DNA damage levels. In multivariate analysis, prognostic value of the DNA damage level in PBL was significantly associated with PFS and OS independently of IGCCCG risk group. Moreover, there was significant correlation between the DNA damage level and response to treatment, non-pulmonary visceral metastases, number of metastatic sites, presence of mediastinal lymph nodes metastases and serum tumor markers level. There was no prognostic value of DNA damage level in PBL before 2nd cycle of chemotherapy and/or in pre-treated GCTs. Conclusions: These data suggest that the DNA damage levels in PBLs of GCT patients are a novel prognostic marker timely identifying patients with poor outcome. We hypothesize that altered DNA damage level in PBLs could be induced by GCTs similarly to cancer-related immunosuppression and is abolished by administration of chemotherapy. Legal entity responsible for the study: Michal Mego. Funding: VEGA 1/0043/18, APVV-15-0086. Disclosure: All authors have declared no conflicts of interest.