Value Of Serum CA Research Articles

18 F FDG PET/CT versus 99m Tc MDP Bone scintigraphy in imaging of metastatic osseous disease in breast cancer patients; Solving the discrepancies in light of serum markers.

To assess the performance of 18 F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) versus 99m Tc MDP bone scan in assessment of metastatic osseous disease in breast cancer patients in relation to serum markers. We reviewed PET/CT studies and bone scans for 37 patients (mean age of 55.38 ± 13.08 years) with metastatic breast cancer to bone. To assess metastatic osseous burden, we used semiquantitative scores derived from PET/CT (PMS) and bone scans (BMS). We used McNemar test to compare lesion detection between both modalities and receiver operator characteristic analysis to define the cutoff value of serum CA 15-3 that best predicts additional value for PET/CT over bone scan. In 13 patients (35.1%), more lesions or higher-intensity lesions were detected on PET/CT, while only 4 patients (10.8%) had more prominent lesions on bone scans ( P = 0.049). Additional lesions seen on PET/CT are predominantly osteolytic or medullary (early phase). Most lesions with higher uptake on bone scans appear sclerotic (late phase). CA 15-3 was positively correlated to PMS ( r = 0.386; P = 0.018) but not to BMS ( r = -0.027; P = 0.874). However, serum alkaline phosphatase was positively correlated to both PMS ( r = 0.389; P = 0.017) and BMS ( r = 0.363; P = 0.027). CA 15-3 value of >47 U/ml best predicted additional findings on PET/CT compared to bone scans (area under the curve = 0.708; P = 0.0261). FDG PET/CT detects metastatic osseous lesions during an earlier phase. A higher CA 15-3 predicts a higher metastatic burden on PET/CT but not on bone scan. Bone scans are less specific, likely by missing early lesions and detecting persistent uptake in healing sclerotic lesions.

Association Between Disturbed Serum Phosphorus Levels and QT Interval Prolongation

INTRODUCTIONQT interval prolongation is a risk factor for fatal arrhythmias and other cardiovascular complications. QT interval prolongation in hemodialysis (HD) patients is not well understood. Hypocalcemia is a suspected, but poorly verified etiology in these patients, and the association between serum phosphorus levels and QT interval prolongation is unknown. We sought to determine the prevalence of QT interval prolongation in HD patients and to verify the association between pre-dialysis serum Ca and P levels and QT interval prolongation. METHODSA cross-sectional study was conducted on adult maintenance HD patients enrolled in the Japanese Society for Dialysis Therapy and Renal Data Registry 2019. After assessing patient characteristics, linear regression analysis was performed with pre-dialysis serum Ca and P levels as exposures and a rate-corrected QT (QTc) interval as the outcome. RESULTSA total of 204,530 patients were analyzed with a mean QTc of 451.2 msec (SD = 36.9 msec). On multivariable analysis, estimated change in QTc (coefficients, [95% confidence interval {CI}])] per 1 mg/dL increase in serum Ca and P was -2.02 [-3.00, -1.04] and 5.50 [3.92,7.09], respectively. In the restricted cubic spline curve, estimated change in QTc increased with lower values of serum Ca. The correlation between serum P and QTc showed a U-shaped curve. CONCLUSIONDecreased serum Ca levels and decreased and increased serum P levels may be associated with QT interval prolongation in maintenance HD patients.

The Value of CA125 and CA19-9 in the Diagnosis of Stage Ⅲ and Ⅳ Endometriosis

Background: To evaluate the effect of carbohydrate antigen 125 (CA125) and CA19-9 in distinguishing stage Ⅲ and Ⅳ endometriosis from benign and malignant tumors, and to explore whether it is related to the clinical features of the disease. Methods: In a retrospective cohort study based on clinical data from hospitals, a total of 183 patients with pathologically confirmed diagnosis of ovarian endometriotic cysts (OEC) in Hainan Provincial People’s Hospital for surgical treatment from January 2019 to August 2022 were selected as the case group, and a total of 276 cases of benign diseases, including 184 cases of benign ovarian tumors, 94 cases of gynecological common diseases, and 102 cases of malignant ovarian tumors were selected as the control group, with a total of 276 cases of benign diseases, including 184 cases of benign ovarian tumors, 94 cases of gynecological common diseases, and 102 cases of malignant ovarian tumors. There were also 23 cases of ruptured ectopic cysts. We compared the clinical characteristics (age of onset, fertility, dysmenorrhea, preoperative CA125 and CA19-9 values) of the patients in the OEC group with those of the other control groups; analyzed the serum CA125 and CA19-9 values in relation to the pathological characteristics of OEC (recurrence, unilateral and bilaterality, multilocularity and unilocularity, rupture, dysmenorrhea, fertility, and staging); and analyzed the CA125 and CA19-9 values by unordered logistic regression, CA19-9 to predict OEC; sensitivity, specificity and cut-off values of CA125, CA19-9 and their combined indexes to diagnose OEC. Results: The symptoms of dysmenorrhea and infertility in OEC group were significantly higher than those in the other three groups. The preoperative CA125 value in OEC group was higher than that in benign tumor and other gynecological diseases group, and significantly lower than that in malignant tumor group. There was no significant difference in the value of CA19-9 and CA125 in the degree of dysmenorrhea, recurrence and infertility. The values of CA19-9 and CA125 of multilocular cysts were higher than those of unicameral cysts, bilateral cysts were higher than unilateral cysts, and ruptured cysts were significantly higher than unruptured cysts. The value of CA125 in the dysmenorrhea group was higher than that in the non-dysmenorrhea group, and that in the fourth stage was higher than that in the third stage, and the difference was statistically significant (p < 0.05). Unordered multicategorical logistic regression analysis determined that CA125, could be a predictor in the comparison of OEC with benign disease; in the benign control group the cut-off value for CA125 was >23.1 IU/mL with an area under the curve (AUC) value of 0.90 (0.869–0.926), a sensitivity of 89.62% and a specificity of 81.52%. In the malignant control group the cut-off value for CA125 was ≤209.2 with an AUC value of 0.859 (0.813–0.897), sensitivity 95.08% and specificity 71.57%. Conclusions: The effect of serum CA19-9 in the diagnosis of Endometriosis (EMT) is not ideal. CA125 has a certain value in the diagnosis of endometriosis, but it is necessary to explore the range of cut-off value.

Diagnostic value of serum CA125 combined with PET/CT in ovarian cancer and tuberculous peritonitis in female patients.

To evaluate the diagnostic value of serum CA125 combined with 18F-FDG PET/CT in ovarian cancer (OC) and tuberculous peritonitis (TBP) in female patients and to establish a diagnostic scoring system. A total of 86 female patients (64 OC and 22 TBP) were included in this study. Serum CA125, PET/CT maximal intensity projection (MIP), maximal standardized uptake value, ovarian mass, ascites volume, and other indicators were analyzed and a diagnostic scoring system was established according to the weights of statistically significant indicators. Univariate analysis showed that serum CA125 in OC and TBP patients were 2079.9 ± 1651.3 U/mL and 448.3 ± 349.5 U/mL (P < 0.001). In MIP images, abdominal lesions were focal distribution in 92.2% (59/64) of OC patients and diffuse distribution in 95.5% (21/22) of TBP patients (P<0.001). Ovarian masses could be observed in 82.8% (53/64) OC patients and 31.8% (7/22) TBP patients (P <0.001). The other indicators were not statistically significant. Logistic regression analysis showed that serum CA125 and MIP were independent risk factors for diagnosis. A diagnostic scoring system could be established based on serum CA125, MIP and ovarian mass, and the diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 98.4% (63/64), 95.5% (21/22), 97.7% (84/86), 98.4% (63/64), and 95.5% (21/22), respectively. Serum CA125 combined with PET/CT is of great value in the diagnosis of OC and TBP. A simple and efficient diagnostic scoring system can be established using serum CA125, MIP image feature, and ovarian mass.

The predictive value of CA-125 for radiologic evidence of metastatic disease in type 2 endometrial cancers.

e17610 Background: Type 2 endometrial cancers encompass histologic variants that are more aggressive and have a higher incidence of extrauterine disease at the time of presentation than their type 1 counterparts. For high grade endometrial carcinomas, current National Comprehensive Cancer Network (NCCN) guidelines propose the "consideration of chest, abdomen and pelvis CT to evaluate for metastatic disease." We sought to investigate the predictive value of serum CA-125 for radiographic evidence of metastatic disease in patients with type 2 endometrial cancers. Methods: An IRB-approved, retrospective study investigating patients diagnosed with endometrial cancers between 2000-2020 at an urban, multi-site health system was conducted. Only patients with type 2 endometrial cancers and both pre-operative computed tomography scans of the chest, abdomen, and pelvis (CT CAP) and serum CA-125 results were included. A Youden’s index was used to calculate the optimal CA-125 cutoff. The sensitivity and specificity of CA-125 in predicting radiographic evidence of extrauterine disease was then calculated using this pre-determined CA-125 cutoff. Results: In total, 2,227 patients diagnosed with endometrial cancer (types 1 and 2) between 2000-2020 were identified. 1,932 cases were excluded due to low grade disease and/or the absence of pre-operative imaging and CA-125 results. Ultimately, 295 cases were included in analyses. A receiver operating characteristic (ROC) curve was used to generate Youden’s index which established the optimal CA-125 cutoff as 68 U/mL (P=0.0005). Using this cutoff, the specificity and sensitivity were determined to be 92.45% and 63.86%, respectively. The positive predictive value was 76.81% and the negative predictive value was 86.73%. Conclusions: According to current NCCN guidelines, pre-operative imaging and CA-125 should be considered if extrauterine disease is suspected in the setting of endometrial cancer. Although the role of serum CA-125 in monitoring clinical response is well documented, the utility of this test in stratifying patients who should undergo further radiologic evaluation is uncertain. Our results suggest that a CA-125 cutoff of &gt; 68 U/mL is predictive of radiographic evidence of metastatic disease and, thus, can be used to determine which patients should receive pre-operative CT CAP.

Application value of Ki67 and serum CA125 in the deep myometrial invasion of endometrial adenocarcinoma

ObjectiveTo investigate the application value of Ki67 and serum CA125 in diagnosing the deep myometrial invasion of endometrial adenocarcinoma.MethodsThis study retrospectively analyzed 80 patients with endometrial adenocarcinoma, who underwent procedure from January 2018 to June 2021 at Senior Department of Obstetrics & Gynecology, the Seventh Medical Center of PLA General Hospital assigned to the Fourth Medical Center. The general clinical data, serum CA125 and Ki67 levels were compared between the superficial muscular infiltration group and the deep myometrial invasion group. We investigated the application value of Ki67 and serum CA125 in diagnosing the deep myometrial invasion of endometrial adenocarcinoma by the ROC curve.Results80 patients were retrospectively analyzed, and 53 cases were superficial muscular infiltration, 27 cases were deep myometrial invasion. There was significant difference in age, tumor diameter, lymph node metastasis, Ki67, serum CA125, p53 status, serum CA125 and Ki67 levels between the two groups (p < 0.05). As high as 35% of Ki67 was the optimal cutoff value for predicting DMI in endometrial adenocarcinoma, and the area under ROC curve was 0.691, the sensitivity and specificity of diagnosis were 88.9% and 56.6%. As high as 43.645 U/ml of serum CA125 was the optimal cutoff value for predicting DMI in endometrial adenocarcinoma, and the area under ROC curve was 0.668, the sensitivity and specificity of diagnosis were 40.7% and 92.5%. After combined detection of both, the area under ROC curve was 0.719, and its sensitivity and specificity of diagnosis were 96.3% and 43.4%.ConclusionSerum CA125 and Ki67 may be used to evaluate DMI in patients with endometrial adenocarcinoma, and the diagnostic value of combination is higher, which provide reference for clinical treatment.

STUDY OF SERUM URIC ACID, CALCIUM AND ALPAND URINARY HYDROXYPROLINE CREATININE RATIO IN POSTMENOPAUSAL WOMEN

During menopause women succumb to physiological and biochemical changes along with middle age health hazards. In view of sudden fall in Estrogens during menopause Osteoporosis of aging is fortied by Estrogen deciency. The present study was done to evaluate bone health through biochemical parameters in Guntur Urban area between September 2021 and January 2022. 50 Premenopausal women and 60 postmenopausal women were selected for the study after screening verbally . Serum Calcium, Phosphorus, Alk, Phosphatase and Uric acid along with 24Hrs urinary excretion of Creatinine, Calcium and Hydroxyproline were estimated in both groups. We could not nd wide difference in the mean values of serum Ca , P, ALP&amp; UAbut Urine 24 Hrs Ca was lower in postmenopausal women (104.55±23.86) compared to premenopausal group (124.42 ±17.78 ). Urine Hydroxyproline(HOP) showed higher values in postmenopausal women (25.79±1.44 ) than in Premenopausal women.(18.00 ± 2.55). All the analytes showed statistically signicant values between the groups and within the groups with P value value of &lt;0.0001. 24Hrs urine Hydroxyproline , which is collagen degradation product correlated with 24hrs urine Ca and Creatinine.With P value &lt; 0.0001 Serum ALP , Ca &amp; Uric acid as shown by ANOVA, both within groups and between groups was statistically signicant P &lt;0.0001. We conclude that collagen degradation product like HOPcan be evaluated and considered as marker for assessment of bone health in postmenopausal women.

Steroid treatment response combined with serological mark in differentiating type-1 autoimmune pancreatitis from pancreatic cancer.

Autoimmune pancreatitis (AIP) and pancreatic cancer (PC) are two different diseases. Their diagnosis, treatment, and prognosis are different, and it is difficult to differentiate them. This study aimed to explore the role of steroid treatment response combined with serological mark in distinguishing type-1 AIP from PC. Clinical data were collected and compared from 50 cases of AIP (group 1) and 100 cases of PC (group 2). The diagnostic value of serum IgG4, CA19-9, globulin, and eosinophil cell (EC) were evaluated. The response of steroid treatment of 28 patients with atypical imaging in group 1 was analyzed. After 2 weeks, the patients were classified as positive and negative steroid response according to the manifestations and/or the radiological changes. The positive response cases (n = 20) were confirmed as AIP, whereas negative ones (n = 8) were finally diagnosed as PC after complete resection. Serum globulin, IgG4, and EC levels in group 1 were significantly higher than those in group 2 (P < .01), and CA19-9 levels were distinctly lower in group 1 (P < .01). The level of serum IgG4 was related to the accuracy of diagnosis of AIP on the basis of the result of logistic regression analysis. Two-weeks steroid therapy response combined with serum IgG4 levels contribute to the differential diagnosis AIP and PC. However, regular and long-term follow-up were important for the differential diagnosis. There was an urgent need to explore the specific markers that distinguish these 2 entities.

Cytology, High-Risk Human Papillomavirus Testing and Serum CA19-9 in a Large Cohort of Patients with Invasive Cervical Adenocarcinomas: Correlation with a New Pathogenetic Classification.

This study aims to investigate the screening value of cytology, high-risk human papillomavirus (hrHPV) testing and serum CA19-9 in cervical adenocarcinomas. We employed HPV RNA in situ hybridization and immunohistochemistry to reclassify 209 cervical adenocarcinomas according to the International Endocervical Adenocarcinoma Criteria and Classification (IECC). We analyzed the diagnostic value of cytology, hrHPV testing and serum CA19-9 in these tumors and their detection variance among IECC histotypes. We found that the sensitivity of cytology or hrHPV test alone was 74.1% (129/174) or 72% (131/182), respectively. Non-HPV related adenocarcinoma showed a lower detection rate of cytology (60%, 27/45 vs. 79.1%, 102/129, p=0.017) or hrHPV testing (9.8%, 4/41 vs. 90.1%, 127/141, p<0.0001), compared to HPV-related adenocarcinomas. The cytology and hrHPV co-testing significantly demonstrated a higher sensitivity (151/165, 91.5%) than single test alone (p<0.001). Nevertheless, the sensitivity of co-testing was substantially lower for gastric-type adenocarcinoma (GAC) (74.1%, 20/27) than that for non-GAC (94.9%, 131/138) (p=0.001). Serum CA19-9 (>40 U/mL) identified 44.1% (15/34) GACs including 75% (6/8) that were missed by co-testing, much higher than for non-GACs (10.7%, 19/177; p<0.001). The combination of cytology, hrHPV test and serum CA19-9 enhanced the detection rate of GACs (92.9%, 26/28). We conclude that cytology and hrHPV co-testing is not very effective for non-HPV related adenocarcinoma, particularly for GAC. As such, additional serum CA19-9 should be given in women with potential cancer risks.

Efficacy and Adverse Events of Apatinib Salvage Treatment for Refractory Diffuse Malignant Peritoneal Mesothelioma: A Pilot Study

ObjectiveTo investigate the clinical efficacy and adverse events (AEs) of apatinib salvage treatment for diffuse malignant peritoneal mesothelioma (DMPM) that has failed to respond to the recommended treatments.Methods27 patients with refractory DMPM were treated with apatinib at our center from April 2014 to October 2020, at the initial dose of 250 mg/d. The dose was reduced to 125 mg/d when serious adverse events (SAEs) occurred. 28-day was set as a treatment cycle. The frequency of follow up was once every 28 days. The efficacy evaluation was conducted according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria and the serum tumor markers before and after apatinib treatment. The safety assessment was performed with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The primary endpoints were objective response rate (ORR) and disease control rate (DCR), and the secondary endpoints were AEs.ResultsThe 27 patients completed a median treatment-cycle of 15.0, ranging from 5.1 to 39.4 cycles. At the median follow-up of 14.3 (4.8-51.8) months, median overall survival (OS) was 59.4 months, median apatinib-treatment-related survival (ATRS) was 14.0 (4.8-36.8) months. Complete response (CR) was observed in 0 case (0.0%), partial response (PR) in 4 cases (14.8%), stable disease (SD) in 12 cases (44.4%), and progression disease (PD) in 11 cases (40.7%). The ORR was 14.8%, and DCR was 59.3%. The median serum CA125 values before and after apatinib treatment were 32.9 (7.0-4592.4) U/mL and 29.7 (6.1-4327.4) U/mL, respectively (P=0.009). The common AEs were hypertension (6/27; 22.2%), hand-foot syndrome (5/27; 18.5%), albuminuria (4/27; 14.8%), anemia (4/27; 14.8%), leukopenia (4/27; 14.8%), rash (2/27; 7.4%), fatigue (2/27; 7.4%), oral ulcers (2/27; 7.4%), hoarseness (2/27; 7.4%), nausea/vomiting (2/27; 7.4%), diarrhea (2/27; 7.4%), headache (1/27; 3.7%), and fever (1/27; 3.7%). The incidence rate of grade III/IV AEs was 16.2%.ConclusionsApatinib is effective in treating refractory DMPM, with promising efficacy and acceptable safety.

Predicting pathologic venous invasion before pancreatectomy with venous resection: When does radiology tell the truth?

BackgroundPatients factors in addition to radiological characteristics could predict the presence of pathologic venous invasion in patients undergoing pancreatectomy with venous resection. MethodsWe tested the predictive value of 6 radiological classification methods for predicting pathologic venous invasion—the Nakao, Ishikawa, MD Anderson, Lu, Raptopoulos, and National Comprehensive Cancer Network methods—on a cohort of 198 pancreatectomies (160 pancreaticoduodenectomies and 38 total pancreatectomies) with venous resection for pancreatic adenocarcinomas. Radiological and clinical factors determining pathologic venous invasion were identified by multivariable logistic analysis. ResultsPathologic venous invasion was detected in 124 patients (63.2%). The multivariable logistic regression analysis identified Lu classification (odds ratio = 1.77, 95% confidence interval =1.34–2.35; P < .0001), elevated serum CA19-9 values (odds ratio = 1.97, 95% confidence interval = 1.00–3.90; P = .04), and preoperative neoadjuvant chemotherapy (odds ratio = 0.38, 95% confidence interval = 0.18–0.79; P = .009) as independent factors associated with pathologic venous invasion. Radiological tumor-vessel contact greater than 50% of the circumference or venous wall deformity was associated with a significantly higher rate of pathological venous invasion (80% vs 52%; P < .0001), deeper (media-intima) venous invasion (47% vs 25%; P < .0001), R1 resection (58% vs 41%; P = .03), higher transfusions (84% vs 66%; P = .005), and arterial resection rates (43% vs 27%; P < .0001). Tumor-vein circumference contact of >50% and/or venous wall deformity was still associated with significantly higher rates of pathologic venous invasion, regardless of whether neoadjuvant chemotherapy was used or not and CA19-9 normalized or not under preoperative treatment. ConclusionPreoperative radiological detection of tumor-vein circumference contact >50% and/or venous wall deformity is associated with up to 80% of cases of pathological venous invasion. The combination of radiologic features with biological (CA19-9) and clinical (presence of preoperative chemotherapy) factors could better refine preoperatively the need for venous resection.

Prognostic Value of Preoperative Serum CA19-9 in Jaundiced Patients with Primary Resection of Pancreatic Head Adenocarcinoma – Analysis of the German StuDoQ/Pancreas Registry

Introduction: Pancreatic carcinoma patients with preoperative CA19-9 serum levels above 500U/ml are classified borderline resectable (BR-B). Up to date, the impact of jaundice on preoperative CA19-9 serum levels has remained unquantified in these patients. Methods: Data on oncologic pancreatic head resections (n=3.079) due to pancreatic carcinoma and prospectively acquired by the German Study, Documentation, and Quality (StuDoQ) registry were analyzed in relation to preoperative CA19-9 and bilirubin serum values. Preoperative CA19-9 values were corrected according to the results of a multivariable linear regression analysis of pathological parameters, bilirubin and CA19-9 values. The impact of CA19-9 adjustment on patient outcome was validated in a second patient cohort (n=345). Results: 420 (24.5%) out of 1703 PDAC patients presented with a preoperative CA19-9 > 500U/ml. While ROC-Analysis failed to determine exact CA19-9 cut-off values for prognostic indicators (R and N-Status), T-, N-, G-Status, UICC-stage and the number of simultaneous vein resections increased with the level of preoperative CA19-9, independent of concurrent jaundice. After adjustment of preoperative CA19-9 values, 18.5% of patients initially staged BR-B showed CA19-9 values below 500U/ml in the registry group. Overall and disease-free-survival of BR-B PDAC patients did not change after CA19-9 correction compared to the raw values (median 19 vs. 10, p<0.001 and 12 vs. 6 months, p<0.001). Conclusions: In this multicenter dataset of PDAC patients, elevation of preoperative CA19-9 correlates with well-defined prognostic pathological parameters. Moreover, this study provides a new CA19-9 correction formula to increase the prognostic value of preoperative CA19-9 serum values in jaundiced patients.

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

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

Values of serum CA125, NSE and 24-hour urine VMA in diagnosis and prediction of treatment of paediatric neuroblastoma.

Paediatric neuroblastoma is a relatively common type of malignant tumour originating from neural crest tissues. Early diagnosis and the performance of specific therapeutic strategies can increase the survival rate and improve the prognosis of children with neuroblastoma. A total of 86 children with neuroblastoma were recruited in this research, and 50 healthy children aged 1-12years were also selected as controls. Twenty-four-hour urine vanillylmandelic acid (VMA) was evaluated by high-performance liquid chromatography. Serum carbohydrate antigen 125 CA125 and neuron-specific enolase (NSE) levels were evaluated by electrochemiluminescence in Cobas E411 autoanalyser. The serum CA125, NSE and 24-hour urine VMA levels of children with stage III-IVs neuroblastoma were significantly higher than those of children with clinical stages I-II; the serum CA125, NSE and 24-hour urine VMA levels of children in the effective treatment group were significantly lower than those in the treatment-ineffective group. The serum CA125 generated sensitivity and specificity of 71.88% and 59.26%, combined with an AUC (area under the curve) of 0.7049. The serum NSE generated sensitivity and specificity of 68.75% and 81.48%, combined with an AUC of 0.7407. The 24-hour urine VMA generated sensitivity and specificity of 90.63% and 59.26%, combined with an AUC of 0.7986. In conclusion, serum CA125, NSE and 24-hour urine VMA levels before treatment could assess the condition of children with neuroblastoma and predict the effect of treatment.

Cell-free DNA promoter hypermethylation as a diagnostic marker for pancreatic ductal adenocarcinoma – An external validation study

BackgroundWe recently identified a diagnostic prediction model based on promoter hypermethylation of eight selected genes in plasma cell-free (cf) DNA, which showed promising results as a diagnostic biomarker for pancreatic ductal adenocarcinoma (PDAC). The aim of the present study was to validate this biomarker profile in an external patient cohort and examine any additional effect of serum CA 19-9. MethodsPatients with PDAC (n = 346, stage I-IV) and chronic pancreatitis (n = 25) were included. Methylation-specific PCR of a 28-gene panel was performed on serum cfDNA samples. The previously developed diagnostic prediction model (age>65 years, BMP3, RASSF1A, BNC1, MESTv2, TFPI2, APC, SFRP1 and SFRP2) was validated alone and in combination with serum CA 19-9 in this external patient cohort. ResultsPatients with PDAC had a higher number of hypermethylated genes (mean 8.11, 95% CI 7.70–8.52) than patients with chronic pancreatitis (mean 5.60, 95% CI 4.42–6.78, p = 0.011). Validation of the diagnostic prediction model yielded an AUC of 0.77 (95% CI 0.69–0.84). The combination of serum CA 19-9 and our test had an AUC of 0.93 (95% CI 0.89–0.96) in the primary study and 0.85 (95% CI 0.79–0.91) in the validation study. ConclusionIn this validation study, PDAC was associated with a higher number of hypermethylated genes in serum cfDNA than chronic pancreatitis. Our diagnostic test was superior to the predictive value of serum CA 19-9 alone in both the primary and the validation study. The combination of our test with CA 19-9 may serve as a clinically useful diagnostic biomarker for PDAC.

Serum Calcium Levels in Adult Patients With Chronic Hypoparathyroidism Treated With rhPTH(1–84) Compared With a Historical Control Cohort

Adult patients (pts) with chronic hypoparathyroidism (HypoPT) have wide fluctuations in albumin-corrected serum calcium (Ca) measurements.1 This study assessed Ca levels over a 5-yr period in adult pts with chronic HypoPT treated with or without recombinant human parathyroid hormone (1–84), rhPTH(1–84). The rhPTH(1–84)-treated pt cohort was from NCT01297309 (RACE) and NCT01199614 (HEXT) clinical trials. A historical control pt cohort with chronic HypoPT who did not receive rhPTH(1–84) or rhPTH(1–34) came from the US Explorys electronic medical record database (Jan 2007−Aug 2019); selection criteria were similar to those used for the rhPTH(1–84)-treated cohort. The index date was the day after initiation of treatment for the rhPTH(1–84) cohort and the day after the first calcitriol prescription for the control cohort. Pts were required to have ≥1 pair of serum albumin and Ca values occurring on the same date during the 6 months before index and 5 yrs (±6 months) after index. For pts from RACE, baseline and study visit data after rhPTH(1–84) initiation were collected from the antecedent trials. Specified ranges for albumin-corrected serum Ca values were: <7.5 mg/dL (<1.875 mmol/L); ≥7.5−<8.0 mg/dL (≥1.875−<2.0 mmol/L); ≥8.0−<9.0 mg/dL (≥2.0−<2.25 mmol/L); ≥9.0−<10.2 mg/dL (≥2.25−<2.55 mmol/L); and ≥10.2 mg/dL (≥2.55 mmol/L). Changes in Ca levels were assessed using multivariable regression models. There were 71 pts in the rhPTH(1–84) cohort and 119 pts in the control. Before the index date, rhPTH(1–84)-treated pts, compared with the control, were younger (mean±SD, 47.8±10.8 vs 54.9±15.5 years; P<0.001) and a lower proportion had acute manifestations of HypoPT (22.5% vs 64.7%; P<0.001). Over a 5-yr period, in adjusted analyses rhPTH(1–84)-treated pts, compared with the control, had a similar mean proportion of <7.5 mg/dL Ca measurements per pt (13.1% vs 13.1%; P=0.41), a higher proportion of ≥7.5−<8.0 mg/dL Ca measurements per pt (18.8% vs 10.6%; P<0.001), a similar proportion of ≥8.0−<9.0 mg/dL Ca measurements per pt (50.7% vs 48.5%; P=0.68), a lower proportion of ≥9.0−<10.2 mg/dL Ca measurements per pt (15.6% vs 24.1%; P<0.001), and a lower proportion of ≥10.2 mg/dL Ca measurements per pt (1.9% vs 3.7%; P=0.27). The rhPTH(1–84) cohort, compared with the control, had a higher proportion of pts with target range Ca measurements ≥7.5−<9.0 mg/dL (≥1.875−<2.25 mmol/L) for at least 50% of their values (88.7% vs 62.2%; P<0.001). Data interpretation is limited by the differing pt management (ie, trial protocols for the rhPTH[1–84] cohort and clinical practice for the control cohort). Over a 5-yr period, per pt serum Ca levels fluctuated in pts with chronic HypoPT, but levels were more stable in pts treated with rhPTH(1–84) and a lower proportion had hypercalcemia, compared with controls. 1. Ayodele O, et al. ASBMR 2020, 11−15 Sep 2020.

Preoperative Serum CA125 and Plasma Fibrinogen Levels as Predictors of Lymphovascular Space Invasion in Endometrial Cancer

Background: Lymphovascular space invasion has been shown to be a predictor of lymph node metastasisand decreased survival in patients with endometrial cancer. Unfortunately, LVSI status is most commonlynot available until after hysterectomy at the time of preparation of the final Pathology report. Therefore;LVSI status represent additional information to be considered in decision making process regarding whetherto perform lymphadenectomy or to deliver adjuvant therapy. Thus, it was important to find biomarkers topredict the risk of LVSI before surgery.Objective: To evaluate the value of serum CA125 and plasma fibrinogen for prediction of lymphovascularspace invasion in women with endometrial cancer.Study Design: A prospective observational cross-sectional study.Settings: was carried out in the Department of Obstetrics and Gynecology/ Baghdad Teaching Hospital, andNursing Home Hospital in Medical City complex, Baghdad, Iraq, over a period of 1 year starting from thefirst of December 2017 to the end of November 2018.Patients and Methods: Fifty-five women with endometrial cancer undergoing surgery were included inthis study. We compared the preoperative level of serum CA125 and plasma fibrinogen with postoperativehistopathological report regarding LVSI, the results were statistically analyzed.Results: (16.4%) of the patients with positive lympho-vascular invasion. CA-125, Fibrinogen, were highlysignificantly increased in patients with positive LVSI. Sensitivity was (88.9%), specificity (95.7%), negativepredictive value (95.0%), positive predictive value (91.0%),and accuracy of the test was (92.3%)whenthe cutoff value for CA125 was (28.75U/ml) while for plasma fibrinogen in cutoff value (317mg/dl)thesensitivity was (100.0%), specificity (95.7%),negative predictive value (100.0%), positive predictive value(95.9%) and the accuracy of the test was (97.8%)Conclusion: The preoperative assessment of serum CA 125 and plasma fibrinogen could be used to predictthe LVSI in endometrial cancer.

Cancer antigen-125 is a predictor of mortality in patients with pulmonary arterial hypertension

BackgroundCarbohydrate antigen 125 (CA 125), known as a tumor marker for ovarian cancer, has been reported to increase and be associated with severity in heart failure and chronic obstructive pulmonary disease. Patients with pulmonary arterial hypertension may also die due to developing right heart failure. The aim of this study is to evaluate the prognostic role of CA-125 in PAH patients. MethodsA total of 40 consecutive patients with PAH were evaluated prospectively. The mean age of patients was 52 ± 11 years (12% males, 88% females) with a median follow-up period of 16 months. ResultsAfter follow-up period, 12 out of 40 patients (30%) died. CA-125 levels were higher among those who died compared to those who survived [78.5 (11.0–292) vs. 27.5 (2.10–138) U/ml, p = 0.001]. The optimal cut-off value of CA-125 to predict mortality was found as 35.29 U/ml, with 85.7% specificity and 75% sensitivity. In multivariable Cox proportional-hazards model with forward stepwise method; CA-125 > 35.32 U/ml on admission (HR = 7.645, 95% CI: 1.356–43.121, p = 0.021), age (HR = 1.132, 95% CI: 1.040–1.233, p = 0.004), TAPSE (HR = 0.740, 95% CI: 0.549–0.998, p = 0.048) and uric acid (HR = 1.444, 95% CI: 1.022–2.042, p = 0.037) remained associated with an increased risk of death. ConclusionIn this study, we showed for the first time that serum CA-125 values were an independent predictor for the long-term mortality in PAH patients.

Serum CA 19.9 as a Tumour Marker in Colorectal Cancer Staging- An Experimental Study

This cross-sectional, descriptive observational study was carried out for a period of 24 months from January 2014 to December 2015 in the Department of Pathology and Department of Surgery, Rajshahi Medical College, Rajshahi for estimation of serum 19-9 level in total fifty four patients. Histopathological Staging was correlated with the preoperative values of serum CA 19-9 level. Data were collected by face to face interview, clinical examination and findings of laboratory investigations. Preoperative serum CA 19-9 levels were estimated by Enzyme Linked Immunosorbent Assay (ELISA) Method. The study revealed that the colorectal carcinoma was highest in the 5th and 6th decade and rectal area (46.3%) and male predominance was observed with male to female ratio being 3:2. A higher incidence of abnormal CA 19-9 level was found in Dukes’ D (100%) and Dukes’ C (84%) diseases than in Dukes’ B (76%) and Dukes’ A (75%) stages. The sensitivity of CA 19-9 in correctly detecting advanced stage CRC carcinoma from those who had early stage of the disease is (36/44) × 100 = 81.8% and its specificity in correctly excluding those who did not have advanced disease is (2/10) × 100 = 20%. The overall diagnostic accuracy is calculated to be (36 + 2)/54 = 70.37%. Regarding diagnostic values for colorectal carcinoma elevated level of serum CA 19-9 can be considered as an important diagnostic tool for differentiating advanced stage of colorectal carcinoma from its early stage&#x0D; TAJ 2020; 33(1): 35-40

Combination of serum TIMP-3, CA125, and NT-proBNP in predicting ventricular remodeling in patients with heart failure following acute myocardial infarction.

Left ventricular remodeling is the basic pathological mechanism of heart failure following acute myocardial infarction (AMI). Determining sensitive indexes for the early prediction of ventricular remodeling is important for the prevention of heart failure. This study aims to investigate the value of serum TIMP-3, CA125, and NT-proBNP in predicting ventricular remodeling in patients with heart failure following AMI. From May 2017 to May 2018, 93 patients with heart failure following AMI were enrolled in the study. The participants were divided into two groups: the ventricular remodeling group (n=51) and the non-ventricular remodeling group (n=42). In addition, 47 healthy subjects who underwent physical examinations in the same period were enrolled as controls. Serum TIMP-3, CA125, and NT-proBNP were measured, in addition to the left ventricular wall thickness (LVWT) and left ventricular mass index (LVMI). The correlation of serum TIMP-3, CA125, and NT-proBNP with the LVWT and LVMI was analyzed, and its value in predicting ventricular remodeling was evaluated. Serum TIMP-3 level was lower (P<0.05) and CA125 and NT-proBNP levels were higher (P<0.05) in both the ventricular remodeling and non-ventricular remodeling groups compared with the control group. Furthermore, the serum TIMP-3 level was lower in the ventricular remodeling group compared with the non-ventricular remodeling group (P<0.05), while the levels of CA125 and NT-proBNP were higher in the ventricular remodeling group compared with the non-ventricular remodeling group (P<0.05). The serum TIMP-3 level was negatively correlated with the LVWT and LVMI, while serum CA125 and NT-proBNP levels were positively correlated with the LVWT and LVMI, respectively. The area under the receiver operating characteristic curve of the combination of serum TIMP-3, CA125, and NT-proBNP levels in predicting ventricular remodeling was 0.850, and the prediction sensitivity and specificity were 74.51% and 87.71%, respectively. The combination of serum TIMP-3, CA125, and NT-proBNP can improve the sensitivity and specificity of predicting ventricular remodeling and can aid in the early prevention and treatment of heart failure.