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El cáncer de ovario es un problema de salud pública para el cual no se cuenta con métodos de tamizaje estandarizados, no obstante, los marcadores Ca125, He4 y el índice de Roma tiene un gran valor en el diagnóstico y pronóstico de esta patología. Objetivo. Analizar el comportamiento de los marcadores tumorales Ca125 y He4 e índice de Roma en la predicción de malignidad en pacientes con masas ováricas. Materiales y Métodos. Se tomaron los resultados de laboratorio de 112 mujeres atendidas en el Hospital General Ambato de los valores séricos de Ca125, He4 y su correspondiente cálculo del índice de Roma. Se los dividió en el grupo pre y postmenopáusico, maligno y benigno. Resultados. El análisis de los resultados definió la relación de Ca 125 y He4 con el diagnóstico de cáncer de ovario con un nivel de confianza del 95% y valor de p<0,05. La probabilidad de diferenciar cáncer de ovario de procesos benigno para Ca125, He4 e índice de Roma fue del 93,33%, 84,4 y 99,7, respectivamente. Conclusiones. El mejor predictor de malignidad es el índice de Roma. Se encontraron valores séricos elevados de He4 mayores para pacientes postmenopáusicas. Se requieren más estudios que avalen un método de tamizaje estandarizado para el cáncer de ovario.
Ovarian cancer is a public health problem for which there are no standardized screening methods; however, Ca125, He4 and Rome index markers are of great value in the diagnosis and prognosis of this pathology. Objective. To analyze the behavior of tumor markers Ca125 and He4 and Rome index in the prediction of malignancy in patients with ovarian masses. Materials and Methods. The laboratory results of 112 women attended at Hospital General Ambato were taken for serum Ca125, He4 and their corresponding calculation of the Rome index. They were divided into premenopausal and postmenopausal, malignant and benign groups. Results. Analysis of the results defined the relationship of Ca 125 and He4 with the diagnosis of ovarian cancer with a confidence level of 95% and value of p<0.05. The probability of differentiating ovarian cancer from benign processes for Ca125, He4 and Rome index was 93.33%, 84.4 and 99.7, respectively. Conclusions. The best predictor of malignancy is the Rome index. Elevated serum He4 values were found to be higher for postmenopausal patients. Further studies are needed to support a standardized screening method for ovarian cancer.
O câncer do ovário é um problema de saúde pública para o qual não existem métodos de triagem padronizados. No entanto, os marcadores índice Ca125, He4 e Roma são de grande valor no diagnóstico e prognóstico desta patologia. Objetivo. Analisar o comportamento dos marcadores tumorais Ca125 e He4 e o índice de Roma na previsão de malignidade em pacientes com massas ovarianas. Materiais e métodos. Os resultados laboratoriais de 112 mulheres tratadas no Hospital Geral Ambato foram tomados para o soro Ca125, He4 e seu correspondente cálculo do índice de Roma. Eles foram divididos em grupos pré e pós-menopausa, malignos e benignos. Resultados. A análise dos resultados definiu a associação de Ca125 e He4 com o diagnóstico de câncer de ovário a um nível de confiança de 95% e valor de p<0,05. A probabilidade de diferenciar o câncer de ovário dos processos benignos para Ca125, He4 e índice de Roma foi de 93,33%, 84,4 e 99,7, respectivamente. Conclusões. O melhor preditor de malignidade é o índice de Roma. Os valores elevados de soro He4 foram considerados mais altos para pacientes na pós-menopausa. São necessários mais estudos para apoiar um método padronizado de triagem para o câncer de ovário.
Subject(s)
Ovarian Neoplasms , Public HealthABSTRACT
Abstract Introduction: Diagnosing extra-pulmonary tuberculosis (EPTB) is a challenge for physicians. It has been suggested that cancer antigen 125 (CA-125), which is produced by mesothelial cells, may be an EPTB diagnostic biomarker. Objective: To describe serum CA-125 levels behavior in patients with TB treated in a referral university hospital located in Cali, Colombia. Materials and methods: A cross-sectional study was conducted in 99 TB patients treated at Fundación Valle del Lili between 2007 and 2016 with CA-125 measurements (U/mL) made before TB treatment was started. Cases were classified as pulmonary TB (PTB) (n=33) or EPTB (n=66). A bivariate analysis was performed to compare the variables of interest (sociodemographic, clinical, and laboratory findings data) between EPTB and PTB groups, and to determine differences between patients with CA-125 positive results and those with negative results in relation to mortality. Results: Elevated CA-125 levels were reported in 55 patients (55.56%), and positive CA-125 results (>35 U/mL) were more frequent in the EPTB group (59.09% vs. 48.48%). In the EPTB group, results were positive in tuberculous serositis cases (100% pericardial TB, 68.42% peritoneal TB, and 66.66% pleural TB), and in 66.66% of miliary TB and spinal TB cases, respectively. Also, 15 TB infection-related deaths were reported in the follow-up period (n=66), of which 13 had a CA-125 positive result, finding a significant difference with those with negative results (p=0.021); however, 47.05% of the surviving patients also had a positive result. Conclusions: Most of tuberculous serositis, miliary TB, and spinal TB cases showed elevated CA-125 levels before starting TB treatment. Therefore, CA-125 may be useful for prognostic purposes in these patients.
Resumen Introducción. El diagnóstico de la tuberculosis extrapulmonar (TBEP) es un reto para los médicos. Se ha sugerido que el antígeno del cáncer 125 (CA-125), producido por las células mesoteliales, puede ser un biomarcador diagnóstico de TBEP. Objetivo. Describir el comportamiento de los niveles séricos del CA-125 en pacientes con tuberculosis (TB) atendidos en un hospital de referencia de Cali, Colombia. Materiales y métodos. Estudio transversal realizado en 99 pacientes con TB y mediciones de CA-125 (U/mL) antes de iniciar tratamiento para TB atendidos en la Fundación Valle del Lili entre 2007 y 2016. Los casos se clasificaron como TB pulmonar (TBP) (n=33) o TBEP (n=66). Se realizó un análisis bivariado para comparar las variables de interés (datos sociodemográficos, clínicos y de laboratorio) entre los grupos TBEP y TBP, y para determinar diferencias entre pacientes con resultados positivos y negativos para CA-125 en relación con la mortalidad. Resultados. Se reportaron niveles elevados de CA-125 en 55 pacientes (55.56%). Los resultados positivos para CA-125 (>35 U/mL) fueron más frecuentes en el grupo TBEP (59.0% vs. 48.48%). En el grupo TBEP se encontraron resultados positivos en los casos de serositis tuberculosa (100% TB pericárdica, 68.42% TB peritoneal y 66.66% TB pleural), y en 66.66% de los casos de TB miliar y vertebral, respectivamente. Además, se reportaron 15 muertes relacionadas con la infección por TB en el período de seguimiento (n=66), de las cuales 13 tuvieron un resultado positivo para CA-125, encontrando una diferencia significativa con aquellas con resultados negativos (p=0.021); sin embargo, el 47.05% de los pacientes supervivientes también tuvo un resultado positivo. Conclusiones: La mayoría de los casos de serositis tuberculosa, TB miliar y vertebral tuvieron niveles elevados de CA-125 antes de iniciar el tratamiento de la TB. El CA-125 puede resultar útil para fines de pronóstico en estos pacientes.
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Resumen El síndrome de Meigs (SM) es la asociación de ascitis, derrame pleural y neoplasias ovárica benigna, en el pseudo-Meigs se agrega CA-125 elevado. Presentamos el caso de una mujer de 67 años con masa anexial derecha, marcadores tumorales negativos. Se realiza ooforectomía, reportan cistoadenofibroma seroso. Doce semanas posteriores con distensión abdominal, pérdida de peso, tomografía abdominal con carcinomatosis peritoneal, antígeno CA-125 de 1,063.4 U/l. Segunda visión laparoscopia, sin neoplasia, corroborada por histopatología. Realizar un diagnóstico de SM es sencillo, no así cuando se presenta un caso atípico de pseudo-Meigs. Los artículos mencionan mejoría significativa posterior al manejo quirúrgico.
Abstract Meigs syndrome (MS) is the association of ascites, pleural effusion and benign ovarian neoplasms, the pseudo-Meigs (PMS) adds elevated CA-125. We present the case of a 67-year-old female with a right adnexal mass, negative tumor markers, performed ororectomy reported serous cystadenofibroma. 12 weeks later with abdominal distension, weight loss, abdominal tomography with peritoneal carcinomatosis, CA -125 antigen of 1063.4U/L. Second laparoscopic view, without neoplasia, corroborated by histopathology. Making a diagnosis of MS is simple, but not when an atypical case of Pseudo-Meigs is presented. The articles mention significant improvement after surgical management.
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Objective:To explore the different coagulation state in patients with adenomyosis and its clinical significance.Methods:Clinical data of the patients admitted to the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2021 were retrospectively analyzed. (1) Differential coagulation state between 25 healthy women and 25 patients with adenomyosis were compared during menstrual and non-menstrual periods. (2) The coagulation indexes of 145 patients with adenomyosis (observation group 1) and 129 patients with cervical intraepithelial neoplasia grade Ⅲ (control group 1) who underwent hysterectomy in non-menstrual period were compared. (3) The coagulation indexes of 154 patients with adenomyosis (observation group 2) and 147 women without myometrial lesions (control group 2) who underwent endometrial curettage during uterine bleeding period were compared. (4) Correlations of coagulation index with cancer antigen 125 (CA 125), cancer antigen 19-9 (CA 19-9) and uterine volume in patients with adenomyosis were analyzed. Results:(1) The coagulation state of each health women during the menstrual and non-menstrual period showed no significant differences (all P>0.05). For the 25 patients with adenomyosis, fibrinogen [FIB; 2.61 g/L(2.50-3.10 g/L)] and D-dimer [0.60 mg/L (0.40-1.00 mg/L)] in the menstrual period were significantly higher than those in the non-menstrual period [2.25 g/L (1.90-2.70 g/L) and 0.27 mg/L (0.20-0.40 mg/L), respectively; both P<0.01], while thrombin time [TT; 16.70 s (16.10-17.40 s)] in the menstrual period was significantly lower than that in the non-menstrual period [17.95 s (17.20-18.40 s); P<0.01]. (2) In the non-bleeding period, D-dimer [0.26 mg/L (0.20-0.40 mg/L)] and platelet count [257.0×10 9/L (212.0×10 9/L-308.5×10 9/L)] of observation group 1 were significantly higher than those of control group 1 (all P<0.01). Besides, FIB ( r=0.237, P=0.004) and D-dimer ( r=0.373, P<0.001) were positively correlated with CA 125, while prothrombin time (PT; r=-0.208, P=0.012) and internationalized normalized ratio of plasma prothrombin time (PT-INR; r=-0.201, P=0.015) were negatively correlated with CA 19-9. (3) In the bleeding period, PT [10.70 s (10.10-11.20 s)] and PT-INR [0.93 (0.90-1.00)] of observation group 2 were significantly lower than those of control group 2 (all P<0.01), while D-dimer [0.41 mg/L (0.20-0.80 mg/L)] was significantly higher than that in the control group 2 ( P<0.001). Furthermore, FIB ( r=0.252, P=0.038) and D-dimer ( r=0.321, P=0.008) were positively correlated with uterine volume, while activated partial thromboplastin time (APTT; r=-0.190, P=0.018) and TT ( r=-0.304, P=0.012) were negatively correlated with uterine volume. (4) During non-menstrual period and uterine bleeding period, APTT and TT in patients of observation group 1 and 2 combined with anemia were significantly lower than those of non-anemia patients (all P<0.05). Conclusion:Patients with adenomyosis have a tendency to hypercoagulability in both the uterine bleeding and non-bleeding periods, which may be related to enlarged uterine volume, increased serum CA 125 and anemia.
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Resumen ANTECEDENTES: Una masa anexial es una prominencia de localización cercana, o relacionada con los órganos reproductores femeninos y sus tejidos circundantes. En la práctica clínica, las masas anexiales representan un dilema en cuanto a su diagnóstico y tratamiento. El diagnóstico suele ser fortuito, luego de un hallazgo en el examen ginecológico o en estudios de imagen. CASO CLÍNICO: Paciente de 29 años, con antecedentes de tres embarazos, dos partos y un aborto, sin comorbilidades asociadas. El último parto se registró en enero del 2021. Acudió a consulta debido a un cuadro de dolor en la parte inferior del abdomen, tipo cólico, de intensidad progresiva 7/10 en la escala visual análoga, irradiado a la zona lumbar, asociado con episodios eméticos, sin ningún otro síntoma, de una semana de evolución. Al ingreso a Urgencias sus condiciones generales se estimaron aceptables: hidratada, álgica, sin alteraciones cardiacas ni pulmonares, sin afectación neurológica ni adenopatías. CONCLUSIONES: Es importante individualizar cada caso, determinar las características ecográficas y llevar a cabo un tratamiento escalonado conforme a la respuesta clínica de las pacientes. La bibliografía y este reporte comprueban la utilidad de los nuevos índices propuestos por la IOTA para el cálculo del riesgo de malignidad de masas complejas anexiales. En este reporte de caso se logra observar una correcta relación entre la sospecha preoperatoria y el desenlace histológico final.
Abstract BACKGROUND: An adnexal mass is a prominence of location close to, or related to, the female reproductive organs and their surrounding tissues. In clinical practice, adnexal masses represent a diagnostic and treatment dilemma. Diagnosis is usually fortuitous, following a finding on gynecological examination or imaging studies. CLINICAL CASE: 29-year-old patient, with a history of three pregnancies, two deliveries and one miscarriage, with no associated comorbidities. The last delivery was recorded in January 2021. She came for consultation due to a picture of pain in the lower abdomen, colic type, of progressive intensity 7/10 on the visual analog scale, radiating to the lumbar area, associated with emetic episodes, without any other symptoms, of one week of evolution. On admission to the emergency department, her general condition was considered acceptable: hydrated, energetic, without no cardiac or pulmonary alterations, without neurological involvement or lymphadenopathies. CONCLUSIONS: It is important to individualize each case, determine the ultrasound characteristics and carry out a stepwise treatment according to the clinical response of the patients. The literature and this report prove the usefulness of the new indexes proposed by IOTA for the calculation of the risk of malignancy of complex adnexal masses. In this case report a correct relationship between preoperative suspicion and final histologic outcome is observed.
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Resumen OBJETIVO: Evaluar el rendimiento diagnóstico de cuatro índices de riesgo de malignidad (IRM) en la predicción de riesgo de cáncer de ovario. MATERIALES Y MÉTODOS: Estudio comparativo y retrospectivo efectuado en pacientes mayores de 18 años con tumor anexial atendidas en el Hospital Christus Muguerza Conchita y Alta Especialidad del 2016 al 2021. Para evaluar el rendimiento diagnóstico de cada índice se utilizó la curva ROC y el índice de Youden para la obtención de sensibilidad y especificidad. RESULTADOS: Se incluyeron 330 pacientes con media de edad de 38 años. Para el IRM1 una S 73.9% y E de 85.3% con punto de corte en 126; IRM2 el mejor punto de corte se estableció en 210, con una S 72.5% y E de 89.3%; IRM3 el mejor punto de corte se estableció en 125, con una S 73.9% y E 85.8%; y para el IRM4 el punto de corte fue 436, con una S 68.1% y E 89.7%. CONCLUSIONES: El IRM es un método fácil, de bajo costo y accesible para la discriminación de pacientes con probable masa anexial maligna. En la población mexicana del noreste de México puede recomendarse la aplicación de cualquiera de los índices.
Abstract OBJECTIVE: Compare the diagnostic performance of four malignancy risk indices in predicting ovarian risk at Hospital Christus Muguerza Conchita and Alta Especialidad. MATERIALS AND METHODS: Retrospective study including clinical records of patients older than 18 years with adnexal tumor treated at the Christus Muguerza Conchita and Alta Especialidad Hospital from 2016 to 2021. The ROC curve was used to evaluate the diagnostic performance of each index, through the obtaining the best cut-off point with the highest sensitivity and specificity from the Youden index. RESULTS: A total of 330 patients were included for the adnexal tumor assessment approach. The mean age of the patients was 38.8 years. For IRM1 an S 81.2% and E of 69.3% with a cut-off point at 126; IRM2 the best cut-off point was established at 210, with an S 72.5% and E of 89.3%; IRM3 the best cut-off point was established at 125, with an S 73.9% and E 85.8%; and for IRM4 the cut-off point was 436, with an S 68.1% and E 89.7%. CONCLUSIONS: MRI is an easy, low-cost and accessible method for the discrimination of patients with probable malignant adnexal mass. The use of any of the indices can be recommended in the Mexican population of northeastern Mexico.
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Introducción: Los tumores benignos de ovario corresponden a un 60-95% de las lesiones anexiales, en edad fértil los más frecuentes corresponden a quistes foliculares y endometriomas. Sin embargo, alrededor del 15% son patología maligna de ovario. Por lo que se debe evaluar aspectos como edad, características ecográficas y la presencia de marcadores tumorales específicos como CA 125. Objetivo general: Describir un reporte de caso y caracterizar la evidencia disponible sobre el abordaje de tumores benignos de ovario. Caso Clínico: Se presenta el caso clínico de una paciente en edad fértil de 43 años, cursando con dolor abdominal asociado a masa anexial, donde destaca la elevación del marcador CA 125 en rango de malignidad, por lo que se solicita valoración por oncología y manejo quirúrgico, confirmándose una masa anexial benigna de características quísticas, sugerente de endometrioma, al descartar patología maligna se realiza quistectomía total. Discusión: La patología anexial es una entidad clínica que puede abarcar características tumorales, ya sean benignas como malignas, por ello frente a lesiones ováricas, siempre se deben descartar estas últimas. Las características ecográficas de la paciente hacían sospechar de un endometrioma, el CA 125 elevado en ella hizo que se optara por un manejo quirúrgico oncológico con biopsia rápida para descartar o confirmar malignidad. Conclusión: Ante la presencia de endometriomas, el tratamiento debe discutirse caso a caso, teniendo en cuenta la sintomatología, deseos de fertilidad futura y tamaño de las lesiones.
Introduction: Benign ovarian tumors correspond to 60-95% of adnexal lesions, in childbearing years the most frequent correspond to follicular cysts and endometriomas. However, about 15% are malignant ovarian pathology. Therefore, aspects such as age, ultrasound characteristics and the presence of specific tumor markers such as CA 125 must be evaluated. General objective: Describe a case report and characterize the available evidence on benign ovarian tumors. Case report: A case of a 43 year old female of childbearing age, presents abdominal pain associated with an adnexal mass, where CA 125 elevations are found in the range of malignancy, for which an oncology evaluation and surgical management. A benign adnexal mass with cystic characteristics is confirmed, suggestive of endometrioma, when malignant pathology is ruled out, a total cystectomy is performed. Discussion: Adnexal pathology is a clinical entity that can include tumor characteristicas, whether benign or malignant, therefore, in the face of ovarian lesions, these should always be ruled out. The sonographic characteristics of the patient made one suspect an endometrioma, the elevated CA 125 in it led to an oncological surgical management with rapid biopsy to rule out or confirm malignancy. Conclusions: In the presence of endometriomas, treatmentshould be discussed individually, taking into account the symptoms, wishes for future fertility, and size of the lesions. Keywords: Ca-125 antigen, Endometriosis, Ovarian neoplasms
Subject(s)
Humans , Female , Adult , Ovarian Neoplasms/diagnostic imaging , CA-125 Antigen/blood , Endometriosis/diagnostic imaging , Ovarian Neoplasms/surgery , Magnetic Resonance Spectroscopy , Adnexal Diseases , UltrasonographyABSTRACT
Abstract Introduction: Progressive structural changes in the peritoneal membrane occur over the course of treatment in peritoneal dialysis (PD), resulting in an increase in cytokines such as CCL2 and structural changes in peritoneal membrane triggering an increase in CA-125 in dialysate, which reflects a probable local inflammatory process, with possible loss of mesothelial cells. Thus, the current study aimed to evaluate the association between plasma and CCL2 and CA-125 dialysate levels in patients undergoing PD. Methods: Cross-sectional study was conducted with 41 patients undergoing PD. The assessments of CA-125 and CCL2 levels were performed using a capture ELISA. Correlations were estimated using Spearman's correlation and the investigation of the association between the explanatory variables (CCL2) and response variable (CA-125) was done for crude ratio of arithmetic means and adjusted utilizing generalized linear models. Results: A moderate positive correlation was observed between the levels of CA-125 and CCL2 in the dialysate (rho = 0.696). A statistically significant association was found between the levels in the CCL2 and CA-125 dialysate (RoM=1.31; CI = 1.20-1.43), which remained after adjustment for age (RoM = 1.31; CI=1.19-1.44) and for time in months of PD (RoM=1.34, CI=1.22-1.48). Conclusion: The association of CA-125 levels with CCL2 in the dialysate may indicate that the local inflammatory process leads to temporary or definitive changes in peritoneal membrane. A better understanding of this pathogenesis could contribute to the discovery of new inflammatory biomarkers.
Resumo Introdução: Alterações estruturais progressivas na membrana peritoneal ocorrem no decorrer do tratamento em diálise peritoneal (DP), resultando em um aumento de citocinas como CCL2 e alterações estruturais na membrana peritoneal desencadeando um aumento de CA-125 no dialisato, o que reflete um provável processo inflamatório local, com possível perda de células mesoteliais. Assim, o presente estudo teve como objetivo avaliar a associação entre CCL2 e CA-125 no plasma e no dialisato de pacientes submetidos à DP. Métodos: Foi realizado um estudo transversal com 41 pacientes submetidos à DP. As avaliações dos níveis de CA-125 e CCL2 foram realizadas utilizando ELISA de captura. As correlações foram estimadas usando a correlação de Spearman, e a investigação da associação entre as variáveis explicativas (CCL2) e a variável resposta (CA-125) foi feita pela razão bruta das médias aritméticas e ajustada utilizando modelos lineares generalizados. Resultados: Foi observada uma correlação positiva moderada entre os níveis de CA-125 e CCL2 no dialisato (rho = 0,696). Foi encontrada uma associação estatisticamente significativa entre os níveis no dialisato de CCL2 e CA-125 (RoM=1,31; IC = 1,20-1,43), que permaneceu após ajuste por idade (RoM = 1,31; IC=1,19-1,44) e pelo tempo de DP em meses (RoM=1,34, IC=1,22-1,48). Conclusão: A associação dos níveis de CA-125 com CCL2 no dialisato pode indicar que o processo inflamatório local leva a alterações temporárias ou definitivas na membrana peritoneal. Uma melhor compreensão desta patogênese pode contribuir para a descoberta de novos biomarcadores inflamatórios.
Subject(s)
Humans , Infant , Peritoneal Dialysis , CA-125 Antigen/blood , Chemokine CCL2/blood , Peritoneum , Dialysis Solutions , Cross-Sectional Studies , Inflammation , Membrane ProteinsABSTRACT
RESUMEN Definimos síndrome de Meigs como la triada de tumor ovárico benigno, derrame pleural y ascitis, una condición clínica rara que se resuelve con la resección del tumor. Estas mismas características pueden presentarse en el síndrome de pseudoMeigs que se asocia a tumores malignos, que agregan un aumento importante de los niveles del marcador CA-125. Es conocido por muchos años, pero su fisiopatología aún no está clara. Se presenta un caso de síndrome pseudo-Meigs y se hace una breve revisión bibliográfica de sus características más importantes.
ABSTRACT Meigs' syndrome is defined as the triad of benign ovarian tumor, pleural effusion and ascites, a rare clinical condition that is treated with tumor resection. Same characteristics may occur in cases of malignant tumors, that add a notable increase in antigen CA-125 serum levels, constituting the pseudo-Meigs syndrome. They have been known for many years, but their pathophysiology remains unclear. We report the case of a pseudo-Meigs syndrome, and a brief bibliography review of the most important characteristics of these syndromes is performed.
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SUMMARY OBJECTIVE To relate disease-free survival and overall survival with type I and type II ovarian cancer and preoperative laboratory parameters biomarkers. METHODS A retrospective study was carried out based on the collection of data from medical records of patients with ovarian tumors. Kaplan-Mayer curves were drawn based on the statistical analysis of the data and were compared using the Log-rank test. RESULTS Disease-free survival in type I ovarian cancer was significantly higher than in type II (p=0.0013), as well as in those with normal levels of CA-125 (p=0.0243) and with a platelet-lymphocyte ratio (PLR) lower than 200 (p=0.0038). The overall survival of patients with type I ovarian cancer was significantly higher than in patients with type II, as well as in patients with normal CA-125 serum levels (p=0.0039) and those with a preoperative fasting glucose of less than 100 mg/dL. CONCLUSION CA-125 levels may predict greater overall and disease-free survival. PLR < 200 may suggest greater disease-free survival, whereas normal fasting glucose may suggest greater overall survival.
RESUMO OBJETIVO Relacionar a sobrevida livre de doença e sobrevida global com câncer de ovário tipos I e II, assim como com parâmetros laboratoriais pré-operatórios biomarcadores. MÉTODOS Estudo retrospectivo realizado com base na coleta de dados de prontuários de pacientes com tumor ovariano. As curvas de Kaplan-Mayer foram realizadas em relação à análise estatística dos dados, sendo comparadas pelo teste de Log-rank. RESULTADOS A sobrevida livre de doença nas pacientes com câncer de ovário tipo I foi significativamente maior do que nas pacientes com câncer de ovário tipo II (p = 0,0013), bem como maior naquelas com níveis normais de CA-125 (p = 0,0243) e com relação plaquetas-linfócitos (RPL) inferior a 200 (p = 0,0038). A sobrevida global de pacientes com câncer de ovário tipo I foi significativamente maior do que em pacientes com tipo II, maior em pacientes com níveis séricos normais de CA-125 (p = 0,0039) e naquelas com glicemia de jejum pré-operatória menor que 100 mg / dL. CONCLUSÃO Os níveis de CA-125 podem predizer uma sobrevida global e livre de doença. A RPL < 200 pode sugerir uma maior sobrevida livre de doença, enquanto uma glicemia normal de jejum, uma maior sobrevida global.
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Humans , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Ovarian Neoplasms/mortality , Ovarian Neoplasms/blood , Ovarian Neoplasms/pathology , Platelet Count , Reference Values , Biomarkers, Tumor/blood , Predictive Value of Tests , Retrospective Studies , Lymphocyte Count , Disease-Free Survival , CA-125 Antigen/blood , Kaplan-Meier Estimate , Preoperative Period , Middle Aged , NeutrophilsABSTRACT
@#Introduction: Endometrial carcinoma is the most common gynaecological malignancy in developed countries and the sixth most common cancer among women worldwide. Cancer staging is vital in treatment decisions and the prediction of prognoses, and is based on imaging studies, histological results and surgery. Therefore, a simple and fast preoperative tool to predict the precise cancer stage of patients is needed. CA 125, a cancer antigen, is used in assessing therapeutic response and cancer surveillance in endometrial carcinoma. However, this tumour marker is not routinely performed in the mentioned circumstances. Studies have shown that preoperative CA 125 was significantly high in patients in a higher stage of endometrial cancer. Thus, this study aims to assess the primary role of CA 125 in predicting the stage of endometrial carcinoma, by correlating preoperative serum CA 125 with clinicopathological parameters. Method: The retrospective data of endometrial carcinoma cases consisting of demographic and clinicopathological parameters as well as preoperative serum CA 125 levels were retrieved from Laboratories Information System (LIS) at Hospital Selayang, Selangor, Malaysia, from January 2000 until June 2016. Only 20 cases fulfilled the inclusion and exclusion criteria. Preoperative serum CA 125 was correlated with demographic and clinicopathological parameters, and was analysed using a Kruskal-Wallis test. Results: There was a significant association between elevated serum CA 125 with myometrial and cervical stroma invasion in endometrial carcinoma (p<0.05). Conclusion: Preoperative serum CA 125 is a useful marker in predicting early stages of endometrial carcinoma, and plays a role in pre-operative cancer staging in endometrial carcinoma.
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Objective To compare the clinical significance of human epididymis protein 4(HE4),CA125, ROMA in the differential diagnosis of ovarian cancer.Methods From May 2016 to October 2017,240 patients with ovarian tumor in Xuzhou Cancer Hospital were selected .According to the result of postoperative pathology ,the patients were divided into benign ovarian disease group ( n =120 ) and ovarian cancer group ( n =120 ) .And 100 healthy women from medical examination center were selected as control group .The electrochemiluminescence ( ECLIA ) technique was used to assess the serum levels of CA 125,HE4,and ROMA was calculated .The clinical significance of HE4,CA125,ROMA in the differential diagnosis of ovarian cancer was analyzed by statistic methods .Results The CA125,HE4 concentrations and ROMA in the ovarian cancer group [(370.9 ±213.2) U/mL,(364.4 ±227.0) pmpl/L, (80.2 ±26.1)％] were higher than those in the benign ovarian disease group and the health control group ( all P<0.01),there were no statistically significant differences between the benign ovarian disease group and the healthy control group(P=0.356,P=0.321,P=0.292).The sensitivity,specificity,positive and negative predictive values , accuracy of ROMA were higher than those of HE 4 and CA125.By using the ROC analysis ,the AUC for CA125,HE4, ROMA were 0.832,0.888,0.960,respectively,AUC(CA125) <AUC(HE4) <AUC(ROMA).Conclusion CA125 and HE4 have important value in the diagnosis of ovarian cancer ,but the ROMA shows the best diagnostic performance and actual value .
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Objective@#To compare the clinical significance of human epididymis protein 4(HE4), CA125, ROMA in the differential diagnosis of ovarian cancer.@*Methods@#From May 2016 to October 2017, 240 patients with ovarian tumor in Xuzhou Cancer Hospital were selected.According to the result of postoperative pathology, the patients were divided into benign ovarian disease group(n=120) and ovarian cancer group(n=120). And 100 healthy women from medical examination center were selected as control group.The electrochemiluminescence (ECLIA) technique was used to assess the serum levels of CA125, HE4, and ROMA was calculated.The clinical significance of HE4, CA125, ROMA in the differential diagnosis of ovarian cancer was analyzed by statistic methods.@*Results@#The CA125, HE4 concentrations and ROMA in the ovarian cancer group[(370.9±213.2)U/mL, (364.4±227.0)pmpl/L, (80.2±26.1)%]were higher than those in the benign ovarian disease group and the health control group(all P<0.01), there were no statistically significant differences between the benign ovarian disease group and the healthy control group(P=0.356, P=0.321, P=0.292). The sensitivity, specificity, positive and negative predictive values, accuracy of ROMA were higher than those of HE4 and CA125.By using the ROC analysis, the AUC for CA125, HE4, ROMA were 0.832, 0.888, 0.960, respectively, AUC(CA125)<AUC(HE4)<AUC(ROMA).@*Conclusion@#CA125 and HE4 have important value in the diagnosis of ovarian cancer, but the ROMA shows the best diagnostic performance and actual value.
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Carbohydrate antigen 125 (CA125) has long been used as an ovarian cancer biomarker. However, because it is not specific for ovarian cells, CA125 could also be used to monitor congestion and inflammation in heart disease. Acute heart failure (HF) is used to identify patients with a worse prognosis in ST-segment elevation myocardial infarction (STEMI). We aimed to determine the association of CA125 with acute HF in STEMI and to compare CA125 with N-terminal pro brain natriuretic peptide (NTproBNP) with a cross-sectional study. At admission, patients were examined to define Killip class and then underwent coronary angioplasty. Blood samples, preferably taken in the hemodynamic ward, were centrifuged (1500 g for 15 min at ambient temperature) and stored at −80°C until biomarker assays were performed. Patients were divided into two groups according to the presence or absence of congestion. Patients in Killip class ≥II were in the congestion group and those with Killip <II in the absence of congestion group. We evaluated 231 patients. The mean age was 63.3 years. HF at admission was identified in 17.7% of patients. CA125 and NTproBNP levels were higher in patients with Killip class ≥II than those with Killip class <II (8.03 vs 9.17, P=0.016 and 772.45 vs 1925, P=0.007, respectively). The area under the receiver operator characteristic curve was 0.60 (95%CI 0.53−0.66, P=0.024) for CA125 and 0.63 (95%CI 0.56−0.69, P=0.001) for NTproBNP. There was no statistical difference between the curves (P=0.69). CA125 has similar use to NTproBNP in identifying acute HF in patients presenting with STEMI.
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Humans , Male , Female , Middle Aged , Aged , Pulmonary Edema/etiology , CA-125 Antigen/blood , ST Elevation Myocardial Infarction/complications , Pulmonary Edema/diagnosis , Pulmonary Edema/blood , Biomarkers/blood , Cross-Sectional Studies , Predictive Value of Tests , Risk Factors , ROC Curve , ST Elevation Myocardial InfarctionABSTRACT
ObjectiveTo investigate the correlation between serum CA125 level and the severity of liver dysfunction in patients with liver cirrhosis. MethodsWanfang Data, CNKI, CBM, and VIP were searched for Chinese articles on the correlation between serum CA125 level and the severity of liver dysfunction in patients with liver cirrhosis published from January, 2008 to October, 2018, with a liver cirrhosis group and a normal control group in each article. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used for quality assessment. The mean and standard deviation of CA125 in liver cirrhosis group, healthy control group, and liver cirrhosis groups with different Child-Pugh classes were analyzed. Meta-Analyst software was used to calculate the standardized mean deviation (SMD) of CA125 in each group and perform the meta-analysis. A heterogeneity analysis was performed for the studies included in this study; a random effects model was used in case of significant heterogeneity, while a fixed effect model was used in case of insignificant heterogeneity. A one-way analysis of variance was used for comparison of continuous data between multiple groups. ResultsA total of 15 articles were included in this study. The meta-analysis showed that the liver cirrhosis group had a significantly higher serum CA125 level than the healthy control group (181.18±110.76 U/ml vs 15.10±7.15 U/ml, SMD=2.28, 95% confidence interval: 1.81-2.76, P＜0.001). The level of CA125 increased significantly with the increase in Child-Pugh class (F=15.704, P＜0.001). ConclusionSerum CA125 level is correlated with the severity of liver dysfunction in patients with liver cirrhosis and thus has a certain value in evaluating the severity of liver dysfunction and predicting prognosis.
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Objective To investigate the predictive value of serum brain-derived neurotrophic factor (BDNF) and cancer antigen 125 (CA125) in the diagnosis and prognosis of coronary heart disease (CHD). Methods One hundred and forty-three patients with CHD in Sinopharm Dongfeng General Hospital from June 2015 to June 2016 were selected. The patients were divided into single-vessel disease group (28 cases), double-vessel disease group (89 cases) and three-vessel disease (26 cases) according to the results of coronary angiography; the end point of follow-up was 2 years after discharge, and the patients were divided into survival group (126 cases) and death group (17 cases). The serum levels of BDNF and CA125 were measured by enzyme-linked immunosorbent assay. The relationship between serum BDNF, CA125 and clinical data, modified Gensini score, prognosis were analyzed. Results The modified Gensini score, BDNF and CA125 in single-vessel disease group were significantly lower than those in double-vessel disease group and three-vessel disease group: (21.84 ± 26.56) scores vs. (84.47 ± 86.28) and (142.37 ± 58.08) scores, (787.47 ± 124.29) μg/L vs. (888.44 ± 137.21) and (1131.77 ± 145.80) μg/L, (36.94 ± 11.80) kU/L vs. (79.11 ± 14.22) and (97.74 ± 15.43) kU/L, the indexes in double-vessel disease group were significantly lower than those in three-vessel disease group, and there were statistical differences (P＜0.05). Pearson analysis result showed that the BDNF and CA125 had positive correlation with modified Gensini score in patients with CHD (r = 0.210 and 0.397, P = 0.012 and 0.000). The BDNF and CA125 in death group were significantly higher than those in survival group:(1 093.59 ± 144.69) μg/L vs. (888.53 ± 164.43) μg/L and (93.93 ± 18.89) kU/L vs. (71.58 ± 23.62) kU/L, and there were statistical differences (P＜0.01). Logistic regression analysis result showed that BDNF and CA125 were the independent risk factors of death within 2 years in patients with CHD ( OR=1.005 and 1.035, 95% CI 1.002 to 1.009 and 1.001 to 1.070, P = 0.005 and 0.044). Receiver operating characteristic curve analysis result showed that the area under curve (AUC) of BDNF for predicting CHD prognosis was 0.827, Yoden index was 0.652, and the best diagnostic value was 999.72 μg/L; the AUC of CA125 for predicting CHD prognosis was 0.783, Yoden index was 0.503, and the best diagnostic value was 87.34 kU/L. The AUC of BDNF combined with CA125 for predicting CHD prognosis was 0.847, and Yoden index was 0.633. Conclusions The levels of BDNF and CA125 are positively correlated with the Gensini score, which could reflect the severity of CHD to some extent. The BDNF and CA125 levels have higher prognostic efficacy for predicting CHD, and the combined efficacy of the two is higher.
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OBJECTIVE: To identify the power of tumor markers for predicting ovarian cancer according to menopausal status. METHODS: The medical records of 876 women with ovarian cysts were retrospectively reviewed. Cancer antigen 125 (CA 125), human epididymis protein 4 (HE4), and Risk of Ovarian Malignancy Algorithm (ROMA) were analyzed. Sensitivity, specificity, and the receiver operating characteristic (ROC) curve analyses of these tumor markers were evaluated. RESULTS: The sensitivity of ROMA was 66.7% and the specificity was 86.8% to detect ovarian malignancy. The patients were divided into 2 groups according to menopausal status: premenopause (n=532, 60.7%) and postmenopause (n=344, 39.3%). For diagnostic accuracy, ROMA was lower than HE4 in premenopausal women (82.7% vs. 91.4%) and lower than CA 125 in postmenopausal women (86.9% vs. 88.7%). The ROC curve analysis revealed that the power of ROMA was not significantly better than that of HE4 in premenopausal women (area under the curve [AUC], 0.731 vs. 0.732, p=0.832), and it was also not significantly better than that of CA 125 in postmenopausal women (AUC, 0.871 vs. 0.888, p=0.440). CONCLUSION: The discrimination power of tumor markers for ovarian cancer was different according to menopausal status. In predicting ovarian malignancy, ROMA was neither superior to HE4 in premenopausal women nor superior to CA 125 in postmenopausal women.
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Female , Humans , Male , Biomarkers, Tumor , CA-125 Antigen , Discrimination, Psychological , Epididymis , Medical Records , Menopause , Ovarian Cysts , Ovarian Neoplasms , Postmenopause , Premenopause , Retrospective Studies , ROC Curve , Rome , Sensitivity and SpecificityABSTRACT
OBJECTIVES: In our institutional experience, involved-field radiation therapy (IFRT) yields favorable outcomes in patients with recurrent epithelial ovarian cancer (EOC). This retrospective study aimed to investigate the clinical benefits of IFRT in this patient population. METHODS: Among patients treated with IFRT for recurrent EOC between 2010 and 2017, 61 patients with 90 treatments were included. IFRT encompassed all treatable lesions identified via imaging studies with 10–15-mm margins. Prescribed doses were ≥45 Gy (equivalent dose in 2 Gy/fraction). RESULTS: Patients were followed up for a median of 19.0 (Interquartile range, 8.6–34.9) months after IFRT. The 2-year in-field control, progression-free survival, and overall survival (OS) rates were 42.7%, 24.2%, and 78.9%, respectively. Fifty-three IFRT sessions (58.9%) were followed by systemic chemotherapy, and the median chemotherapy-free interval (CFI) was 10.5 (95% confidence interval=7.3–13.7) months. A higher carbohydrate antigen-125 (CA-125) level correlated with a worse 2-year OS (69.2% vs. 91.0%; p=0.001) and shorter median CFI (4.7 vs. 11.9 months; p12 months. For patients with a normal CA-125 level and/or platinum-sensitive tumor, IFRT prolonged CFI regardless of pre-existing carcinomatosis, gross tumor volume, and number of treatment sites. CONCLUSION: Our early experience demonstrates the safety and feasibility of IFRT as an effective salvage therapy and enables a “chemotherapy holiday” in selected recurrent EOC settings. The CA-125 value before IFRT (within normal range) and/or platinum sensitivity could be used as selection criteria for IFRT.
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Humans , CA-125 Antigen , Carcinoma , Disease-Free Survival , Drug Therapy , Ovarian Neoplasms , Patient Selection , Platinum , Retrospective Studies , Salvage Therapy , Tumor BurdenABSTRACT
OBJECTIVES: The global obesity epidemic has great impact on the prevalence of low-grade endometrial carcinoma. The preoperative tumor serum marker cancer antigen 125 (CA-125) might contribute to improved identification of high-risk patients within this group. The study aimed to investigate the prognostic value of CA-125 in relation to established preoperative prognosticators, with a focus on identifying patients with poor outcome in low-grade endometrial carcinoma (EC) patients. METHODS: Prospective multicenter cohort study including all consecutive patients surgically treated for endometrial carcinoma in nine collaborating hospitals from September 2011 until December 2013. All preoperative histopathological diagnoses were reviewed in a blinded manner. Associations between CA-125 and clinicopathological features were determined. Univariable and multivariable analysis by Cox regression were used. Separate analyses were performed for preoperatively designated low-grade and high-grade endometrial carcinoma patients. RESULTS: A total of 333 patients were analyzed. CA-125 was associated with poor prognostic features including advanced International Federation of Gynecology and Obstetrics (FIGO) stage. In multivariable analysis, age, preoperative tumor and CA-125 were significantly associated with disease-free survival (DFS); preoperative grade, tumor type, FIGO and CA-125 were significantly associated with disease-specific survival (DSS). Low-grade EC patients with elevated CA-125 revealed a DFS of 80.6% and DSS of 87.1%, compared to 92.1% and 97.2% in low-grade EC patients with normal CA-125. CONCLUSION: Preoperative elevated CA-125 was associated with poor prognostic features and independently associated with DFS and DSS. Particularly patients with low-grade EC and elevated CA-125 represent a group with poor outcome and should be considered as high-risk endometrial carcinoma.
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Female , Humans , Biomarkers , CA-125 Antigen , Cohort Studies , Diagnosis , Disease-Free Survival , Endometrial Neoplasms , Gynecology , Obesity , Obstetrics , Prevalence , Prospective StudiesABSTRACT
OBJECTIVE: To 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. METHODS: A retrospective chart review of all stage III and IV ovarian, fallopian tube, and peritoneal cancer patients treated with NAC in 2007–2016 was conducted. RESULTS: About 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. CONCLUSIONS: Administering 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.