The trend of serum CA125 levels during the first three courses of chemotherapy as a predictor of second-look findings in patients with ovarian carcinoma.

The serum CA125 levels were monitored monthly in a group of 20 patients with ovarian carcinoma undergoing a six-month chemotherapy cycle. None of the 8 patients with serum CA125 levels higher than 65 U/ml before the third course of chemotherapy had negative second-look findings at the end of chemotherapy. Conversely, no evidence of disease at surgical re-evaluation was found in 9 out of 12 (75%) patients with antigen levels lower than 65 U/ml before the third chemotherapy course; on the other hand, none of the 4 patients of this group in whom serum CA125 values fell below 65 U/ml only after the third course, achieved a complete surgical response. Among the 9 patients in whom second-look surgery documented a complete response, 8 had CA125 levels below 35 U/ml and one had CA125 values above 35 U/ml but lower than 65 U/ml at the three-month check-point. These data suggest that the trend of serum CA125 levels during the first three courses of chemotherapy is a strong predictor of second-look findings in patients with ovarian carcinoma at the completion of treatment.

The association of ultrasonography and CA-125 test in the preoperative evaluation of ovarian carcinoma.

The aim of this study was to verify the role of the association of pelvic ultrasonography and CA-125 assay in the preoperative evaluation of ovarian carcinoma. The Authors examined 119 patients undergoing laparotomy for adnexal masses. Thirty-six had an ovarian carcinoma, the other 83 patients were affected by benign ovarian pathologies. Before surgery every patient underwent a pelvic ultrasonography. The data resulting from ultrasonography were processed on the basis of a personal scoring morphologic echostructural evaluation system. Furthermore in every patient the preoperative serum levels of CA-125 were measured. In the group of patients with ovarian carcinoma the ultrasonography score was greater than or equal to 10 in 26, while serum CA-125 was greater than or equal to 65 U/ml in 30 and greater than or equal to 35 U/ml in 31. In the group of patients with benign ovarian pathology the ultrasonography score was found to be greater than or equal to 10 in 2, while serum CA-125 was greater than or equal to 65 U/ml in 4 and greater than or equal to 35 U/ml in 20. Fixing 10 as reference value of ultrasonography score for ovarian carcinoma diagnosis, pelvic ultrasonography and a sensitivity of 72.2%, a specificity of 97.9%, a diagnostic accuracy of 89.9%. With a reference value of 65 U/ml CA-125 had a sensitivity of 83.3%, a specificity of 95.2%, a diagnostic accuracy of 91.9%. With a reference value of 35 U/ml CA-125 had a sensitivity of 86.1%, a specificity of 75.9%, a diagnostic accuracy of 79.0%.(ABSTRACT TRUNCATED AT 250 WORDS)

Preoperative evaluation of CA 125 and CA 19-9 serum levels in patients with ovarian masses.

Serum CA 125 and CA 19-9 were presurgically measured in 40 patients with ovarian carcinoma and in 108 with benign ovarian pathologies. The sensitivity for ovarian carcinoma of CA 125 (cut-off value = 65 U/ml) and CA 19-9 (cut-off value = 40 U/ml) were 67.5% and 37.5% respectively. In particular serum CA 125 was elevated in 71.9% of non-mucinous and in 50% of mucinous carcinomas, while serum CA 19-9 was high in 25% of non-mucinous and in 87.5% of mucinous malignancies. The correlation of CA 19-9 with mucinous histotype was significant. Elevated serum levels of CA 125 and CA 19-9 were observed respectively in 14.7% and in 13.8% of benign adnexal masses. The percentages of elevated serum marker levels were significantly higher in patients with ovarian carcinoma than in women bearing benign ovarian pathology (P less than 0.001 for CA 125; P less than 0.01 for CA 19-9). Serum CA 125 and CA 19-9 alone cannot clarify the nature of an adnexal mass. However, the measurement of serum levels of these markers could give additional information to other diagnostic methods, such as ultrasonography, for discriminating benign from malignant ovarian pathologies.

Correlation of CA125 and CA19-9 serum levels with clinical course and second-look findings in patients with ovarian carcinoma.

CA125 and CA19-9 levels were serially evaluated in blood samples from 21 patients during and after integrated surgical and chemotherapeutic treatment for ovarian carcinoma. Serial measurement of CA125 and CA19-9 correlated with clinical course of disease in 89.7 and 72.7% of instances, respectively. The decrease of serum CA125 and/or CA19-9 in the normal range at the end of chemotherapy does not exclude the presence of residual disease, which can be accurately evaluated only by second-look laparotomy. Serum CA125 and/or CA19-9 can raise some months before clinical and ultrasonographic detection of recurrence. CA125 is the most reliable marker in ovarian carcinoma; however, the concomitant measurement of CA19-9 could offer some benefit in the monitoring of patients with this neoplasia.

Combined evaluation of some tumor associated antigens in the monitoring of integrated surgical and chemotherapeutic treatment of epithelial ovarian cancer.

The authors measured the presurgical serum levels of some tumor associated antigens in 36 patients bearing primitive ovarian carcinoma and in 284 controls. Ca125, which has shown a sensitivity (SE) of 63.8% and a specificity (SP) of 92.6%, was elevated especially in serous and undifferentiated carcinomas, while Ca19-9 (SE = 33.3% and SP = 89.7%) and CEA (SE = 19.4% and SP = 96.4%) were more often pathological in mucinous ones. TPA (SE = 75.0% and SP = 81.3%) had no particular correlation with any histotype. Parallel assessment of Ca125 and Ca19-9 showed a SE = 83.3% and a SP = 83.8%. In patients with epithelial ovarian cancer, the circulating concentrations of tumor markers were periodically measured during and after chemotherapy. Ca125 levels correlated with the course of disease in 87.1% of instances, while Ca19-9 ones correlated in 72.2% and TPA ones in 78.6%. Constantly high concentrations of one or more markers during chemotherapy are indicative for unresponsiveness of cancer to cytostatic drugs. Serum levels of one or more tumor antigens elevated at diagnosis and in the normal range at the end of primary treatment can be associated both with a pathological complete regression and with a persistence of neoplastic disease at second look laparotomy. Considering the different sensitivity of every single marker in carcinomas of different histotype, the combined evaluation of multiple tumor associated antigens seems to offer the best information in the monitoring of epithelial ovarian cancer.

Second look laparotomy in the management of malignant epithelial ovarian neoplasias.

In the present study we examined 15 patients with malignant epithelial ovarian neoplasms who underwent primary surgery and chemotherapy at the Institute of Obstetric and Gynecologic Clinic of the University of Pisa between 1983 and 1985. At the time of diagnosis and monthly during chemotherapy plasma levels of CEA, CA 19-9, CA 125 and TPA were detected. At the end of pharmacological treatment a second-look laparotomy was performed in each patient to assess the status of cancer. At this time the clinical response was complete in 13 patients and partial in 2. These results were confirmed at second-look laparotomy in 11 of 13 cases of complete clinical remission and in 1 of the 2 cases of partial clinical remission. Two patients in complete clinical remission showed persistent disease. The other one in partial clinical remission was surgically found to have unmodified tumor. Tumoral markers, and especially CA 125, have a good correlation with the clinical course of the disease. However these tumor associated antigens cannot replace second-look laparotomy for assessing the response to cytostatic drugs. In fact patients with normal serum levels of these markers at the end of chemotherapy, were surgically found to have both complete pathological remission and persistent disease. Therefore we have come to the conclusion that the second-look laparotomy and the evaluation of tumor markers have to be performed together in the management of malignant ovarian neoplasms.