Preoperative D-dimer plasma assay is not a predictor of clinical outcome for patients with advanced ovarian cancer.

D-dimer (DD) plasma levels are significantly higher in patients with ovarian cancer than in those with benign ovarian masses. The aim of this paper is to assess whether preoperative DD plasma assay has a prognostic relevance for 35 patients with advanced ovarian cancer receiving platinum-based chemotherapy. Preoperative DD levels ranged from 162 to 3720 ng/ml. The 25, 50, and 75% quartiles of DD levels were 1600, 1894, and 2069 ng/ml, respectively. Preoperative DD levels correlated neither with the common clinicopathological prognostic variables nor with the disease status at the end of first-line chemotherapy. Survival was related to residual disease after initial surgery (> or =2 cm vs <2 cm, P = 0.003), but not to preoperative DD levels. In conclusion, the present data seem to show that preoperative DD plasma assay is not a predictor of clinical outcome for patients with advanced ovarian cancer.

Prothrombin fragment F1+2 and thrombin-antithrombin III complex (TAT) plasma levels in patients with gynecological cancer.

The pretreatment plasma levels of prothrombin fragment F1+2 and thrombin-antithrombin III complex (TAT) were measured in 56 consecutive patients with gynecological cancer and in 33 apparently healthy volunteer nonpregnant women as control. Prothrombin fragment F1+2 concentrations were significantly elevated in the 18 patients with ovarian cancer (median, 3.2 nmol/ liter; range, 0.9-17.0 nmol/liter, P < 0.0001), in the 24 patients with cervical cancer (median, 1.7 nmol/liter; range, 0.6-15.0 nmol/ liters, P < 0.0001), and in the 14 patients with endometrial cancer (median, 1.5 nmol/liter; range, 0.6-3.0 nmol/liter, P = 0.036) when compared to controls (median, 1.0 nmol/liter; range, 0. 1 -2.1 nmol/ liter). Similarly, TAT levels were significantly higher in patients with ovarian cancer (median, 5.3 microgram /ml; range, 1.3-65.0 microgram/ml , P < 0.0001), cervical cancer (median, 3.8 microgram/ml; range, 2.1 - 11.0 microgram / ml, P < 0.0001), and endometrial cancer (median, 2.7 microgram/ml; range, 1.9-19.0 microgram /ml, P = 0.008) when compared to controls (median, 2.2 microgram/ml; range, 1.0-5.0 microgram/ml). Prothrombin fragment F1+2 levels correlated with TAT levels (r = 0.659, P < 0.0001). Among ovarian cancer patients, prothrombin fragment F1+2 and TAT concentrations correlated with FIGO stage (III-IV versus 1, P = 0.01 and P = 0.003, respectively) and CA 125 levels (P 0.02 and P < 0.0001, respectively). The present data confirmed the occurrence of hemostasis activation in patients with gynecological cancer, and in particular in those with ovarian cancer.

Preoperative evaluation of D-dimer and CA 125 levels in differentiating benign from malignant ovarian masses.

Plasma levels of D-dimer (DD) and CA 125 were measured preoperatively in 121 patients with ovarian masses submitted to laparotomy. DD and CA 125 levels were higher in the 56 patients with epithelial ovarian cancer than in the 65 patients with benign ovarian disease (P < 0.0001). The logistic regression procedure showed that both DD assay (cutoff 416 ng/ml) and CA 125 assay (cutoff 65 U/ml) were significant predictive variables for malignancy (P = 0.0001). The concordance between predicted probabilities and observed responses was 75.7% for DD, 72.1% for CA 125, and 90.8% for Dd and CA 125. It is worth noting that DD was increased ( > 416 ng/ml) in 73% of FIGO stage I patients, whereas CA 125 was above 65 U/ml in only 33.3%. Sensitivity, specificity, positive predictive value, and negative predictive value of the tests in differentiating benign from malignant ovarian masses were as follows: 76.8, 93.8, 91.5, and 82.4%, respectively, for CA 125; 94.6, 76.9, 77.9, and 94.3%, respectively, for the combination CA 125 or DD; and 73.2, 100.0, 100.0, and 81.3%, respectively, for the combination CA 125 and DD. The combination CA 125 and DD seems to be a useful diagnostic tool to differentiate benign from malignant ovarian masses. Elevated preoperative levels of both antigens are invariably associated with a postsurgical diagnosis of epithelial ovarian cancer.

The measurement of plasma D-dimer (DD) levels in the follow-up of patients with ovarian cancer.

Peripheral blood samples for the measurement of DD and CA 125 were drawn from 39 patients with ovarian cancer at different times from first surgery. Both median DD and CA 125 levels were significantly higher in the 20 samples drawn from patients with clinically evident disease than in the 37 samples from patients without clinical evidence of disease (477 vs 300 ng/ml p = 0.006, and 66 vs 11 U/ml, p < 0.0001, respectively). DD levels did not correlate with CA 125 levels. The sensitivity, specificity and diagnostic accuracy of the tests in the assessment of clinical disease status were as follows: 65%, 62% and 63% for DD (cut-off = 416 ng/ml); 70%, 92% and 84% for CA 125 (cut-off = 35 U/ml); 90%, 59% and 70% for DD "or" CA 125; and 45%, 95% and 77% for DD "and" CA 125. DD levels correlated with the clinical course of disease in ovarian cancer patients. However, the concomitant determination of DD and CA 125 did not improve the reliability of CA 125 assay alone in the follow-up of these patients.

Pretreatment plasma levels of fibrinopeptide-A (FPA), D-dimer (DD), and von Willebrand factor (vWF) in patients with ovarian carcinoma.

The preoperative plasma levels of fibrinopeptide-A (FPA), D-dimer (DD), and von Willebrand Factor (vWF) were measured in 125 patients with ovarian masses undergoing laparotomy and in 88 healthy nonpregnant women as controls. FPA, DD, and vWF levels were significantly higher in the 58 patients with ovarian carcinoma than in the 67 patients with benign ovarian disease or controls. FPA and DD values were significantly higher in advanced (FIGO stage III-IV) than in early ovarian carcinoma. Among patients with advanced disease, FPA and DD levels correlated with none of the common clinicopathological prognostic variables; conversely, vWF values were related to FIGO stage (IV versus III, P < 0.02) and size of residual disease after initial surgery (> 2 cm versus < or = 2 cm, P < 0.05). In conclusion, increased fibrin production and degradation occur in patients with ovarian carcinoma.

Pretreatment plasma levels of fibrinopeptide-A (FPA), D-dimer (DD), and von Willebrand factor (vWF) in patients with operable cervical cancer: influence of surgical-pathological stage, tumor size, histologic type, and lymph node status.

The preoperative plasma levels of fibrinopeptide A (FPA), D-dimer (DD), and von Willebrand Factor (vWF) were measured in 38 patients with cervical cancer undergoing radical hysterectomy with pelvic lymphadenectomy. The surgical-pathological stage of disease was Ib in 17 patients, IIa in 9 patients, and IIb in 12 patients. The tumor size was < or = 4 cm in 20 patients and > 4 cm in 18 patients. The histologic type was squamous cell carcinoma in 32 patients and adenocarcinoma in 6 patients. Positive pelvic lymph nodes were found in 10 patients. When compared to controls, FPA, DD, and vWF levels were significantly raised in patients with surgical-pathological stage IIb disease but not in patients with stage Ib or IIa disease. The values of FPA, DD, and vWF were related to surgical-pathological stage (stage IIb vs stage Ib-IIa: P < 0.005, P < 0.001, and P < 0.001, respectively) and tumor size (> 4 cm vs < or = 4 cm: P < 0.05, P < 0.005, and P < 0.02, respectively), but not to histologic type. vWF values were also related to lymph node status (positive vs negative lymph nodes: P < 0.02). FPA and DD levels were higher in patients with positive lymph nodes than in patients with negative lymph nodes, but the difference did not reach the statistical significance even due to the small number of patients involved. In conclusion, increased fibrin production and degradation seem to occur in patients with stage IIb cervical cancer. The biological meaning of this hemostasis activation deserves further investigation.

Serum soluble interleukin-2 receptor (sIL-2R) assay in cervical and endometrial cancer. Preliminary data.

Pretreatment serum levels of soluble interleukin-2 receptor (sIL-2R), CA 125, and SCC were measured in 183 patients with malignant or benign uterine diseases. Serum sIL-2R levels were higher in the 46 patients with cervical cancer (p < 0.05) or in the 35 patients with endometrial cancer (p < 0.05) than in the 102 patients with benign uterine diseases. Raised serum concentrations of sIL-2R (> or = 50 U/mL), CA 125 (> or = 35 U/mL) and SCC (> or = 2 ng/mL) were found in 50.0%, 15.0% and 67.5% of 40 patients with squamous cell carcinoma of the cervix, respectively. Serum sIL-2R values were > or = 50 U/mL in 83.3% of 6 patients with cervical adenocarcinoma. Elevated serum levels of sIL-2R, CA 125 and SCC were detected in 51.4%, 11.3% and 14.3% of 35 patients with endometrial cancer, respectively. The sensitivity of SCC for squamous cell carcinoma of the cervix was better than that of sIL-2R. On the other hand, we observed that sIL-2R was the most sensitive antigen for endometrial cancer; therefore it could represent a new tumor marker for the management of patients with this malignancy.

Evaluation of some hemostatic parameters in patients with cervical carcinoma.

It is well known that cancer induces changes in hemostasis. Plasma levels of Fibrinopeptide A (FPA), D-Dimer (DD), von Willebrand Factor (FvW) and fibrinogen were-assayed at diagnosis in 66 patients with cervical carcinoma and in 67 healthy women as controls. FPA, DD and fibrinogen levels were significantly higher in patients with FIGO stage I b-IIa cervical carcinoma than in controls (2.25 +/- 0.25 vs 1.19 +/- 0.15 p less than 0.001; 307 +/- 35 vs 112 +/- 8 p less than 0.001; 375 +/- 23 vs 280 +/- 17 p less than 0.001 respectively). A further increase of DD, FPA but not of fibrinogen concentrations was observed in advanced stages of disease (3.52 +/- 0.81 vs 2.25 +/- 0.25 p less than 0.1; 943 +/- 98 vs 307 +/- 35 p less than 0.001; 407 +/- 26 vs 375 +/- 23 p = NS respectively). FvW levels in patients with early stage cervical carcinoma were in the normal range, while in patients with advanced cancer, they were significantly higher (175 +/- 8 vs 104 +/- 2 p less than 0.001). A significant correlation was found between plasmatic levels of FPA and DD, FPA and FvW, DD and FvW (r = 0.57 p less than 0.01; r = 0.76 p less than 0.01; r = 0.54 p less than 0.01 respectively). Our data seem to indicate that in patients with cervical carcinoma, and in particular in those with advanced cancer, there is an activation of blood coagulation and fibrinolysis.