Asia-Oceania J. Obstet. Gynaecol. Vol. 18, No. I : 37-43 1992
Significance of the Serum CA125 Level in Recurrent Ovarian Cancer
Haruo Nishimura, Masamichi Tashiro, Kinya Hamaguchi, Yasuyuki Kiyozuka, Hiroshi Ide, Nobumasa Tateno, Tadashi Miyoshi, and Michiaki Yakushiji Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka,Japan
Abstract Thirty-four recurrent cases of 89 patients with ovarian cancer treated in our department between 1985 and 1989 were examined for changes in serum CA125 level. 1) Upon confirmation of recurrence, 17 patients were positive for CA125 and 15 were negative. 2) According to the histopathological type, the rate of CA125 positivity in patients with recurrence was high for serous adenocarcinoma, suggesting that determination of CA125 is useful for detection of recurrence. I n contrast, all patients with rnucinous adenocarcinoma or endometrioid adenocarcinoma were negative for CA125. 3) The CA125 positivity rate upon confirmation of recurrence was 9% in patients whose CA125 was less than 1,000 U/mZ on initial examination, suggesting that close management of such patients is necessary. 4) Elevation of CA125 by 3 steps or more within the normal range (less than 35 U/mZ) was useful for predicting recurrence. 5) The cut-off level of CA125 during follow-up should be set at 16 U/mZ. 6) I t was difficult to evaluate remission with only the serum CAI25 level. It is impossible to avoid second look operation at present. These results indicate that pretreatment values and changes of the parameter within the normal range (less than 35 U/mZ) have to be considered when using CA125 as a marker of tumor recurrence.
Key words: CA125, ovarian cancer, cut-off value Introduction It is difficult to diagnose tumors of the ovaries because of their anatomical location, which made any surgical approach impossible. This prevents with the early detection of ovar-
ian cancer. However, this problem is gradually being overcome due to the recent development of diagnosticimaging and serological diagnostic methods. I n this regard, the role of the CA125 reported by Bast et d.?)is of particular importance.
Received: Nov. 1, 1991 Reprint request to: Dr. Haruo Nishimura, D e p m e n t of Obstetrics and Gynecology, Kunune University School of Medicine, 67 Asahi-machi, Kunune, Fdcuoka 830, Japan
37
H. NISHIMURA ET AL.
Table 1. Patients characteristics F I G 0 stage
Histological type Stage I
Stage I1
Stage I11
Stage IV
Total
Serous Mucinous Endometrioid Clear cell Unclassified
5 10 1 5 1
5 1 5 3 2
37 3 4 2 0
4 0 0 0 1
51 14 10 10 4
Total
22
'16
46
5
89
Kurume University Hospital (1985-1989)
Table 2. Preoperative serum CA125 values versus histological types Histological type
No. of pts.
Positive pts.
Positivity rates
Mean value (U/ml)
Serous Mucinous Endometrioid Clear cell Unclassified
51 14 10 10 4
48 8 10 8 2
94.1 57.1 100.0 80.0 50.0
4058.3 453.9 216.3 646.3 956.2
Total
89
76
85.4
2532.4
Early detection of recurrence would treatly improve prognosis in patients with ovarian cancer, the recurrence of which is frequent. We studied the usefulness of the serum CA125 level in detecting recurrent carcinoma as well as in making the initial diagnosis.
Materials and Methods The subjects were 89 patients whose serum CA125 levels were determined preoperatively and who were histopathologically diagnosed as having ovarian cancer by laparotomy. They were chosen from patients with ovarian cancer examined between 1985 and 1989 (Table 1). The 89 patients were divided into those without recurrence after remission (Group A), those with recurrence (Group B), and those without remission (Group C), and each group was examined for changes in CA125 level and the relationship between the change in CA125 and clinical background. Remission was defined as the state in which no tumor was clinically detected and the serum CA125 level was normal (under 35 U/mZ). Recurrence was defined as the state in which a lesion was
38
confirmed by cytodiagnosis or histodiagnosis. These results were statistically evaluated by the ~2 test.
Results 1. Positivity Rate of CAI25 According to Histopathological Type The rate of CA125 positivity on initial examination was high in patients with serous adenocarcinoma and endometrioid adenocarcinoma. Only about half of the patients with mucinous adenocarcinoma or unclassified adenocarcinoma were positive for CA125. The mean CA125 level in serous adenocarcinoma was significantly higher than that in other histological types (Table 2).
2. Clinical Course in 89 Patients Of 89 patients, 38 were in Group A, 34 in Group B, and 17 in Group C. According to histopathological type, none of the patients with unclassified type of adenocarcinoma showed recurrence, but there was no tendency according to histological type (Table 3).
RECURRENT OVARIAN CANCER
Table 3. Clinical outcome of all 89 patients No. of pts.
Serous
Mucinous
Endometrioid
Clear cell
Unclassified
38 34 17
13 26 12
9 3 2
7 1 2
6 4 0
3 0 1
Group A Group B Group C
Table 4. Serum CA125 values at the time of recurrence No. of pts.
Serous
Mucinous
Endometrioid
Clear cell
17 15 2
15 9 2
0 3 0
0
2 2 0
Positive Negative Unknown
Table 5. Preoperative serum CA12S value and its positivity rates at recurrence (Ulml)
5 35 35 < 5500 500
Significance of the Serum CA125 Level in Recurrent Ovarian Cancer
Haruo Nishimura, Masamichi Tashiro, Kinya Hamaguchi, Yasuyuki Kiyozuka, Hiroshi Ide, Nobumasa Tateno, Tadashi Miyoshi, and Michiaki Yakushiji Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka,Japan
Abstract Thirty-four recurrent cases of 89 patients with ovarian cancer treated in our department between 1985 and 1989 were examined for changes in serum CA125 level. 1) Upon confirmation of recurrence, 17 patients were positive for CA125 and 15 were negative. 2) According to the histopathological type, the rate of CA125 positivity in patients with recurrence was high for serous adenocarcinoma, suggesting that determination of CA125 is useful for detection of recurrence. I n contrast, all patients with rnucinous adenocarcinoma or endometrioid adenocarcinoma were negative for CA125. 3) The CA125 positivity rate upon confirmation of recurrence was 9% in patients whose CA125 was less than 1,000 U/mZ on initial examination, suggesting that close management of such patients is necessary. 4) Elevation of CA125 by 3 steps or more within the normal range (less than 35 U/mZ) was useful for predicting recurrence. 5) The cut-off level of CA125 during follow-up should be set at 16 U/mZ. 6) I t was difficult to evaluate remission with only the serum CAI25 level. It is impossible to avoid second look operation at present. These results indicate that pretreatment values and changes of the parameter within the normal range (less than 35 U/mZ) have to be considered when using CA125 as a marker of tumor recurrence.
Key words: CA125, ovarian cancer, cut-off value Introduction It is difficult to diagnose tumors of the ovaries because of their anatomical location, which made any surgical approach impossible. This prevents with the early detection of ovar-
ian cancer. However, this problem is gradually being overcome due to the recent development of diagnosticimaging and serological diagnostic methods. I n this regard, the role of the CA125 reported by Bast et d.?)is of particular importance.
Received: Nov. 1, 1991 Reprint request to: Dr. Haruo Nishimura, D e p m e n t of Obstetrics and Gynecology, Kunune University School of Medicine, 67 Asahi-machi, Kunune, Fdcuoka 830, Japan
37
H. NISHIMURA ET AL.
Table 1. Patients characteristics F I G 0 stage
Histological type Stage I
Stage I1
Stage I11
Stage IV
Total
Serous Mucinous Endometrioid Clear cell Unclassified
5 10 1 5 1
5 1 5 3 2
37 3 4 2 0
4 0 0 0 1
51 14 10 10 4
Total
22
'16
46
5
89
Kurume University Hospital (1985-1989)
Table 2. Preoperative serum CA125 values versus histological types Histological type
No. of pts.
Positive pts.
Positivity rates
Mean value (U/ml)
Serous Mucinous Endometrioid Clear cell Unclassified
51 14 10 10 4
48 8 10 8 2
94.1 57.1 100.0 80.0 50.0
4058.3 453.9 216.3 646.3 956.2
Total
89
76
85.4
2532.4
Early detection of recurrence would treatly improve prognosis in patients with ovarian cancer, the recurrence of which is frequent. We studied the usefulness of the serum CA125 level in detecting recurrent carcinoma as well as in making the initial diagnosis.
Materials and Methods The subjects were 89 patients whose serum CA125 levels were determined preoperatively and who were histopathologically diagnosed as having ovarian cancer by laparotomy. They were chosen from patients with ovarian cancer examined between 1985 and 1989 (Table 1). The 89 patients were divided into those without recurrence after remission (Group A), those with recurrence (Group B), and those without remission (Group C), and each group was examined for changes in CA125 level and the relationship between the change in CA125 and clinical background. Remission was defined as the state in which no tumor was clinically detected and the serum CA125 level was normal (under 35 U/mZ). Recurrence was defined as the state in which a lesion was
38
confirmed by cytodiagnosis or histodiagnosis. These results were statistically evaluated by the ~2 test.
Results 1. Positivity Rate of CAI25 According to Histopathological Type The rate of CA125 positivity on initial examination was high in patients with serous adenocarcinoma and endometrioid adenocarcinoma. Only about half of the patients with mucinous adenocarcinoma or unclassified adenocarcinoma were positive for CA125. The mean CA125 level in serous adenocarcinoma was significantly higher than that in other histological types (Table 2).
2. Clinical Course in 89 Patients Of 89 patients, 38 were in Group A, 34 in Group B, and 17 in Group C. According to histopathological type, none of the patients with unclassified type of adenocarcinoma showed recurrence, but there was no tendency according to histological type (Table 3).
RECURRENT OVARIAN CANCER
Table 3. Clinical outcome of all 89 patients No. of pts.
Serous
Mucinous
Endometrioid
Clear cell
Unclassified
38 34 17
13 26 12
9 3 2
7 1 2
6 4 0
3 0 1
Group A Group B Group C
Table 4. Serum CA125 values at the time of recurrence No. of pts.
Serous
Mucinous
Endometrioid
Clear cell
17 15 2
15 9 2
0 3 0
0
2 2 0
Positive Negative Unknown
Table 5. Preoperative serum CA12S value and its positivity rates at recurrence (Ulml)
5 35 35 < 5500 500
