Re. Zuckerman et al.--Sensitivity of CA-125 in patients with liver cirrhosis in the presence of ascites

Validation of a Novel Biomarker Panel for the Detection of Ovarian Cancer

BACKGROUND

Ovarian cancer is the most lethal gynecological malignancy. Our integrated -omics approach to ovarian cancer biomarker discovery has identified kallikrein 6 (KLK6) and folate-receptor 1 (FOLR1) as promising candidates but these markers require further validation.

METHODS

KLK6, FOLR1, CA125, and HE4 were investigated in three independent serum cohorts with a total of 20 healthy controls, 150 benign controls, and 216 ovarian cancer patients. The serum biomarker levels were determined by ELISA or automated immunoassay.

RESULTS

All biomarkers demonstrated elevations in the sera of ovarian cancer patients compared with controls (P < 0.01). Overall, CA125 and HE4 displayed the strongest ability (AUC 0.80 and 0.82, respectively) to identify ovarian cancer patients and the addition of HE4 to CA125 improved the sensitivity from 36% to 67% at a set specificity of 95%. In addition, the combination of HE4 and FOLR1 was a strong predictor of ovarian cancer diagnosis, displaying comparable sensitivity (65%) to the best-performing CA125-based models (67%) at a set specificity of 95%.

CONCLUSIONS

The markers identified through our integrated -omics approach performed similarly to the clinically approved markers CA125 and HE4. Furthermore, HE4 represents a powerful diagnostic marker for ovarian cancer and should be used more routinely in a clinical setting.

IMPACT

The implications of our study are 2-fold: (i) we have demonstrated the strengths of HE4 alone and in combination with CA125, lending credence to increasing its usage in the clinic; and (ii) we have demonstrated the clinical utility of our integrated -omics approach to identifying novel serum markers with comparable performance to clinical markers. Cancer Epidemiol Biomarkers Prev; 25(9); 1333-40. ©2016 AACR.

High serum carbohydrate antigen 125 concentration can predict serous effusion but not gastrointestinal malignancy in male patients

This study aims to evaluate the diagnostic accuracy of carbohydrate antigen 125 (CA125) in male patients for predicting gastrointestinal malignant diseases. One hundred twenty consecutive male patients underwent CA125 test after admission to the Department of Gastroenterology in Changhai Hospital, the Second Military Medical University, from April to June 2013. Data of age, main symptoms, and final diagnosis were summarized. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of CA125 for malignancy were estimated, and the receiver operating characteristic (ROC) analysis and the area under the curve (AUC) were also performed to evaluate the diagnostic value of CA125 in male patients. The PPV, NPV, PLR, and NLR of CA125 in malignancy were 55 %, 69 %, 1.90, and 0.71, respectively. However, we found that an elevated serum CA125 level was more common in male patients with serous effusion than those with malignancy. The PPV, NPV, PLR, and NLR of CA125 in serous effusion were 85 %, 96 %, 12.70, and 0.09, respectively. In the ROC analysis, the AUC values for CA125 was 0.96 (95 % confidence interval, 0.93-0.99) for discriminating patients with serous cavity effusion from those without serous effusion. CA125 has a higher accuracy in detecting serous effusion than malignancy in male patients with gastrointestinal diseases. It is of little significance for male patients to perform CA125 test for malignancy.

Elevation of serum and ascites CA125 levels in liver cirrhosis

AIM

To evaluate the range of serum and ascitic cancer antigen(CA) 125 levels in patients with liver cirrhosis and to explore possible factors associated with CA 125 elevation.

METHODS

A total of 70 patients were studied. Group I consisted of 30 patients with liver cirrhosis with or without ascites. Group II consisted of 30 patients with digestive malignant tumors with or without asictes. And group III consisted of 10 patients with benign (but not cirrhotic) ascites. CA 125 levels were measured in sera of all the patients and also simultaneously in ascitic fluids of 15 patients.

RESULTS

Serum CA125 levels in 87% patients from group I were elevated, especially in those with ascites (95% vs 38% in patients without ascites, P<0.01) irrespective of the etiology of cirrhosis. Serum CA 125 levels were correlated with Child-Pugh scores (r = 0.38) but it was marginally significant (P = 0.06). All the patients with ascites from group II and group III had elevated serum CA 125 levels. There was no difference in serum CA 125 levels among patients with ascites from group I (275±175 kU/L), group II (368±190 kU/L) and group III (396±287 kU/L), neither did ascitic CA 125 levels (P>0.05), but serum CA 125 levels were significantly higher than those of patients without ascites from group I (72±83 kU/L) and group II (83±42 kU/L). The levels of serum CA 125 were lower than, but correlated with that of ascites CA 125 (198±108 kU/L vs 460±234 kU/L, r = 0.58, P = 0.026). The elevation of serum CA 125 in malignant ascites was more often accompanied with abnormalities of other tumor markers compared with that in benign ascites(90% vs 6%, P<0.01). Among the 38 patients with only serum CA125 elevation but not accompanied with a rise of other tumor markers, 36 (95%) were diagnosed as benign ascites.

CONCLUSION

The elevation of serum CA 125 is common in liver cirrhosis patients. It is correlated with the amount of ascites, and possibly insufficiency of liver function. Serum CA 125 probably derives from ascites. It usually predicts benign disease if the elevation of serum or ascites CA 125 is not accompanied with a rise of other tumor markers.

Elevation of serum and ascites cancer antigen 125 levels in patients with liver cirrhosis

BACKGROUND AND AIM

Serum cancer antigen (CA) 125 elevation has been reported in patients with liver disease, but it is poorly characterized. The present study aimed to evaluate the range of serum and ascitic CA 125 levels in patients with liver cirrhosis and to explore possible factors associated with CA 125 elevation.

METHODS

A total of 70 patients were studied. Group I consisted of 30 patients with liver cirrhosis with or without ascites. Group II consisted of 30 patients with digestive malignant tumors with or without ascites. Group III consisted of 10 patients with benign ascites. The CA 125 levels were measured in the serum of all patients and also simultaneously in the ascitic fluid of 15 patients.

RESULTS

Serum CA125 levels in 80% of (24/30) patients from group I were elevated, particularly in those with ascites, irrespective of the etiology of cirrhosis. Serum CA 125 levels were correlated with Child-Pugh scores (r = 0.38), but not significantly (P = 0.06). All patients from group II with ascites and from group III had elevated serum CA 125 levels, but there was no difference in the serum CA 125 levels between patients with ascites from group I (275 +/- 175 U/mL), group II (368 +/- 190 U/mL) or group III (396 +/- 287 U/mL), nor was there a significant difference in ascitic CA 125 levels (P > 0.05). The levels of serum CA 125 (198 +/- 108 U/mL) were lower than, but correlated with that of ascites (460 +/- 234 U/mL, r = 0.58, P = 0.026). The elevation of serum CA 125 accompanied by abnormalities of other tumor markers was more common in malignant ascites than in benign ascites (90% compared with 6%, P < 0.05).

CONCLUSION

The elevation of serum CA 125 is common in patients with liver cirrhosis. It is related to the presence of ascites, and possibly to the insufficiency of liver function, but not the etiology of cirrhosis and ascites. Serum CA 125 probably comes from ascites. It usually predicts benign disease if the elevation of serum or ascites CA 125 is not accompanied by the abnormalities of other tumor markers.