Maternal serum Ca125 and Ca15-3 antigen levels in normal and pathological pregnancy

MUC16 can Predict the Pregnancy Outcomes in Human and Intraperitoneal Administration of MUC16 can Rescue Pregnancy Losses in Mouse Models

Mucin 16 (MUC16) participates in the process of embryo implantation, but few studies have examined the association between MUC16 and pregnancy loss. To investigate this association, the expression of MUC16 in serum and decidua was compared between women with pregnancy loss and ongoing pregnancies. In vitro experiments and animal models were used to explore the role and underlying mechanisms of MUC16 in pregnancy loss. In human study, the expression of MUC16 in serum and decidua was both consistently lower in the women with pregnancy loss compared with those in women with ongoing pregnancies. In vitro experiments revealed the interaction of MUC16 with peripheral blood natural killer (pNK) cells. MUC16 changed the phenotype and reduced the pro-inflammation ability of pNK cells. MUC16 also inhibited the cytotoxicity of pNK cells through the Src homology region 2 domain-containing phosphatase-1/extracellular signal-regulated kinase (SHP-ERK) pathway. Furthermore, MUC16 promoted the migration, invasion and tube formation of trophoblast cells by co-culturing together with pNK cells. In vivo experiments, the mouse model of abortion was used to further confirm that intraperitoneal administration of MUC16 could rescue the pregnancy loss. This study reveals the still-unknown connection between MUC16 and pNK cells and indicates that MUC16 provides a novel method for future prediction and treatment of unfavorable pregnancy outcomes.

Correlation of Serum Cancer Antigen-125 (CA-125) Levels with Severity of Pre-eclampsia

Background

Pre-eclampsia is often associated with unfavourable feto-maternal outcomes. There is a lacuna in its pathophysiology, which emphasizes the need to research for tests, which can predict or correlate with the severity of pre-eclampsia. Cancer antigen-125 (CA-125) is a simple, readily available biomarker with evidence of its secretion at the choriodecidual unit and may have a possible role. This study compared serum CA-125 levels between normal pregnant and pre-eclamptic women and determined its clinical usefulness in correlating with the severity of pre-eclampsia.

Methods

A case-control study was conducted enrolling 58 women with pre-eclampsia further divided into severe and non-severe groups and 62 gestational age-matched healthy, pregnant controls. Serum CA-125 levels were compared between the two groups.

Results

The mean serum CA-125 in the controls was 16.44 ± 8.28 IU/ml, 13.82 ± 9.18 IU/ml in the non-severe and 23.55 ± 30.55 IU/ml in the severe pre-eclampsia group (p = 0.134). Serum CA-125 had a significant association with systolic blood pressure (SBP) p = 0.002), diastolic blood pressure (DBP) (p = 0.026), foetal growth restriction (p = 0.025), pre-term birth (p = 0.039) and a highly significant association with 24-h urinary protein, liver enzymes, placental abruption, need of maternal intensive care as well as with poor neonatal outcome including stillbirth and neonatal mortality (p < 0.001).

Conclusion

Serum CA-125 levels were found to be higher in the severe pre-eclampsia group as compared to non-severe pre-eclampsia and normotensive group, but the difference was not statistically significant. More studies on a larger scale are required to prove the usefulness of this marker with respect to maternal and perinatal outcome as well as its association with pre-eclampsia and its severity.

Serum CA-125 as a predictor in the early diagnosis of ectopic pregnancy in Vietnam - A case-control study

INTRODUCTION

This study aimed to determine the predictive value of cancer antigen-125 (CA-125) in combination with serum beta-human chorionic gonadotropin (β-hCG) and progesterone in the early detection of ectopic pregnancy (EP).

METHODS

Between May 2019 and May 2020, the cross-sectional study recruited 42 cases of EP and 42 cases of IUP at the same gestational age who visited the Department of Obstetrics and Gynecology, Hospital of Hue University of Medicine and Pharmacy. EP was diagnosed based on surgical (laparoscopy) and postoperative pathology examination.

RESULTS

There were significant differences of mean level of β-hCG (2570 mUI/mL vs. 18357.7 mUI/mL), progesterone (10.79 ± 8.16 ng/ml vs. 27.42 ± 4.17 ng/ml) and CA-125 (26.90 ± 10.26 U/mL vs. 70.61 ± 20.89 U/mL) between the EP and the IUP groups (p < 0.001). In the prediction of early diagnosis of EP, the cut-off value of CA-125 at 30.94 U/mL has a sensitivity of 89.3% and a specificity of 87,9%; the cut-off value of β hCG at 2750mIU/ml has the sensitivity of 75%, specificity of 78,8%; the cut-off value of progesterone at 10.24 ng/mL has the sensitivity of 85.7%, specificity of 81.8%. A combination of CA-125, β hCG, and progesterone had a sensitivity of 92.8% and a specificity of 90.9% in early diagnosis of EP.

DISCUSSION

Serum CA-125 levels can be used independently or in combination with other markers in the early diagnosis of EP.

Siglecs family used by pathogens for immune escape may engaged in immune tolerance in pregnancy

The Siglecs family is a group of type I sialic acid-binding immunoglobulin-like receptors that regulate cellular signaling by recognizing sialic acid epitopes. Siglecs are predominantly expressed on the surface of leukocytes, where they play a crucial role in regulating immune activity. Pathogens can exploit inhibitory Siglecs by utilizing their sialic acid components to promote invasion or suppress immune functions, facilitating immune evasion. The establishing of an immune-balanced maternal-fetal interface microenvironment is essential for a successful pregnancy. Dysfunctional immune cells may lead to adverse pregnancy outcomes. Siglecs are important for inducing a phenotypic switch in leukocytes at the maternal-fetal interface toward a less toxic and more tolerant phenotype. Recent discoveries regarding Siglecs in the reproductive system have drawn further attention to their potential roles in reproduction. In this review, we primarily discuss the latest advances in understanding the impact of Siglecs as immune regulators on infections and pregnancy.

Assessment of CA-125 First-Trimester Values as a Potential Screening Marker for Pre-Eclampsia

Background: Pre-eclampsia is a major public health issue. Current screening methods are based on maternal characteristics and medical history, but complex predictive models combining different clinical and biochemical markers have been proposed. However, although their accuracy is high, the implementation of these models in clinical practice is not always feasible, especially in low- and middle-resource settings. CA-125 is a tumoral marker, accessible and cheap, with proven potential as a severity marker in the third trimester of pregnancy in pre-eclamptic women. Assessment of its use as a first-trimester marker is necessary. Methods: This observational study involved fifty pregnant women between 11 and 14 weeks of pregnancy. Clinical and biochemical markers (PAPP-A), known for their value in pre-eclampsia screening, were recorded for every patient as well as first-trimester value of CA-125 and third-trimester data regarding blood pressure and pregnancy outcome. Results: No statistical correlation between CA-125 and first-trimester markers was observed except with PAPP-A, with which it exhibited a positive correlation. Additionally, no correlation was made between it and third-trimester blood pressure or pregnancy outcomes. Conclusions: CA-125 first-trimester values do not represent a valuable marker for pre-eclampsia screening. Further research on identifying an accessible and cheap marker to improve pre-eclampsia screening in low- and middle-income settings is needed.

Cancer antigen 125 and C-reactive protein inflammatory mediators and uric acid in association with preeclampsia in North Kordofan State, Western Sudan

Pathophysiology of pre-eclampsia depends on a defective trophoblastic invasion of uteroplacental blood vessels that leads to placental ischemia and induction of an inflammatory process within the placenta. This process may trigger the expression of Cancer antigen 125 (CA 125), C-reactive protein (CRP) and uric acid (UA). This research aimed to evaluate the association of serum CA 125, CRP and uric acid with Preeclampsia. The study recruited 200 singleton Sudanese pregnant women, who were divided into three groups: controls (n = 100), mild preeclampsia (n = 46) and severe preeclampsia (n = 54). The study subjects were matched for maternal age, gestational age and body mass index. Blood samples were taken for measurement of the different variables using immune- assay and enzymatic automated chemical analysis. The levels of CA 125 in mild and severe preeclampsia were (21.94±0.749 IU/ml) and (40.78±1.336 IU/ml) respectively, which was significantly different (P<0.001) from the control mean (16.48±0.584 IU/ml). There was also a significant difference between the mean levels of CRP in mild and severe preeclampsia (15.17±0.788 mg/L), (31.50±1.709 mg/L) compared with controls (4.79±0.178 mg/L), (P<0.01). There was also a significant difference in the mean levels of UA in mild and severe cases (6.44±0.293 and7.37±0.272) in comparison with the controls (4.00±0.061); (P<0.001). There were significant differences between severe and mild groups (P<0.05). Cancer antigen 125, CRP and UA levels‎ correlated positively with mean arterial blood pressure (MAP) where (r >0.7; P < 0.001). ROC curve validates the utility of these biomarkers for monitoring preeclampsia (AUC >0.8; P < 0.001). In conclusion CA 125, CRP and UA were significantly higher in preeclampsia compared with the controls. The rise of the analytes was directly associated with the severity of the disease.

Role of CA-125 Level as a Marker in the Management of Severe Pre-Eclampsia

BACKGROUND AND OBJECTIVES

Hypertensive disorders of pregnancy remain one of the leading causes of morbidity and mortality in maternal-fetal medicine worldwide, particularly in low-resource settings. Despite extensive research in the last decades, pre-eclampsia prediction and, thus, effective prevention remains an unsolved problem. Current evidence suggests that CA-125, an already recognised tumoral marker and, lately, a valuable severity marker of heart failure, can be used to evaluate pre-eclampsia severity and thus improve the identification and management of high-risk patients; Materials and Methods: This is a case-control study involving 100 pregnant patients over 25 weeks of gestation, grouped based on the severity of hypertension in gestational hypertension (n = 22), non-severe pre-eclampsia (n = 11), severe pre-eclampsia (n = 17), and a control group (normotensive) (n = 50). Clinical and biochemical parameters recommended by the international guidelines for evaluating hypertensive pregnant patients were gathered from every patient in addition to CA-125 levels. The correlation was analysed.

RESULTS

Mean CA-125 levels increased with the severity of hypertension from a mean of 8.97 U/mL (±2.84) in the normotensive group to a mean of 21.23 U/mL (±11.18) in the severe pre-eclampsia group. Significant differences were observed between each group. The correlation of CA-125 levels with the assessed clinical and biochemical parameters showed positive correlations with MAP, 24 h proteinuria, and LDH values and negative correlations with platelet count, gestational age at birth, and birth weight Conclusions: The reported results support this marker's promising role as a severity marker and its potential to improve pre-eclampsia management allowing a better selection of high-risk patients, aiding in decision making related to hospitalisation and/or timing of birth. Further studies are needed to improve the accuracy of the obtained results, identify an accurate cut-off and an optimal time of measurement, and achieve standardisation in measuring the marker.

Genome-wide association study of serum tumor markers in Southern Chinese Han population

Background

Serum indicators AFP, CA50, CA125, CA153, CA19-9, CEA, f-PSA, SCC-Ag have been confirmed as tumor markers (TMs). We conducted a genome-wide association study on 8 tumor markers of our 427 Han population in southern China, in order to identify genetic loci that are significantly associated with the level of 8 tumor markers.

Methods

We use Gene Titan multi-channel instrument and Axiom Analysis Suite 6.0 software for genotyping. We used IMPUTE2 software for imputation, and 1000 Genomes Project (Phase 3) was used as haplotype reference. After necessary quality control and statistical analysis, genetic loci genome-wide associated with TMs (p < 5E-8) will be identified. Finally, we selected Top SNPs (p < 5E-7) from the GWAS results for replication test. We used SPSS software to draw the distribution box plots of serum TMs under different genotypes of significant loci.

Results

The results showed that there were only MUC1 (mucin 1)-rs4072037 significantly genome-wide associated with CA153 (p = 1.28E-18). However, we found that a total of 30 genetic loci have a suggestively significant genome-wide association with the level of 8 serum tumor markers (p < 5E-6). Then 3 Top SNPs (p < 5E-7) were selected for replication verification. The results showed that MUC1-rs4072037 was still significantly associated with CA153 in another population (p = 3.73E-08). Comparing with the TT genotype of rs4072037, the CA153 level was higher under CC or CT genotype of rs4072037.

Conclusion

MUC1-rs4072037 is significantly genome-wide associated with CA153 level. There are 30 genetic loci suggestively genome-wide associated with level of tumor markers among the Han population from Southern China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09236-6.

Epidemiologic and biologic correlates of serum HE4 and CA125 in women from the National Health and Nutritional Survey (NHANES)

OBJECTIVES

In women with ovarian cancer, tumor features largely determine serum HE4 and CA125 levels, but non-tumor factors may also influence levels and be better understood by studying determinants in a well-characterized sample of women without cancer.

METHODS

Serum HE4 and CA125 were measured in 2302 women from the 2001-2002 cohort of the National Heath and Nutritional Survey (NHANES). Publicly-available data on this cohort included demographic/reproductive variables, blood counts, and measurements of C-reactive protein (CRP), total homocysteine (tHcy), cotinine, and creatinine which were examined as predictors of HE4 and CA125 using multivariate models and correlational analyses.

RESULTS

HE4 increased non-linearly by age and current smokers had higher HE4. CA125 was lower in postmenopausal women and non-whites and trended downward with increasing BMI. Current-users of oral contraceptives (OCs) had lower HE4 and CA125; and a downward trend for CA125 was seen with increasing OC use. Pregnant women had higher CA125 and nursing women higher HE4. HE4 and CA125 were positively correlated with neutrophils, monocytes, and the neutrophil-to-lymphocyte ratio and inversely correlated with lymphocytes and the lymphocyte-to-monocyte ratio. CRP was positively correlated with both HE4 and CA125 in postmenopausal women. Strong positive correlations existed for HE4 with both tHcy and creatinine.

CONCLUSIONS

Serum levels of HE4 and CA125 are influenced by several hormonal or environmental stimuli which affect non-cancerous tissues normally expressing HE4 or CA125. Cytokine co-expression in those tissues may, in turn, affect white cell counts and account for their correlation with HE4 or CA125 levels.

Vitamin B12 and folic acid associated megaloblastic anemia: Could it mislead the diagnosis of breast cancer?

CA 15-3 is a tumor-associated antigen and is overexpressed in breast tumors, and may also be high in some other non-cancerous conditions. The aim of this study was to investigate the effect of megaloblastic anemia due to vitamin B12 or folic acid deficiency on the levels of tumor markers. Five-year patient data were retrospectively analyzed. The associations between megaloblastic anemia due to vitamin B12 deficiency and CA 15-3, CA 125, CA 19-9, CEA, and AFP levels were analyzed. Furthermore, association between CA 15-3 level and megaloblastic anemia due to folic acid deficiency was evaluated. Median CA 15-3 level was 38.1 U/mL in the group with megaloblastic anemia due to vitamin B12 deficiency(n = 15), 46.7 U/mL in the group with megaloblastic anemia related to folic acid deficiency (n = 3), and 17.8 U/mL in the normal group(n = 1724). CA 15-3 levels were significantly higher among patients with vitamin B12- and folic acid-associated megaloblastic anemia compared to the normal group (p = 0.001 and p = 0.005, respectively). Megaloblastic anemia due to vitamin B12 deficiency was not associated with any significant differences in CA 125, CA 19-9, CEA, or AFP levels compared to the normal group (p = 0.777, p = 0.327, p = 0.577, and p = 0.197, respectively). The numbers of anemic and normal subjects compared in these tests were 12 vs. 1501, 17 vs. 1827, 4 vs. 897, and 8 vs. 1041, respectively. In conclusion, megaloblastic anemia results in ineffective erythropoiesis, and increased levels of CA 15-3 may be associated with this issue. Clinicians should take this into account when evaluating for a pre-diagnosis of breast cancer.

Association between serum CA125 levels in preeclampsia and its severity among women in Lagos, South-West Nigeria

BACKGROUND

Preeclampsia is a syndrome of unknown etiology characterized by hypertension, proteinuria, and/or organ dysfunction. CA125 is an antigenic determinant recognized by the murine monoclonal antibody OC125 quantified by radioimmunoassay. Its role in obstetrics is yet to be fully understood as most clinical trials advocating its uses are widely experimental in nature and unacknowledged.

AIM

This study was done to assess the relationship between serum concentration of CA125 in normal pregnancies and those complicated with preeclampsia.

METHODS

A case-control study involving 70 women diagnosed with preeclampsia and 70 healthy controls matched for age, parity, and gestational age at enrollment. Venous samples were collected from each participant after informed consent was obtained. The preeclampsia group was further subdivided into mild and severe preeclampsia and all participants were followed up till delivery with records of delivery, maternal, and neonatal outcomes obtained thereafter. Serum CA125 levels were determined by standard enzyme-linked immunosorbent assay (ELISA) method. Hypothesis testing was done using chi-square test for categorical variables, and the independent-samples t-test and ANOVA for numerical variables. All significances were reported at P < 0.05.

RESULTS

The mean serum level of CA125 in women with preeclampsia was significantly greater than those with normal pregnancy (54.17 IU/mL vs. 12.49 IU/mL, P < 0.05). CA125 level also correlated positively with systolic blood pressure (r = 0.406, P < 0.05), diastolic blood pressure (r = 0.433, P < 0.05), serum uric acid levels (r = 0.407, P = 0.001), platelet levels (r = 0.341, P = 0.001), and urinary protein levels (r = 0.325, P = 0.002). The CA125 levels between the three categories of participants in the study were: normotensive control (12.49 ± 6.62 mIU/L), mild preeclampsia (29.43 ± 3.7 mIU/L), and severe preeclampsia (64.25 ± 9.21 mIU/L), respectively (P = 0.023).

CONCLUSION

We can infer from this study that increased maternal serum CA 125 levels are associated with the preeclampsia and its severity. However, further validation of these findings with more robust multicenter prospective and longitudinal characterization of maternal serum CA125 profiles in pregnancy should be carried out in subsequent investigations to determine its suitability as a predictive biomarker for preeclampsia in women of African descent.

Measurement of HE4 and CA125 and establishment of reference intervals for the ROMA index in the sera of pregnant women

INTRODUCTION

Cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) are biomarkers for ovarian cancer. Their specificity and sensitivity are often limited during pregnancy as a result of great fluctuations. The risk of ovarian malignancy algorithm (ROMA) score, which combines CA125, HE4, and menopausal status, may improve diagnostic performance. There are no reports regarding the ROMA index in pregnant women. Therefore, the aim of our study was to establish appropriate reference intervals (RIs) for the ROMA index in pregnant Chinese women and compare them with those of CA125 and HE4 during pregnancy.

METHODS

Serum concentrations of CA125 and HE4 were simultaneously measured in healthy pregnant women via electrochemiluminescence immunoassay (ECLIA). The ROMA index was calculated using premenopausal algorithms.

RESULTS

The RIs for the ROMA index calculated by premenopausal algorithms were substantially closer to the normal range in the first 2 trimesters. For pregnant women, the great misclassifications identified in CA125 may be reversed by the use of ROMA index.

CONCLUSIONS

We established the RIs for HE4 and CA125, as well as the ROMA index, in pregnant women at different gestational periods. The ROMA index is suggested to be a more promising tumor marker for pregnant women diagnosed with malignance.

Cancer antigen 125 after delivery in women with a normal pregnancy: a prospective cohort study

OBJECTIVE

To establish reference intervals for cancer antigen 125 (CA-125) in women with expected normal pregnancy, delivery, and early postpartum period.

DESIGN

Prospective observational study.

SETTING

Department of Clinical Biochemistry and Obstetrics, Copenhagen University Hospital, Gentofte, Denmark.

POPULATION

Eight hundred and one women with expected normal pregnancies were investigated. Of these, 640 delivered vaginally, 82 by emergency cesarean section, and 79 by elective cesarean section; 720 women had uncomplicated pregnancies.

METHODS

Samples were collected at gestational weeks 13-20, 21-28, 29-34, 35-42, during labor, and on first and second day postpartum. Reference intervals were calculated for each gestational period as recommended by the International Federation of Clinical Chemistry and Laboratory Medicine.

MAIN OUTCOME MEASURES

Concentration of serum CA-125 during the gestational period and around delivery.

RESULTS

CA-125 was fairly stable below 35 U/mL during pregnancy but increased markedly during vaginal delivery, to a minor degree during emergency cesarean section, and only slightly during elective cesarean section. In the early postpartum period, CA-125 decreased with an apparent half-life of 24 h.

CONCLUSIONS

The CA-125 cut-off value (<35 U/mL) used for non-pregnant women can be used for women during pregnancy after gestational week 13 as a supplement to ultrasound evaluation of ovarian cysts. The wide range of CA-125 concentration during normal pregnancies makes it unlikely that small fluctuations in CA-125 can be clinically useful for identifying other conditions. Measuring CA-125 around the time of delivery is not recommended. Gestational age-specific reference intervals during normal pregnancy are not needed.

Maternal serum CA-125 level is elevated in severe preeclampsia

AIM

The aim of this study was to determine the relationship between serum concentrations of cancer antigen-125 (CA-125) and pre-eclampsia severity.

METHODS

We evaluated 91 females with a singleton pregnancy. Serum CA-125 levels were measured in subjects with severe pre-eclampsia (n=34) and those with mild pre-eclampsia (n=24). Females with healthy pregnancies (n=31) served as the control group. The three study groups were statistically similar in terms of maternal age, gestational age, and body mass index.

RESULTS

The CA-125 level was significantly higher in the severe pre-eclampsia group than that in the mild pre-eclampsia and control groups (p<0.05). No significant difference in CA-125 levels between the mild pre-eclampsia and control groups was observed. CA-125 level was positively correlated with proteinuria (r=0.489, p=0.000), systolic blood pressure (r=0.503, p=0.018), and diastolic blood pressure (r=0.532, p=0.000). In contrast, CA-125 was negatively correlated with birth weight (r=0.266, p=0.012) and gestational age at birth (r=0.250, p=0.018).

CONCLUSIONS

CA-125 level increased in severe pre-eclampsia, which reflected abnormal trophoblastic invasion and chronic inflammation. Elevated levels of CA-125 in pre-eclamptic patients may be a marker of the disease severity.

Surgical intervention for adnexal masses during pregnancy

We aimed to evaluate the influence of surgical intervention on gestational and neonatal outcomes in women who underwent elective surgery in the second trimester of gestation because of an adnexal mass. We retrospectively reviewed the hospital records of women who underwent elective surgery for adnexal masses in the second trimester of gestation between 2006 and 2012. The ages of the women ranged between 17 and 33 years. Eight women underwent a laparotomy, and one woman, who aborted on the day of the operation, underwent a laparoscopy. Dermoid cysts, cystadenoma and borderline ovarian tumours were present in four, two and two of the women, respectively. Eight women had no complications after surgery and delivered healthy newborns at term. We concluded that elective surgery on an adnexal mass in the second trimester of gestation is safe for both the mother and the fetus.

Maternal serum CA 19-9 and CA 15-3 levels in pregnancies affected by trisomy 21

OBJECTIVES

To investigate the levels of tumour markers CA 19-9 and CA 15-3 in the first trimester maternal serum of euploid control and trisomy 21 pregnancies.

METHODS

Maternal serum marker levels of 69 trisomy 21 and 388 euploid controls were quantified by the Kryptor analyser, and levels were compared between the two groups after analysis for confounding factors. Monte Carlo simulation was carried out to determine the effect of adding potential markers to the combined test.

RESULTS

Neither marker was affected by gestational age; however, CA 19-9 required correction for maternal weight. CA 19-9 was significantly increased in trisomy 21 pregnancies (0.98 MoM in euploid, 1.16 MoM in trisomy 21, p = 0.024). Levels of CA 15-3 were not found to differ significantly (1.03 MoM in euploid, 1.09 in trisomy 21, p = 0.130). Detection rates were unaffected by addition of CA 19-9 to the combined test.

CONCLUSION

Although a small significant increase in CA 19-9 levels was found in trisomy 21 group, it is unlikely to be of any use as part of a trisomy 21 screening tool.

Physiologic variations of serum tumor markers in gynecological malignancies during pregnancy: a systematic review

BACKGROUND

Recent insights provide support for the treatment of cancer during pregnancy, a coincidence that poses both mother and fetus at risk. Our aim was to critically review studies on the physiologic variations during pregnancy, the most common tumor markers used in diagnosis and follow-up of gynecological cancers.

METHODS

We conducted a systematic review of six tumor markers during normal pregnancy: carbohydrate antigen (CA) 15-3 (breast cancer); squamous cell carcinoma antigen (cervical cancer); and CA 125, anti-Müllerian hormone, inhibin B and lactate dehydrogenase (ovarian cancer).

RESULTS

For CA 15-3, 3.3% to 20.0% of all measurements were above the cut-off (maximum 56 U/mL in the third trimester). Squamous cell carcinoma antigen values were above cut-off in 3.1% and 10.5% of the measurements (maximum 4.3 µg/L in the third trimester). Up to 35% of CA 125 levels were above cut-off: levels were highest in the first trimester, with a maximum value up to 550 U/mL. Inhibin B, anti-Müllerian hormone and lactate dehydrogenase levels were not elevated in maternal serum during normal pregnancy.

CONCLUSION

During normal pregnancy, tumor markers including CA 15.3, squamous cell carcinoma antigen and CA 125 can be elevated; inhibin B, anti-Müllerian hormone and lactate dehydrogenase levels remain below normal cut-off values. Knowledge of physiological variations during pregnancy can be clinically important when managing gynecological cancers in pregnant patients.

The mucin MUC16 (CA125) binds to NK cells and monocytes from peripheral blood of women with healthy pregnancy and preeclampsia

PROBLEM

MUC16 (CA125) released from ovarian tumors binds to NK cells and monocytes via the inhibitory receptor Siglec-9. Here, we investigate whether MUC16 also binds to circulating immune cells during pregnancy and in women with preeclampsia.

METHOD OF STUDY

MUC16 binding was monitored by flow cytometry and immunoprecipitation, and RT-PCR was used to monitor indigenous expression in immune cells. Serum CA125 levels were measured by a clinical assay.

RESULTS

MUC16 was equally distributed on Siglec-9(pos) CD16(pos)/CD56(dim) and CD16(neg)/CD56(br) NK cells in the healthy pregnant and preeclampsia groups. While serum CA125 levels and number of NK and monocytes were similar, increased binding of MUC16 was observed on these immune cells in the preeclampsia cohort as compared to the healthy pregnant samples.

CONCLUSION

MUC16 binding to NK cells and monocytes likely contributes to tolerance of the fetal allograft from maternal responses and may also serve as a novel biomarker for preeclampsia.

Natural and Induced Humoral Responses to MUC1

MUC1 is a membrane-tethered mucin expressed on the ductal cell surface of glandular epithelial cells. Loss of polarization, overexpression and aberrant glycosylation of MUC1 in mucosal inflammation and in adenocarcinomas induces humoral immune responses to the mucin. MUC1 IgG responses have been associated with a benefit in survival in patients with breast, lung, pancreatic, ovarian and gastric carcinomas. Antibodies bound to the mucin may curb tumor progression by restoring cell-cell interactions altered by tumor-associated MUC1, thus preventing metastatic dissemination, as well as counteracting the immune suppression exerted by the molecule. Furthermore, anti-MUC1 antibodies are capable of effecting tumor cell killing by antibody-dependent cell-mediated cytotoxicity. Although cytotoxic T cells are indispensable to achieve anti-tumor responses in advanced disease, abs to tumor-associated antigens are ideally suited to address minimal residual disease and may be sufficient to exert adequate immune surveillance in an adjuvant setting, destroying tumor cells as they arise or maintaining occult disease in an equilibrium state. Initial evaluation of MUC1 peptide/glycopeptide mono and polyvalent vaccines has shown them to be immunogenic and safe; anti-tumor responses are scarce. Progress in carbohydrate synthesis has yielded a number of sophisticated substrates that include MUC1 glycopeptide epitopes that are at present in preclinical testing. Adjuvant vaccination with MUC1 glycopeptide polyvalent vaccines that induce strong humoral responses may prevent recurrence of disease in patients with early stage carcinomas. Furthermore, prophylactic immunotherapy targeting MUC1 may be a strategy to strengthen immune surveillance and prevent disease in subjects at hereditary high risk of breast, ovarian and colon cancer.

Serum concentrations of CA 125, CA 15-3, CA 19-9 and CEA in normal pregnancy: a longitudinal study

PURPOSE

Although cancer diagnosed during pregnancy is rare, the coexistence of pregnancy and malignancy becomes more common in view of prolongation of reproductive age. Therefore, it is important that the specificity of a tumor marker be evaluated during pregnancy to avoid misinterpretation in the follow-up of a pregnant cancer patient. The present study aims to investigate the serum concentrations of CA-125, CA 15-3, CA 19-9 and CEA in healthy pregnant women through gestation.

METHODS

In this prospective study, we followed thirty healthy pregnant women. Blood samples were obtained during each trimester of pregnancy (10-12, 22-24 and 34-36 weeks). The maternal serum levels of CA-125, CA 15-3, CA 19-9 and CEA were measured using electrochemiluminescence immunoassay.

RESULTS

There was no difference between the first and second trimester serum levels of CA 125, CEA and CA 19-9. However, serum CA 125 levels in third trimester were found to be significantly elevated in pregnants compared to the second trimester (median values 19.6 vs. 15.6 IU/mL, p = 0,009). Similarly, the serum CEA levels in third trimester were significantly higher than those of second trimester (median values 1.1 vs. 0.7 ng/ml, p = 0.001). It is also found that CEA and CA 19-9 assay values were significantly elevated in the third trimester of pregnancy when compared with the first trimester of pregnancy (CEA median values 1.1 vs. 0.7 ng/ml, p = 0.02 and CA 19-9 median values 11.6 vs. 7.7 IU/mL, p = 0,02). Three trimester had statistically similar levels for serum CA 15-3 (median values 17.5, 19.7 and 18.3 U/mL, respectively). The four tumor markers assay values were found generally within the normal range.

CONCLUSIONS

These findings suggest that maternal serum levels of CA 125, CEA and CA 19-9 were increased during third trimester of pregnancy. However, these elevations were within the normal range. CA 15-3 is independent of gestation and reliable tumor markers in monitoring malignancy in pregnant patients.

Serum concentrations of CA-125 in normal and preeclamptic pregnancies

AIM

The present prospective study aims to investigate the serum concentrations of CA-125 in normal and preeclamptic pregnancies and thus to specify the clinical utility of this biochemical marker in prediction, diagnosis and follow up of preeclampsia.

METHODS

The present study reviews a total of 242 women with singleton pregnancy. These participants were categorized into three groups: control (n = 100), mild preeclampsia (n = 78) and severe preeclampsia (n = 64). The three study groups were statistically similar in aspects of maternal age, gestational age and body mass index.

RESULTS

Serum CA-125 concentrations were found to correlate positively with systolic blood pressure (r = 0.345, p = 0.001), diastolic blood pressure (r = 0.379, p = 0.001), platelet count (r = 0.368, p = 0.001), serum levels of uric acid (r = 0.415, p = 0.001) and urine concentrations of protein (r = 0.357, p = 0.001). On the other hand, CA-125 levels correlated negatively with estimated fetal weight (r = -0.451, p = 0.001) and birthweight (r = -0.363, p = 0.001). When the cut-off point for serum CA-125 concentrations was accepted as 50 IU/ml, the sensitivity and specificity of this biochemical marker were, respectively, 93.7 and 88.0% for the detection of preeclamptic pregnancies. On the other hand, positive and negative predictive values for CA-125 were computed as 91.7 and 90.7%, respectively ( χ (2) = 30,184, p = 0.001).

CONCLUSION

The present study suggests that CA-125 is a biochemical marker which reflects the severity of the underlying inflammatory process in preeclampsia. Since it is much more available and relatively less expensive, it seems to be a promising test for screening preeclampsia. In accordance, the present study suggests 50 IU/ml as a cut-off point for CA-125 in screening preeclampsia.

The diagnostic value of beta-human chorionic gonadotropin, progesterone, CA125 in the prediction of abortions

This study was conducted to investigate the effectiveness of serum levels of free beta-hCG, progesterone, CA125 and their combined use in the prediction of first trimester abortions. A total of 140 singleton pregnant women between 5 and 13 weeks' gestational age were included as Group I (n = 21) who resulted in abortion including missed abortion, incomplete abortion, complete abortion and inevitable abortion; Group II (n = 129) included normal pregnancies. When using the free beta-hCG level of <20 ng/ml as a cut off point, the sensitivity, specificity, PPV and NPV were 91%, 82%, 46% and 98%, when using a progesterone of <15 ng/ml as a cut off point, they were 91%, 89%, 59%, 98%. The single measurement of free beta-hCG or progesterone levels can be useful in the prediction of first trimester spontaneous abortions, but using progesterone may be recommended since it has high availability and low cost.

Anti-MUC1 antibodies and ovarian cancer risk: prospective data from the Nurses' Health Studies

BACKGROUND

The surface epithelial glycoprotein MUC1 becomes overexpressed and hypoglycosylated in adenocarcinomas; similar changes occur during nonmalignant inflammatory events. Antibodies developed against tumor-like MUC1 in response to such events could be one way through which ovarian cancer risk factors operate.

METHODS

We evaluated the association between anti-MUC1 antibodies and risk of ovarian cancer in a prospective nested case-control study in the Nurses' Health Studies. We used an ELISA to measure plasma anti-MUC1 antibodies in 117 ovarian cancer cases collected at least 3 years before diagnosis and 339 matched controls.

RESULTS

In controls, younger women (P-trend = 0.03), those with a tubal ligation (P = 0.03), and those with fewer ovulatory cycles (P-trend = 0.04) had higher antibody levels. In cases, women with late-stage disease (P = 0.04) and those whose specimen was >11 years remote from diagnosis (P = 0.01) had higher antibody levels. Overall, increasing anti-MUC1 antibody levels were associated with a nonsignificant trend for lower risk for ovarian cancer, but there was highly significant heterogeneity by age (P-heterogeneity = 0.005). In women <64 years, the antibody level in quartiles 2 to 4 versus quartile 1 were associated with reduced risk (relative risk = 0.53; 95% confidence interval, 0.31-0.93; P-trend = 0.03), whereas in women > or = 64 years, the corresponding relative risk was 2.11 (95% confidence interval, 0.73-6.04); P-trend = 0.05).

CONCLUSION

Anti-MUC1 antibodies evaluated several years before diagnosis may be associated with lower risk of subsequent ovarian cancer in women <64 years old at assessment.

IMPACT

Key elements of an "immune model" to explain ovarian cancer risk factors are confirmed and should be evaluated in larger prospective studies.

CA-125 and CRP are elevated in preeclampsia

OBJECTIVE

To determine the relationship between the cancer antigen-125 (CA-125) and C-reactive protein (CRP) with preeclampsia and eclampsia.

METHODS

The study group included 54 preeclamptic/eclamptic women, and 56 healthy pregnant women served as the control group. Mean arterial pressure (MAP) and albumin levels were used to monitor the severity of disease. CRP and CA-125 levels were determined. The cut-offs for CRP and CA-125 were 5 mg/L and 35 IU/ml. The t-test, Pearson correlation and ANOVA were used for statistical analysis. Values of p < 0.05 were considered to be significant.

RESULTS

CRP and CA-125 parameters were significantly higher in the study group (p < 0.001), and were significantly higher in severe preeclampsia and eclampsia groups than in mild preeclampsia (p < 0.001). Significant correlations were found between CRP/MAP, CRP/albumin, CA-125/MAP and CA-125/albumin (p < 0.001).

CONCLUSION

CRP and CA-125 are elevating markers in preeclampsia.

[French recommendations for ovarian cancer management during pregnancy]

Evaluation of the fetus using prenatal ultrasound has resulted in increased detection of asymptomatic adnexal masses during pregnancy. Such masses are rarely malignant (1/10 000 to 1/50 000 pregnancies), but the possibility of borderline or cancer must be considered. It is a common assumption by both patients and physicians that if an ovarian cancer is diagnosed during pregnancy, treatment necessitates sacrificing the well-being of the fetus. However, in most cases, it is possible to offer appropriate treatment to the mother without placing the fetus at serious risk. The care of a pregnant woman with cancer involves evaluation of sometimes competing maternal and fetal risks and benefits. These recommendation approaches attempt to balance these risks and benefits; however, they should be considered advisory and should not replace specific interdisciplinary consultation with specialists in maternal-fetal medicine, gynecologic oncology, and pediatrics, as well as imaging and pathology, as needed. Second level ultrasound including Doppler is needed. MRI is not often necessary, and CA 125 is of low contribution. We suggest surgery be performed after 15 SA for ovarian masses which (1) persist into the second trimester, (2) are greater than 5 to 10 cm in diameter, or (3) have solid or mixed solid and cystic ultrasound characteristics. During antepartum surgical staging and debulking, homolateral salpingo-oophorectomy and peritoneal cytology and exploration are necessary. Women found to have advanced stage epithelial ovarian cancer should consider having completion of the debulking of the reproductive organs at the conclusion of the pregnancy. If chemotherapy is indicated, we recommend delaying administration, if possible, after the delivery or at least after 20 SA in order to minimize the potential fetal toxicity.

Tumor Markers In Biological Fluids Associated With Pregnancy

Proteins that are expressed by both malignant and healthy fetal tissues are recognized as oncofetal. These antigens are associated with cell proliferation and differentiation and are produced in high concentrations in pregnancy and malignancy. Their biological role in malignancy is the suppression of the host's immune system, while in pregnancy they affect the maternal immune response, generating maternal tolerance toward the embryo. This review describes the levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), squamous cell carcinoma antigen (SCC), cancer antigen 15-3 (CA 15-3), mucin-like carcinoma-associated antigen (MCA), tissue polypeptide-specific antigen (TPS), carbohydrate antigen 19-9 (CA 19-9), and prostate-specific antigen (PSA) in maternal serum (MS), umbilical cord serum (UC), and amniotic fluid (AF) and outlines their roles in the assessment of pregnancy and malignancy. All antigens studied, except CA 15-3, are oncofetal. The presence of considerable concentrations of AFP, hCG, CEA, CA125, SCC, MCA, TPS, CA 19-9, and PSA in AF during pregnancy may be attributed to their involvement in biological functions associated with fetal development, differentiation, and maturation. MS CEA, CA 15-3, and CA 19-9, in contrast to all the others, are not influenced significantly by pregnancy and thus remain reliable tumor markers in monitoring malignancy in pregnant patients.

Ovarian cysts during pregnancy: dilemmas in diagnosis and management

With routine obstetric ultrasound examinations, ovarian cysts are now more commonly diagnosed during pregnancy and their management is still a challenging clinical issue among obstetricians. The aim of this paper is to review the different management options of ovarian cysts detected during pregnancy, and it highlights the emergence of laparoscopic technique as a valuable therapeutic tool in these conditions. The review shows that conservative management and ultrasound follow-up is sufficient for the majority of cases of ovarian cysts during pregnancy. It also discusses the limitations of tumour markers during pregnancy, and the controversy around ultrasound-guided aspiration procedures. Emerging evidence suggests that if surgery is necessary, then it is preferable to perform an elective laparoscopic procedure at 16 - 23 weeks' gestation. It is time to consider establishing a UK registry to monitor the treatment offered to those women and to develop national guidelines to help in the management of this controversial issue.

Conditions associated with antibodies against the tumor-associated antigen MUC1 and their relationship to risk for ovarian cancer

Many cancers, including ovarian, overexpress epithelial mucin (MUC1) and promote anti-MUC1 antibodies that may correlate with more favorable prognosis. By extension, risk for ovarian cancer might be reduced by preexisting MUC1-specific immunity. We measured anti-MUC1 antibodies in 705 control women, identified events predicting antibodies, and estimated ovarian cancer risk by comparing profiles of events generating antibodies in controls with those in 668 ovarian cancer cases. Factors predicting antibodies included oral contraceptive use, breast mastitis, bone fracture or osteoporosis, pelvic surgeries, nonuse of talc in genital hygiene, and to a lesser extent intrauterine device use and current smoking. There was a significant increase in the likelihood of having anti-MUC1 antibodies from 24.2% in women with 0 or 1 condition, to 51.4% in those with five or more conditions. By the same index of events, the risk for ovarian cancer was inversely associated with number of conditions predisposing to anti-MUC1 antibodies. Compared with having experienced 0 or 1 event, the adjusted risk for ovarian cancer decreased progressively with relative risks (and 95% confidence limits) of 0.69 (0.52-0.92), 0.64 (0.47-0.88), 0.49 (0.34-0.72), and 0.31 (0.16-0.61), respectively for women with two, three, four, and five or more events related to the presence of antibodies (P(trend) < 0.0001.) We conclude that several traditional and new risk factors for ovarian cancer may be explained by their ability to induce MUC1 immunity through exposure of MUC1 to immune recognition in the context of inflammatory or hormonal processes in various MUC1-positive tissues.

The effect of endometriosis, cycle stage, lymphocyte suppression and pregnancy on CA-125 levels in peritoneal fluid and serum in baboons

BACKGROUND

Serum CA-125 during the mid-follicular phase has been reported to be a clinically useful and reproducible marker in the diagnosis of advanced endometriosis in women. This study was undertaken to document the effect of the menstrual cycle, pregnancy and lymphocyte suppression on CA-125 levels in peritoneal fluid (PF) and serum in baboons with a normal pelvis and baboons with endometriosis.

METHODS

CA-125 levels were measured in 264 serum samples that were serially obtained during one menstrual cycle from 10 animals with and without endometriosis. In addition, CA-125 levels were determined in 204 archived samples (serum, n = 112 and PF, n = 92) obtained from 32 female baboons with or without endometriosis. The CA-125 assays were performed by radioimmunoassay using kits from Centocor (Malvern, PA, USA).

RESULTS

Serum CA-125 levels were at their highest during menstruation and decreased progressively during the follicular and luteal phase. PF CA-125 levels were increased during the follicular phase in baboons with a normal pelvis, but no cyclic changes were observed in animals with endometriosis. Serum CA-125 levels were unaffected by induction, lymphocyte suppression or pregnancy. Induction of endometriosis resulted in increased PF CA-125 levels, whereas lymphocyte suppression or pregnancy had no effect.

CONCLUSION

In baboons, serum CA-125 originates mainly from eutopic endometrium whereas the main source of PF CA-125 seems to be the peritoneum or ectopic endometrium. The baboon appears to be a valid model to further study the relationship between endometriosis and CA-125.

Increased Serum CA-15.3 Levels in Patients with Megaloblastic Anemia due to Vitamin B12 Deficiency

OBJECTIVES

To estimate the usefulness of serum tumor markers' monitoring, as predictors of gastric cancer in patients with pernicious anemia.

PATIENTS AND METHODS

We investigated serum levels of carcinoembryonic antigen (CEA), alpha-fetal protein, cancer antigen (CA)-19.9, CA-125 and CA-15.3 in 50 patients with pernicious anemia and in 24 healthy controls, matched for age and sex. In 38 patients, the evaluation was repeated 1-6 months after the correction of cobalamin deficiency.

RESULTS

All patients and controls had normal serum CEA and alpha-FP, and the levels of these markers as well as those of CA-125 and CA-19.9 did not differ between the two groups. All 50 patients, but only 2 controls exhibited increased serum CA-15.3, and the difference between the two groups was very significant (129.4 +/- 84.9 vs. 19.8 +/- 7.3 IU/ml, p < 0.001), while no difference between males and females was found. A thorough clinical examination of all patients, and mammographic study in 18 females did not reveal any finding suspicious of breast cancer. CA-15.3 levels were positively correlated with serum lactate dehydrogenase, and negatively with B(12) and hemoglobin, but they were substantially decreased after the correction of anemia, in all 38 patients tested, and in 33 of them they were restored to normal. After a median follow-up of 34 months, one patient developed a colon cancer, but none showed any sign suspicious of breast cancer.

CONCLUSIONS

Serum CA-15.3 shows an aberrant increase in untreated patients with pernicious anemia, which is reversed after the correction of the anemia. The possible origin seems unrelated to mammary tissue, and may be released by the apoptosing bone marrow megaloblastic erythroblasts.

Management of ovarian cysts

BACKGROUND

The treatment of an ovarian cyst relies on its nature, and accurate preoperative discrimination of benign and malignant cysts is therefore of crucial importance. This study was undertaken to review the literature concerning the preoperative diagnosis and treatment of ovarian cysts.

METHODS

Articles concerning ovarian cysts from a medline literature search during the period 1985-2003 were included in addition to articles found as references in the initial publications.

RESULTS

Different methods for discriminating between benign and malignant ovarian cysts are discussed. The diagnosis and the treatment are assessed in relation to age, menopausal status, pregnancy, and whether the cyst is presumed to be benign or malignant. In general, expectant management is the choice in premenopausal and pregnant women with non-suspicious cysts and normal levels of CA-125. In postmenopausal women, unilocular, anechoic cysts less than 5 cm in diameter together with a normal CA-125 may be followed up. Operation is recommended in women with cysts larger than 5 cm and/or elevated levels of CA-125. Women with symptoms should be operated regardless of age, menopausal status, or ultrasound findings.

CONCLUSIONS

The preoperative discrimination between benign and malignant ovarian cysts is a challenge. Multimodal methods improve the results of single modalities, but we still need improved preoperative diagnostic tools. Furthermore, these methods should be validated in consecutive patient populations large enough to give a reliable estimate of the method's sensitivity and specificity.

Vaginal bleeding in the first 20 weeks of pregnancy

The first and foremost diagnosis to exclude in the pregnant patient presenting with vaginal bleeding is ectopic pregnancy. Once ectopic pregnancy is ruled out, miscarriage should be considered as a clinical spectrum. Its management is directed according to the integrity of the internal cervical os and patient hemodynamic status. Treatment with anti-D immune globulin is warranted for all Rh-negative patients. Urgent obstetric consultation is necessary for most miscarriage presentations.