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Zhang Q, Wang Z, Tang H, Zhang B, Yue C, Gao J, Ying C. Serum CYFRA21-1 and SCC-Ag levels in women during pregnancy and their diagnostic value for cervical cancer. Cancer Treat Res Commun 2023; 38:100786. [PMID: 38198984 DOI: 10.1016/j.ctarc.2023.100786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The incidence of cervical cancer increases every year during pregnancy. Cervical cytology in pregnant women has a unique morphology and liquid-based cytology methods are prone to cause false positives. The aim of this study was to investigate the serum cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) and squamous cell carcinoma associated antigen (SCC-Ag) concentrations in healthy pregnant women during pregnancy and to assess their diagnostic value for cervical cancer in pregnancy. METHODS In this prospective study, 165 healthy non-pregnant women, 441 healthy pregnant women and 22 patients with cervical cancer in pregnancy were recruited. The healthy pregnant women group included 143 women in the first trimester (T1), 147 in the second (T2) and 151 in the third (T3). RESULTS Both SCC-Ag and CYFRA21-1 levels were significantly different in the healthy pregnant women group compared to the control group. The CYFRA21-1 and SCC-Ag were higher in the T1 and T3 than in the control groups. However, there was no statistically significant difference in serum CYFRA21-1 and SCC-Ag levels in the T2 group compared to the control group. The AUCs of CYFRA21-1, SCC-Ag and CYFRA21-1 combined with SCC-Ag were 0.674, 0.792, and 0.805, respectively. The cut-off values of CYFRA21-1 and SCC-Ag were 6.64 ng/mL and 1.75 ng/mL, respectively. CONCLUSIONS Serum CYFRA21-1 and SCC-Ag levels were higher in pregnant women during early and late pregnancy compared to non-pregnant individuals, while they were not statistically different from non-pregnant women during mid-trimester. CYFRA21-1 and SCC-Ag have diagnostic value for cervical cancer in pregnancy.
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Affiliation(s)
- Qianlan Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Department of Clinical Laboratory, No. 419, Fangxie Road, Shanghai, China
| | - Zhiheng Wang
- Obstetrics and Gynecology Hospital of Fudan University, Department of Clinical Laboratory, No. 419, Fangxie Road, Shanghai, China
| | - Huijing Tang
- Obstetrics and Gynecology Hospital of Fudan University, Department of Clinical Laboratory, No. 419, Fangxie Road, Shanghai, China
| | - Bin Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Department of Clinical Laboratory, No. 419, Fangxie Road, Shanghai, China
| | - Chaoyan Yue
- Obstetrics and Gynecology Hospital of Fudan University, Department of Clinical Laboratory, No. 419, Fangxie Road, Shanghai, China
| | - Jin Gao
- Obstetrics and Gynecology Hospital of Fudan University, Department of Clinical Laboratory, No. 419, Fangxie Road, Shanghai, China
| | - Chunmei Ying
- Obstetrics and Gynecology Hospital of Fudan University, Department of Clinical Laboratory, No. 419, Fangxie Road, Shanghai, China.
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Oike T, Oike T, Ando K, Iwase A, Ohno T. The Non-Cancer Specific Elevation of the Serum Squamous Cell Carcinoma Antigen during the Post-Radiotherapy Follow-Up of Cervical Cancer Patients. Diagnostics (Basel) 2021; 11:diagnostics11091585. [PMID: 34573927 PMCID: PMC8464782 DOI: 10.3390/diagnostics11091585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/03/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022] Open
Abstract
The elevation of the serum squamous cell carcinoma (SCC) antigen unrelated to disease progression occurs during the follow-up of patients with cervical cancer treated with radiotherapy. Although known empirically, the incidence and characteristics of this non-cancer specific elevation in SCC remain unclear. Here, we examined the post-treatment kinetics of SCC in 143 consecutive patients with squamous cell carcinoma of the cervix treated with definitive radiotherapy; in all patients, progression-free disease status was confirmed by periodic monitoring for at least 36 months (median, 61 months). We found that the 5-year cumulative incidence of post-treatment SCC elevation was unexpectedly high at 37.3% (59/143 patients), and that 59.3% (35/59) of event-positive patients experienced multiple events. The median peak SCC level for a given event was 2.0 ng/mL (interquartile range, 1.7–2.9 ng/mL). The multivariate analysis showed that renal dysfunction was associated significantly with a greater incidence of SCC elevation (p = 0.046). In addition, the 5-year cumulative incidence of SCC elevation was significantly greater in patients with renal dysfunction than in those without (54.8% vs. 32.9%, respectively; hazard ratio, 2.1 [95% confidence interval, 1.1–4.2]; p = 0.028). These data will be useful for monitoring cervical cancer patients treated with radiotherapy.
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Affiliation(s)
- Tae Oike
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi 371-8511, Gunma, Japan; (T.O.); (A.I.)
| | - Takahiro Oike
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi 371-8511, Gunma, Japan; (K.A.); (T.O.)
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-machi, Maebashi 371-8511, Gunma, Japan
- Correspondence:
| | - Ken Ando
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi 371-8511, Gunma, Japan; (K.A.); (T.O.)
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi 371-8511, Gunma, Japan; (T.O.); (A.I.)
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi 371-8511, Gunma, Japan; (K.A.); (T.O.)
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-machi, Maebashi 371-8511, Gunma, Japan
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Van Ostade X, Dom M, Tjalma W, Van Raemdonck G. Candidate biomarkers in the cervical vaginal fluid for the (self-)diagnosis of cervical precancer. Arch Gynecol Obstet 2017; 297:295-311. [PMID: 29143101 PMCID: PMC5778162 DOI: 10.1007/s00404-017-4587-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Abstract
Purpose Despite improvement in vaccines against human papilloma virus (HPV), the causative agent of cervical cancer, screening women for cervical precancer will remain indispensable in the coming 30–40 years. A simple test that could be performed at home or at a doctor’s practice and that informs the woman whether she is at risk would significantly help make a broader group of patients who aware that they need medical treatment. Cervical vaginal fluid (CVF) is a body fluid that is very well suited for such a test. Methods Narrative review of cervical (pre)cancer candidate biomarkers from cervicovaginal fluid, is based on a detailed review of the literature. We will also discuss the possibilities that these biomarkers create for the development of a self-test or point-of-care test for cervical (pre)cancer. Results Several DNA, DNA methylation, miRNA, and protein biomarkers were identified in the cervical vaginal fluid; however, not all of these biomarkers are suited for development of a simple diagnostic assay. Conclusions Proteins, especially alpha-actinin-4, are most suited for development of a simple assay for cervical (pre)cancer. Accuracy of the test could further be improved by combination of several proteins or by combination with a new type of biomarker, e.g., originating from the cervicovaginal microbiome or metabolome.
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Affiliation(s)
- Xaveer Van Ostade
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium. .,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium.
| | - Martin Dom
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium.,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium
| | - Wiebren Tjalma
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Geert Van Raemdonck
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium.,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium
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Cavaco-Gomes J, Jorge Moreira C, Rocha A, Mota R, Paiva V, Costa A. Investigation and Management of Adnexal Masses in Pregnancy. SCIENTIFICA 2016; 2016:3012802. [PMID: 27119043 PMCID: PMC4826943 DOI: 10.1155/2016/3012802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
Adnexal masses can be found in 0.19 to 8.8% of all pregnancies. Most masses are functional and asymptomatic and up to 70% resolve spontaneously in the second trimester. The main predictors of persistence are the size (>5 cm) and the imagiological morphocomplexity. Those that persist carry a low risk of malignancy (0 to 10%). Most malignant masses are diagnosed at early stages and more than 50% are borderline epithelial neoplasms. Ultrasound is the preferred method to stratify the risk of complications and malignancy, allowing medical approach planning. Pregnancy and some gestational disorders may modify the levels of tumor markers, whereby their interpretation during pregnancy should be cautious. Large masses are at increased risk of torsion, rupture, and dystocia. When surgery is indicated, laparoscopy is a safe technique and should ideally be carried out in the second trimester of pregnancy.
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Affiliation(s)
- João Cavaco-Gomes
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Cátia Jorge Moreira
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Anabela Rocha
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Raquel Mota
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Vera Paiva
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Antónia Costa
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
- Porto Medical Faculty, 4200-319 Porto, Portugal
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Mor A, Tal R, Irani M, McCalla S, Haberman S, Garg D, Wajntraub B. Carcinoembryonic antigen as a biomarker for meconium-stained amniotic fluid. Int J Gynaecol Obstet 2015; 132:329-31. [PMID: 26674317 DOI: 10.1016/j.ijgo.2015.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/10/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess whether elevated carcinoembryonic antigen (CEA) concentration in amniotic fluid can indicate meconium-stained amniotic fluid (MSAF). METHODS In a prospective cohort study, women with a term singleton pregnancy who were in labor but had intact membranes were recruited at a center in Israel over a 5-month period in 2013. Only women who subsequently underwent artificial rupture of membranes following a clear medical indication were included. Samples of amniotic fluid, urine, and serum were collected. Amniotic fluid was examined by sight and classified as clear, MSAF, or undetermined. CEA concentration in the samples was measured. RESULTS Among 81 participants, 45 had clear amniotic fluid, 28 had MSAF, and eight had undetermined amniotic fluid. Mean CEA concentration was more than 10 times higher in MSAF (2658 μg/L, standard error 250) than in clear amniotic fluid (238 μg/L, standard error 29; P<0.001). Receiver operating characteristic curve analysis demonstrated a sensitivity of 96% and a specificity of 100% for distinguishing MSAF from clear amniotic fluid at a CEA cutoff of 799.2 μg/L. CEA concentrations in urine and serum were all within the normal range (≤5 μg/L), irrespective of amniotic fluid status. CONCLUSION High CEA concentrations in amniotic fluid can assist in the diagnosis of MSAF. These findings could provide the basis for a bedside test to detect MSAF following rupture of membranes.
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Affiliation(s)
- Amir Mor
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Reshef Tal
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Mohamad Irani
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Sandra McCalla
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Shoshana Haberman
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Deepika Garg
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Birgitta Wajntraub
- Department of Obstetrics and Gynecology, Laniado Medical Center, Netanya, Israel
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Seong WJ, Lee DY, Koo TB. Do the levels of tumor makers or proinflammatory cytokines in mid-trimester cervical fluid predict early-stage cervical shortening? J Obstet Gynaecol Res 2015; 41:1715-20. [PMID: 26419324 DOI: 10.1111/jog.12782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/03/2015] [Accepted: 05/12/2015] [Indexed: 11/27/2022]
Abstract
AIM In the present study, we aimed to assess the biomarkers in mid-trimester cervical fluid that can predict early stage cervical shortening. MATERIAL AND METHODS We obtained cervical swab specimens from 96 gravidas, after which the cervical length was measured, at approximately 20 weeks of gestation. Cervical length was measured again at 4 weeks after the initial examination. Cervical shortening was noted in 20 women between 20 and 24 weeks of gestation (group A), whereas no cervical shortening was noted in 76 women (group B). We evaluated the use of the levels of tumor markers, proinflammatory cytokines, and matrix metalloproteinase-8 (MMP-8) as candidate biomarkers. CA-125 and carcinoembryonic antigen levels were determined by using an automatic immunoassay system in both groups. Furthermore, IL-1β, IL-8, tumor necrosis factor-α, and MMP-8 levels were measured using an enzyme-linked immunosorbent assay. RESULTS The levels of inflammatory cytokines and MMP-8 did not differ between the two groups, and were not correlated with cervical length or the change in cervical length. Although CA-125 and carcinoembryonic antigen levels were higher in group A, they were not statistically significant (P = 0.304 and 0.092, respectively). CONCLUSION Early stage cervical shortening in mid-trimester was not associated with an increase in the levels of tumor markers or proinflammatory cytokines in cervical fluid.
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Affiliation(s)
- Won Joon Seong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu
| | - Dong Young Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu
| | - Tae Bon Koo
- Department of Obstetrics and Gynecology, Andong General Hospital, Andong, Korea
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Busardò FP, Frati P, Zaami S, Fineschi V. Amniotic fluid embolism pathophysiology suggests the new diagnostic armamentarium: β-tryptase and complement fractions C3-C4 are the indispensable working tools. Int J Mol Sci 2015; 16:6557-70. [PMID: 25807263 PMCID: PMC4394548 DOI: 10.3390/ijms16036557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/03/2015] [Accepted: 03/10/2015] [Indexed: 11/16/2022] Open
Abstract
Amniotic fluid embolism (AFE) is an uncommon obstetric condition involving pregnant women during labor or in the initial stages after delivery. Its incidence is estimated to be around 5.5 cases per 100,000 deliveries. Therefore, this paper investigated the pathophysiological mechanism, which underlies AFE, in order to evaluate the role of immune response in the development of this still enigmatic clinical entity. The following databases (from 1956 to September 2014) Medline, Cochrane Central, Scopus, Web of Science and Science Direct were used, searching the following key words: AFE, pathophysiology, immune/inflammatory response, complement and anaphylaxis. The main key word “AFE” was searched singularly and associated individually to each of the other keywords. Of the 146 sources found, only 19 were considered appropriate for the purpose of this paper. The clinical course is characterized by a rapid onset of symptoms, which include: acute hypotension and/or cardiac arrest, acute hypoxia (with dyspnoea, cyanosis and/or respiratory arrest), coagulopathies (disseminated intravascular coagulation and/or severe hemorrhage), coma and seizures. The pathology still determines a significant morbidity and mortality and potential permanent neurological sequelae for surviving patients. At this moment, numerous aspects involving the pathophysiology and clinical development are still not understood and several hypotheses have been formulated, in particular the possible role of anaphylaxis and complement. Moreover, the detection of serum tryptase and complement components and the evaluation of fetal antigens can explain several aspects of immune response.
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Affiliation(s)
- Francesco Paolo Busardò
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy.
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy.
- Neuromed, Istituto Mediterraneo Neurologico (IRCCS), Via Atinense 18, Pozzilli, 86077 Isernia, Italy.
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy.
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy.
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Han SN, Lotgerink A, Gziri MM, Van Calsteren K, Hanssens M, Amant F. Physiologic variations of serum tumor markers in gynecological malignancies during pregnancy: a systematic review. BMC Med 2012; 10:86. [PMID: 22873292 PMCID: PMC3425318 DOI: 10.1186/1741-7015-10-86] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 08/08/2012] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Sileny N Han
- Leuven Cancer Institute, Gynecologic Oncology, University Hospitals Leuven, KU Leuven, Belgium
| | - Anouk Lotgerink
- Department of Obstetrics and Gynecology, Jessa Hospital, Hasselt, Belgium
| | | | | | - Myriam Hanssens
- Foeto-Maternal Unit, University Hospitals Leuven, KU Leuven, Belgium
| | - Frédéric Amant
- Leuven Cancer Institute, Gynecologic Oncology, University Hospitals Leuven, KU Leuven, Belgium
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Park Y, Lee JH, Hong DJ, Lee EY, Kim HS. Diagnostic performances of HE4 and CA125 for the detection of ovarian cancer from patients with various gynecologic and non-gynecologic diseases. Clin Biochem 2011; 44:884-8. [PMID: 21549107 DOI: 10.1016/j.clinbiochem.2011.04.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 02/28/2011] [Accepted: 04/17/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We compared diagnostic performance of CA125 and HE4 in various gynecologic and non-gynecologic diseases. DESIGN AND METHODS Sera from 176 patients with various diseases were collected, and CA125 and HE4 levels were compared. ROC curves were constructed to estimate the diagnostic performance. RESULTS Levels of both markers were elevated in ovarian cancer. CA125 was also high in benign gynecologic diseases, but HE4 was not. CA125 levels of pregnant women were higher than those of control group, and HE4 was increased in chronic renal diseases. The sensitivity for discriminating ovarian cancer from healthy or benign conditions was 44.8% for HE4 and 55.2% for CA125 at 95% specificity. The ROC-AUC values for HE4 and CA125 were 0.85 and 0.87 respectively. CONCLUSIONS HE4 demonstrated comparable diagnostic performances to CA125, though each marker had its own strengths and weaknesses. Combining CA125 and HE4 might be more advantageous than either one alone.
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Affiliation(s)
- Yongjung Park
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Sarandakou A, Protonotariou E, Rizos D. Tumor Markers In Biological Fluids Associated With Pregnancy. Crit Rev Clin Lab Sci 2008; 44:151-78. [PMID: 17364691 DOI: 10.1080/10408360601003143] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Kiran G, Kiran H, Guler FI, Ekerbicer HC, Kilinc M. Maternal serum and umbilical cord tumor marker levels at term pregnancy. Acta Obstet Gynecol Scand 2004; 84:85-9. [PMID: 15603573 DOI: 10.1111/j.0001-6349.2005.00584.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the study was to compare the levels in fetal and maternal compartments of cancer antigen (CA) 125, CA 15-3, carbohydrate antigen (CA) 19-9, and carcinoembryonic antigen (CEA) and to determine the effects of fetal sex, parity, and fetal weight on umbilical cord (UC) and maternal serum (MS) levels of these markers. METHODS MS and UC levels of these markers were determined in blood samples taken simultaneously during cesarean delivery for 53 cases. All statistical analyses were performed using nonparametric tests (Wilcoxon's signed rank test, Mann-Whitney U-test, Kruskal-Wallis anova). Correlations were evaluated with Spearman's rank correlation coefficients. RESULTS All marker levels of MS were significantly different to those of UC. There was no association between MS and UC levels of four markers and fetal sex. No significant difference could be demonstrated between fetal weight and marker levels in MS and UC. No significant difference could be demonstrated between parity and marker levels except CEA in MS that was elevated in multigravida group. CONCLUSIONS Our results support that all markers except CA 15-3 have oncofetal origin. We concluded that further studies are required to reveal the effects of fetal sex on MS CA 19-9 and effects of parity on MS CEA levels.
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Affiliation(s)
- Gurkan Kiran
- Department of Obstetrics and Gynecology, Kahramanmaras Sutcuimam University, School of Medicine, Kahramanmaras, Turkey.
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Sarandakou A, Rizos D, Botsis D, Kassanos D, Thomopoulos P, Protonotariou E, Phocas I. Mucin-like carcinoma-associated antigen (MCA) during normal pregnancy. Eur J Obstet Gynecol Reprod Biol 2001; 96:51-4. [PMID: 11311760 DOI: 10.1016/s0301-2115(00)00384-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the usefulness of Mucin-like carcinoma-associated antigen (MCA) in monitoring pregnant patients with breast cancer. STUDY DESIGN Maternal serum (MS) and amniotic fluid (AF) antigen values were measured by an enzyme immunoassay in 30 pregnant women during the second trimester, in 28 during the third and in 26 at parturition. Sera only from 26 women in the first trimester and from 26 healthy, non-pregnant women (controls) were also analyzed. RESULTS Maternal serum MCA concentrations increased significantly with gestational age (p<0.0001). The frequency of elevated serum values was 5% in the first, 35% in the second and 100% in the third trimester and at parturition. Antigen values in AF were markedly higher than those in MS (p<0.0001) and increased also significantly with advancing gestation (p<0.0001). A strong correlation was observed between MS and AF antigen values (r=0.77, p<0.0001). Maternal serum values at parturition were dependent on the mode of delivery, being higher in the cases who delivered vaginally, compared to those delivered by elective caesarean section (p<0.006). CONCLUSION Our data suggest that pregnancy affects significantly maternal serum MCA. Consequently, MCA seems to be a non-reliable marker in monitoring pregnant patients.
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Affiliation(s)
- A Sarandakou
- Hormone Laboratory, Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, 11528, Athens, Greece.
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Sarandakou A, Phocas I, Botsis D, Rizos D, Trakakis E, Chryssikopoulos A. Vaginal fluid and serum CEA, CA125 and SCC in normal conditions and in benign and malignant diseases of the genital tract. Acta Oncol 1998; 36:755-9. [PMID: 9490096 DOI: 10.3109/02841869709001350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Carcinoembryonic antigen (CEA), CA125, and squamous cell carcinoma antigen (SCC) were evaluated in paired vaginal fluid and serum samples from 69 women, mean age 40.6 (20-78) years. Fifteen of the subjects were normal females (controls), 12 were pregnant, 20 had benign gynecological diseases, 5 presented severe cervical dysplasias and 17 suffered from cancer of the genital tract. Highly elevated CEA, CA125 and SCC concentrations (median, range) were found in vaginal fluid: 186 ng/ml (12-5420); 890 U/ml (54-65000); 1600 ng/ml (27-13000) respectively, compared with those in the paired serum samples: 1 ng/ml (0.5-8.6); 12 U/ml (3.0-1590); 1 ng/ml (0.3-19). Vaginal fluid CEA, CA125 and SCC values were significantly different among the five studied groups (p < 0.0002; p < 0.02: p < 0.002 respectively), being significantly higher in the patients with benign gynecological diseases, compared with those in the patients with malignancies of the genital tract (p < 0.0001; p < 0.02; p < 0.005), and those in controls (p < 0.02; p < 0.007; p < 0.02 respectively). The results of this study suggest that: 1) CEA, CA125 and SCC seem to be normal constituents of vaginal fluid. 2) The distribution of CEA, CA125 and SCC between vaginal fluid and the circulation is affected by pregnancy, inflammation and cancer of the genital tract.
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Affiliation(s)
- A Sarandakou
- Second Department of Obstetrics and Gynecology, Areteion University Hospital, Athens, Greece
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Podnos YD, Gamboa G, Kurosaki T, Buller R, Walker JL, Manetta A. Ovarian vein vs peripheral blood CA125 serum levels: a comparative study. Gynecol Oncol 1997; 66:71-4. [PMID: 9234924 DOI: 10.1006/gyno.1997.4712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Direct sampling from the ovarian vessels may be considered as a supplementary method of ovarian cancer diagnosis providing further clinical information for the staging and localization of ovarian carcinoma. This present multi-institutional study evaluates and compares the clinical values of CA125 serum levels sampled directly from the right and left ovarian veins to the peripheral blood supply in an effort to correlate CA125 values to tumor volume and location. METHODS Serum samples from 43 patients with primary ovarian carcinoma were evaluated for the presence of CA125. All patients underwent surgery for the primary tumor, and stage was defined according to the classification of the International Federation of Gynecology and Obstetrics. The measurement of CA125 was accomplished by radioimmunoassay. RESULTS Twenty of 20 patients with serous papillary adenocarcinoma, 8/12 patients with tumors of low malignant potential, 6/6 patients with endometrioid carcinoma, 2/4 patients with clear cell adenocarcinoma, and 1/1 patients with mucinous adenocarcinoma had elevated (>35 U/mL) peripheral CA125 levels. Peripheral blood CA125 values had Spearman correlation coefficients of 0.96 and 0.95 with left and right ovarian vein CA125 values, respectively. Similarly, left and right ovarian vein CA125 values had a correlation coefficient of 0.98. CA125 values were moderately correlated with tumor volume in this sample. Spearman correlation coefficients between left ovarian vein CA125 values and left and right tumor volume were 0.51 and 0.43, respectively. Spearman correlation coefficients between right ovarian vein CA125 levels and left and right tumor volume were 0.41 and 0.46, respectively. Those between peripheral CA125 values and left and right tumor volume were 0.56 and 0.36, respectively. Median CA125 values for stage I diseases were elevated (53.25, 101.5, and 74.50 for left, right, and peripheral, respectively). DISCUSSION Direct sampling from the ovarian veins compared to that from the peripheral veins did not appear to offer additional information regarding ovarian tumor volume and location.
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Affiliation(s)
- Y D Podnos
- Department of Obstetrics and Gynecology, University of California, Irvine, Medical Center (UCIMC), Orange 92668, USA
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Phocas I, Sarandakou A, Rizos D, Dimitriadou F, Mantzavinos T, Zourlas PA. Tumour-associated antigens, CEA, CA 125 and SCC in serum and follicular fluid of stimulated and unstimulated cycles. Eur J Obstet Gynecol Reprod Biol 1994; 54:131-6. [PMID: 8070597 DOI: 10.1016/0028-2243(94)90252-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Serum and follicular fluid levels of CEA, CA 125 and SCC of women participating in an IVF program, in 42 cycles stimulated with GnRH-a and gonadotropins and in 26 unstimulated cycles triggered with HCG, were evaluated and compared with (a) steroid and gonadotropin levels, (b) the results of IVF, and (c) serum values in a control group of women with spontaneous normal ovulatory cycles. In the control group, serum antigens did not vary significantly during the 3 phases of the cycle. In stimulated cycles the median values in serum were 0.7 ng/ml (range, 0.0-2.1) for CEA, 14.0 U/ml (3.3-32.4) for CA 125 and 2.05 ng/ml (1.1-17.8) for SCC, whereas the median values in follicular fluid were 0.6 (0.0-27.9), 21.5 (0-670) and 21.4 (1-360), respectively. In unstimulated cycles the median values and ranges in serum were 0.9 (0.4-3.9), 12.1 (4.8-63.4) and 1.85 (0.7-4.4), respectively, whereas in follicular fluid they were 2.9 (0.4-180.7), 32 (1.7-600) and 231 (10.8-904). Different follicles of the same patients in stimulated cycles showed a wide divergence for all three antigens. In unstimulated cycles all three antigens in follicular fluid were strongly-correlated and a significant inverse correlation was observed between LH and both CA 125 and SCC in serum. In either group of cycles, no significant relationship was found between any serum or follicular fluid antigen and estradiol or testosterone, pregnancy rate, or oocyte quality and fertilization.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- I Phocas
- Second Department of Obstetrics and Gynecology, University of Athens, Areteion University Hospital, Greece
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