Plasma D-Dimer Measurement as a Marker of Gynecologic Tumors: Comparison with CA 125

Background

Fibrin is formed and degraded Intra-abdominally in ovarian cancer, and the cross-linked fibrin degradation product, D-dimer (D-D), has been found in increased concentrations In the plasma of these patients.

Methods

D-dimer and Ca 125 levels were determined simultaneously in 110 patients with gynecologic neoplasms. D-dimer and Ca 125 assays were performed using the Dimertest Stripwell EIA Kit (Ortho) and CA 125-11 EIA assay (Roche), respectively.

Results

D-dimer plasma and Ca 125 serum levels were significantly higher in patients with ovarian cancer (mean ± SE = 894.2 ± 173.7 ng/ml and 760.5 ± 292.7 U/ml, respectively) than in those with uterine cancer (mean DD ± SE = 109.7 ± 23.5 ng/ml and mean Ca 125 ± SE = 50.0 ± 23.1 U/ml) or those with benign disease (mean D-D ± SE = 70.5 ± 5.5 ng/ml and mean Ca 125 ± SE = 6.6 ± 2.8 U/ml). The levels of both markers Increased with regard to ovarian cancer disease status. Mean D-D ± SE was 90.0 ± 22.8 ng/ml and mean Ca 125 ± SE was 2.1 ±1.2 U/ml in patients with complete remission; mean D-D ± SE was 143.3 ± 33.5 ng/ml and mean Ca 125 ± SE was 26.2 ± 13.6 U/ml in patients with partial remission. In active disease, both markers had very high levels: D-D mean ± SE = 1021.6 ± 173.0 ng/ml and Ca 125 mean ± SE = 1154.7 ± 458.1 U/ml. In all groups of ovarian cancer patients, D-dimer sensitivity was better than that of Ca 125. In advanced ovarian cancer patients, the D-dimer concentration in ascites was up to 100 fold that in plasma.

Conclusions

Our results suggest that D-dimer can serve as a sensitive indicator to monitor the extent and course of the disease in ovarian cancer patients. The patient follow-up is ongoing to establish the predictive value of D-dimer measurement with respect to prognosis.

Measurement of the Ovarian Cancer-Associated Antigen CA 125 in Monitoring Tumor Burden and Response to Chemotherapy

CA 125 serum levels were measured in 74 patients with ovarian carcinoma. Among 31 patients undergoing a second look laparotomy (SL) after chemotherapy pathologic complete response (PCR) was observed in 14 patients, residual disease (RD) < 2 cm in 7 patients and RD >2 cm in 10 patients. The disease status was compared to the CA 125 serum levels measured just before SL. Thirteen of the 14 patients with PCR had serum CA 125 values < 35 U/ml (specificity: 93 %). On the other hand, only 10 of the 17 patients with RD showed serum levels > 35 U/ml (sensitivity: 59 %). Moreover, in the 43 patients receiving chemotherapy, CA 125 levels correlated with the course of the disease in 36 (84 %). With regard to early detection of recurrence, in 9/14 patients with PCR, whose CA 125 levels were monitored monthly, by 1 to 7 months an increase of the tumor marker preceded clinical evidence of relapse in 9/9 relapses (100%). In conclusion, CA 125 assay can be helpful in the management of ovarian cancer patients, in monitoring the response to chemotherapy, in the early detection of tumor recurrence, and in predicting the SL findings, although the low sensitivity could be a major drawback in patients with RD before SL.

[Evaluation of the levels of radiofrequency electromagnetic fields in the territory of the city of Bari in outside and inside environments]

In this study we measured the levels of the high frequency field in the proximity of non-ionizing radiation sources (wireless transmitting stations for mobile telephones and radio and television transmitters) in nine districts of the city of Bari. The measurements were taken both inside and outside closed environments. For the indoor measurements we took into account electromagnetic field generating equipment (VDT, electric domestic appliances, mobile telephones) in working and non-working order and with the windows open and shut respectively. We carried out these measurements according to the methods laid down in the Italian regulation CEI ENV 50166-2 of May 1995, as shown in the enclosure to the Ministerial Decree of 10.9.98 n.381. The electromagnetic field levels near wireless transmitting stations for mobile telephones are certainly modest when we consider that they never exceeded the limits established by the aforesaid Ministerial Decree. On the contrary radio and television equipment creates a much greater source of exposure. The electromagnetic field levels are certainly superior to those of the wireless transmitting stations although they never exceed, except in one isolated case, the values established by the Ministerial Decree 381/98.

A prothrombotic state in breast cancer patients treated with adjuvant chemotherapy

Cancer is often associated with abnormal activation of coagulation leading to a prothrombotic state. Some chemotherapeutic agents used for cancer may induce thrombosis but their biological alterations in the hemostatic system are not yet well understood. This study evaluated alterations of coagulative and fibrinolytic parameters following chemotherapy. In plasma samples of 38 patients (median age: 49 years) receiving CMF (schedule 1-21 or 1-8) for Stage II breast cancer, we evaluated: PT, aPTT, antithrombin III (AT-III), protein C (PC), protein S (PS), thrombin-antithrombin complex (TAT), prothrombin fragment F 1 + 2 (F 1 + 2), fibrinogen (Fbg), tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1) and D-dimer (D-D). PT, aPTT, and Fbg were determined with routine methods; AT-III, PC, and PS were measured with coagulative tests; PC and PS were also evaluated with immunoenzymatic methods, t-PA, PAI-1, D-D, TAT, and F 1 + 2 were measured with immunoenzymatic methods. All tests were performed immediately before starting therapy and after each cycle. A PC antigen decrease appeared soon after beginning therapy and lasted throughout chemotherapy. The lowest values were present after the first treatment both in the CMF 1-21 group (mean +/- SD = 72.5 +/- 10.8%) and in the CMF 1-8 group (mean +/- SD = 77.2 +/- 6.9%): PC activity was also decreased. PS antigen decreased after the first administration (mean +/- SD = 73.3 +/- 10% in CMF 1-21 group, and 72.5 +/- 4.9% in CMF 1-8 group): PS activity also decreased. PAI-1 antigen levels increased (mean +/- SD = 43.1 +/- 20.4 ng/ml in the CMF 1-21 group, and 37.5 +/- 12.2 ng/ml in CMF 1-8 group) lasting up to the last cycle. CMF provokes a trend toward hypercoagulability; this effect should be considered when chemotherapy is employed in advanced cancer patients at high risk for thrombosis, or in patients with other risk factors.

Her-2/neu and fibrinolytic factors in human breast-cancer

HER-2/neu status and t-PA, u-PA, and PAI-1 cytosol content were evaluated in 88 primary breast cancer patients to determine the relationships between these parameters. HER-2/neu was amplified in 24% (20/84) of tumor samples and overexpressed in 28% (14/50). In the overall series, median t-PA, u-PA and PAI-1 contents, measured by the enzyme-linked immmunoassay (ELISA), resulted in 1.7, 1.1 and 1.0 ng/mg cytosol protein (cyt prot), respectively. HER-2/neu overexpressed cases showed higher u-PA levels than those normally expressed whereas t-PA and PAI-1 levels did not vary in HER-2/neu altered and non altered cases. The t-PA levels did not differ in cases with or without HER-2/neu alterations, when separately considering the node-negative and node-positive cases. A significant relationship between t-PA levels and HER-2/neu alterations was observed only in the ER(+) tumors: t-PA levels were lower in amplified and overexpressed cases (1.4 versus 2.5 ng/mg cyt prot in amplified and single copy gene, respectively; 1.6 versus 2.3 ng/mg cyt prot in overexpressed and normally expressed cases, respectively). Therefore, t-PA and HER-2/neu could provide additional prognostic information for ER-negative patients.

Tissue-type plasminogen activator as marker of functional steroid receptors in human breast cancer

The relationship between tissue-type plasminogen activator (t-PA) antigen content and receptor status was investigated in 200 human breast cancer cytosols to evaluate the efficacy of t-PA as a marker of functional steroid receptors. t-PA level was measured by an enzyme-linked immunoassay (ELISA) and estrogen (ER) and progesterone (PgR) receptors were assayed by the DCC method. A highly significant correlation was found between t-PA levels and receptor status. The mean +/- SE enzyme content was 13.5 +/- 2.9 in ER+ tumors and 1.8 +/- 0.3 ng/mg protein in ER- tumors; the enzyme content in PgR+ tumors was 14.2 +/- 3.3 and 3.4 +/- 1.4 ng/mg protein in PgR- tumors. When tumors were divided into four subgroups according to receptor content (ER+PgR+, ER+PgR-, ER-PgR+, and ER-PgR-), t-PA concentration was able to differentiate these groups. Also, t-PA level was compared to several clinical variables; it was not correlated with menopausal status or lymph node involvement. However, t-PA content varied according to tumor size. Our data shows that t-PA content in tumor cytosols is statistically related to receptor status and that determination of t-PA levels in breast cancer might furnish additional information as to the functional state of the receptors which may be necessary for planning hormone therapy.