Increased Mortality in Postmenopausal Women with Serum CA125 Elevation

Jeyarajah, Arjun; Ind, Thomas; MacDonald, Nicola; Skates, Steven J.; Oram, David; Jacobs, Ian

doi:10.1006/gyno.1999.5350

Cited by 7 publications

(2 citation statements)

References 21 publications

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“…We observed that a CA‐125 level greater than 39.77 U/mL did not correlate with disease recurrence; however, interestingly, it was associated with OS, suggesting that mortality may be influenced by other factors, such as comorbidities. A previous study in healthy postmenopausal women found that a serum CA‐125 level >30 U/mL was significantly associated with an increased risk of death from all causes within the next 5 years 29 . Further research is needed to determine the underlying mechanisms for the linkage between elevated CA‐125 levels and increased all‐cause mortality.…”

Section: Discussionmentioning

confidence: 99%

Integration of pretreatment tumor markers in a nomogram model for prognostic prediction of FIGO stage I endometrial cancer: A multi‐institutional cohort study

Lin,

Wu,

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTraditionally, the prognosis of patients with FIGO stage I endometrial cancer is determined by clinicopathological risk factors. In this study, we assessed the potential contribution of pretreatment carcinoembryonic antigen (CEA) and carbohydrate antigen‐125 (CA‐125) levels to estimating the prognosis of these patients and aimed to develop and validate a prognostic nomogram.MethodsThis retrospective study included patients with FIGO stage I endometrial cancer who underwent treatment between January 2009 and December 2021 in the four institutes of Chang Gung Memorial Hospital. To identify optimal cutoff values of CEA and CA‐125 for predicting survival, receiver operating characteristic (ROC) curves were generated, the Kaplan–Meier method was used to estimate survival, and a Cox regression model was used to analyze the independent prognostic factors. Finally, a nomogram and calibration curve were constructed to predict patient survival probability.ResultsOf the 1559 patients evaluated, the optimal cutoff values of CEA and CA‐125 were 1.44 ng/mL (area under the ROC curve [AUC] 0.601) and 39.77 U/mL (AUC 0.503), respectively. Multivariate Cox regression analysis showed that pretreatment CEA (hazard ratio [HR] 2.11, 95% confidence interval [95% CI] 1.35–3.28), CA‐125 (HR 2.07, 95% CI 1.31–3.27), age >70 years (HR 12.54, 95% CI 5.05–31.11), myometrial invasion >50% (HR 1.69, 95% CI 1.03–2.73), non‐endometrioid histology (HR 1.83, 95% CI 1.14–2.95), high‐grade tumor (HR 2.41, 95% CI 1.46–3.97), and lymphovascular space invasion (HR 2.32, 95% CI 1.26–4.25) were significant variables associated with overall survival. These factors were used to construct the nomogram model, which showed good concordance and accuracy.ConclusionsIntegration of pretreatment CEA and CA‐125 in a prognostic nomogram is feasible. Our prediction model has the potential to assist clinicians in guiding appropriate clinical practice.

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Section: Discussionmentioning

confidence: 99%

Integration of pretreatment tumor markers in a nomogram model for prognostic prediction of FIGO stage I endometrial cancer: A multi‐institutional cohort study

Lin,

Wu,

et al. 2024

Intl J Gynecology & Obste

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“…Among postmenopausal women, the prevalence of malignant pathology is greater, and conditions such as endometriosis or pelvic inflammatory disease are rare, thus improving the specificity substantially [14]. Also, it has been shown among this older group that persistent elevated levels are associated with a 5-fold increased risk of mortality within 5 years [15]. With these aspects in mind, investigation of CA 125 as a screening tool for symptomatic women in primary care has been undertaken and yielded encouraging information [16].…”

Section: Introductionmentioning

confidence: 99%

Exploration of Preliminary Objective Triage by Menopause Score and CA 125 Result Prior to Accelerating Fast-Track Booking for Suspected Ovarian Cancer—A Role for the Pathway Navigator?

Woolas,

Young,

Brinkmann

et al. 2024

Diagnostics

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The 28-days-to-diagnosis pathway is the current expected standard of care for women with symptoms of ovarian cancer in the UK. However, the anticipated conversion rate of symptoms to cancer is only 3%, and use of the pathway is increasing. A rapid triage at the moment of receipt of the referral might allow resources to be allocated more appropriately. In secondary care, multidisciplinary teams (MDTs) use the risk of malignancy index (RMI) score, (multiply menopausal status pre = 1 or post = 3 × ultrasound score = 0 − 3 × the CA 125 level), using a score of >200, to triage urgency and management in possible ovarian cancer cases. The most powerful determinant of the RMI score variables is CA 125 level, an objective number. Could a simple modification of the RMI score retain a high sensitivity for cancer whilst improving specificity and, consequently, decrease the morbidity of false-positive classification? To test this hypothesis, a retrospective evaluation of an ovarian two-week-wait telephone clinic of one consultant gynaecological oncologist was undertaken. Enquiry re menopause status was scored as one for pre- and three for postmenopausal or uncertain. CA 125 levels of >67 u/mL for premenopausal and >23 u/mL for postmenopausal women were used to precipitate urgent cross-sectional imaging requests and MDT opinions. These CA 125 cut thresholds were calculated using an assumption that the RMI imaging score, regardless of whether the result was available, could be three. We contemplate that women who did not exceed a provisional RMI score of >200 might be informed they are extremely unlikely to have cancer, removed from the malignancy tracker and appropriate follow-up arranged. One hundred and forty consecutive cases were analysed; 43% were deemed premenopausal and 57% postmenopausal. Twenty of the women had cancer, eighteen (90%) of whom had an RMI > 200. One hundred and twenty were benign, and only twenty-three (19%) classified as urgent cases in need of accelerated referral to imaging. In contrast, CA 125 > 35 u/mL, whilst retaining the sensitivity of 90%, misclassified 36 (30%) of the benign cases. It is possible that a telephone triage via a questionnaire determining menopausal status and the CA 125 result could offer a sensitivity for cancer of 90% and urgent expert review of under 20% of benign cases. This rapid initial telephone assessment could be presented by a trained pathway navigator, physician associate or nurse specialist. Substantial savings in NHS cancer services resources, anxieties all around and reduced patient morbidity may occur as a result.

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The Significance of Serum CA 125 Elevation in Malignant and Nonmalignant Diseases

Sjövall¹,

Nilsson²,

Einhorn³

2002

Gynecologic Oncology

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Increased Mortality in Postmenopausal Women with Serum CA125 Elevation

Cited by 7 publications

References 21 publications

Integration of pretreatment tumor markers in a nomogram model for prognostic prediction of FIGO stage I endometrial cancer: A multi‐institutional cohort study

Integration of pretreatment tumor markers in a nomogram model for prognostic prediction of FIGO stage I endometrial cancer: A multi‐institutional cohort study

Exploration of Preliminary Objective Triage by Menopause Score and CA 125 Result Prior to Accelerating Fast-Track Booking for Suspected Ovarian Cancer—A Role for the Pathway Navigator?

The Significance of Serum CA 125 Elevation in Malignant and Nonmalignant Diseases

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