Predictive value of the combination of serum markers, CA125, CASA and TPS in ovarian cancer

Abstract

The serum markers CA125, CASA and TPS were compared, with particular reference to the clinical applications of these tumor markers in the management of patients with ovarian cancer (discrimination of benign and malignant disease; indicating prognosis; predicting preclinical recurrence), (i) Using recommended cut-off points, CASA (>/=4 U ml-1 and TPS (>/=80 U l-1 showed similar sensitivities in ovarian carcinoma (56% and 57% respectively), though these were lower than with CA125 (85% >/= 35 U ml-1). The combined use of CA125 with either CASA or TPS at higher cut-off points excluding benign disease (CA125> 345 U ml-1; CASA> 6 U ml-1; TPS> 359 U l-1) improved the discrimination of ovarian cancer from benign adnexal masses (100% positive predictive value with 65% of ovarian cancers detected with CA125-CASA, 61% with CA125-TPS vs 46% with CA125 alone). The combined preoperative use of these markers may therefore assist the general gynecologist in avoiding potentially difficult oncologic surgery. (ii) TPS was the best preoperative indicator of prognosis, possibly due to its association with cell proliferation, while CASA was superior as a postoperative prechemotherapeutic prognostic indicator, possibly due to it being a more accurate indicator of residual disease than the other markers, or the surgeons' assessment. Similarly, CASA gave the best differentiation of patients with minimal residual disease (<1 cm) into those with a good or poor prognosis, (iii) CA125 and CASA each detected preclinical recurrence after surgery and adjuvant therapy in seven of 11 patients (mean lead times 4.6 and 3.1 months respectively) while TPS detected four of these patients (mean lead time 2.4 months). The combined use of CA125 with either assay led to the preclinical detection of eight of 11 patients, with the mean lead time increased to 5.3 months with the CA125-CASA combination.

Cathepsin B-Like Activity as a Serum Tumour Marker in Ovarian Carcinoma

“…In an attempt to promote earlier diagnosis and improve monitoring of ovarian cancer, numerous markers have been studied (2)(3)(4)(5)(6). To date, none has been found suitable for widespread clinical application.…”

Tissue polypeptide specific antigen in the follow-up of ovarian and cervical cancer patients

“…TPS is a serum tumor marker which has been studied in a wide variety of malignancies, such as lung, colon, breast, ovarian and urological cancers (Tarle et al, 1994;Devine et al, 1995;Kornek et al, 1995;van der Gaast et al, 1994;Klein et al, 1994).…”

“…TPS is therefore believed to achieve higher specificity rates than TPA. TPS has been proposed as a useful tool in evaluating treatment response and early detection of relapse in a variety of human malignancies such as pancreatic, prostatic, cervical, ovarian cancer and gastrointestinal tumors (Banfi et al, 1993;Gitsch et al, 1992;Tarle et al, 1994;Devine et al, 1995;Kornek et al, 1995). Elevated TPS serum levels prior to therapy have been shown to parallel poor patient outcome in several malignancies, e.g., non-small cell lung cancer (van der Gaast et al, 1994).…”

Comparative analysis of CA125, tissue polypeptide specific antigen, and soluble interleukin‐2 receptor α levels in sera, cyst, and ascitic fluids from patients with ovarian carcinoma

“…It also has been reported that CA125 is a better marker for nonmucinous ovarian malignancy compared with mucinous ovarian malignancy 1, 5. The management of patients with epithelial ovarian carcinoma, especially in establishing response to treatment or predicting clinical outcome, can be improved by combining the evaluation of CA125 levels with the evaluation other serum markers 2, 5, 8–10…”

“…TPS can contribute to the prediction of prognosis and response to treatment in patients with different types of carcinoma 2, 5, 11. Compared with most other markers that measure tumor mass, the TPS level in serum reflects tumor cell activity 2, 5, 8, 9…”