The management of ovarian carcinoma is improved by the use of cancer-associated serum antigen and CA 125 assays

Abstract

Background. The new tumor‐associated mucin assay, cancer‐associated serum antigen (CASA), was assessed with the CA 125 assay for use in the management of patients with epithelial ovarian cancer. Methods. CASA and CA 125 were assessed retrospectively for use in (1) monitoring 28 patients with Stage 3 or 4 ovarian carcinoma during therapy, (2) predicting the outcome of 41 second‐look laparotomies (SLL), and (3) predicting the survival outcome by measuring these levels after surgery but before chemotherapy in 65 patients with Stage 3 disease. Results. Of 20 patients with recurrence after an initial response, the presence of CASA levels detected recurrence in 65% before clinical detection; CA 125, 50%; and the combination of CASA and CA 125, 80%. Six patients whose disease was in long‐term remission did not have elevations of either marker. When used to predict the results of SLL, the positive predictive values of CASA and CA 125 were 77% and 100%, respectively. The negative predictive values for CASA and CA 125 were 71% and 66%, respectively. CASA detected 50% of positive SLL where microscopic disease only was found; the CA 125 test did not. Multivariate analysis of survival rates using levels of CASA and CA 125, age, residual disease, tumor type and grade, or the presence or absence of cisplatin in the chemotherapeutic regimen found that postoperative CASA levels ranked above all prognostic factors except age. CASA levels may be more accurate than surgical reporting of residual disease or they may define a subset of patients with biologically more aggressive ovarian carcinoma. Conclusions. The CASA test is sensitive to ovarian carcinoma, and both CASA and CA 125 are more useful when used in conjunction.

Cancer-associated serum antigen level: a novel prognostic indicator for survival in patients with recurrent ovarian carcinoma

“…In first-line treatment, the clinical course was accurately reflected in 65% of patients (19) , and the sensitivity of CASA to depict residual tumor at time of a second-look diagnostic operation ranged between 22% and 32% (14,16) . Furthermore, the prognostic value of CASA in primary clinical setting has been extensively studied and CASA level has been found to be a reliable prognostic factor for survival (13)(14)(15)(16)(17)(18) . This is the first report that evaluates the CASA level as a prognostic factor for survival in patients with recurrent ovarian cancer.…”

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Testicular, Prostate, Colorectal, Breast, and Ovarian Cancers

“…One study has demonstrated that CASA can detect more cases with small volume disease than CA125, and that 50% of patients with microscopic disease are detected by CASA alone (473 ). Another study has shown that the prognostic value of postoperative serum CASA level is superior to CA125 and other parameters including residual disease, histological type, tumor grade, and the cisplatin-based chemotherapy (484 ).…”

Serum tumour marker CA 125 in monitoring of ovarian cancer during first-line chemotherapy

“…Other investigators suggested progression criteria that were valid only during follow-up of patients where CA 125 concentrations had decreased to below the cut-off value after initial chemotherapy. According to these suggestions a positive CA 125 signal of progression was either based upon a single increment above the cut-off value (Niloff et al, 1986;van der Burg et al, 1990;Hising et al, 1991;Ward et al, 1993;Gard and Houghton, 1994), or upon an increase of concentrations to twice the upper limit of normal . Thus, several empirical criteria for CA 125 progression have been applied, but none have been precise enough to eliminate falsepositive results.…”