J Korean Soc Menopause.  2013 Apr;19(1):26-35. 10.6118/jksm.2013.19.1.26.

The Clinico-Pathologic Features and Significance of Preoperative CA 125 in Patients Who Had an Operation for Ovarian Tumors

• Kim CR
• Ku CH
• Jeon IS
• Son DW
• Lee JS

• KMID: 1768794
• DOI: http://doi.org/10.6118/jksm.2013.19.1.26

Abstract

OBJECTIVES
The aim of this study is to confirm the clinical and histopathologic findings of ovarian tumors and determine the malignancy before operation. It will attribute to early diagnosis, determining direction of treatment and improving prognosis of malignant ovarian tumor.
METHODS
Seven hundred sixty-five patients who had an operation for ovarian tumors in the department of Obstetrics and Gynecology of Gachon University Gil Medical Center from April 2007 to December 2009 were enrolled as subjects. A retrospective analysis of age, parity, menopausal status, preoperative CA 125, histology, ultrasound, and treatment method was done.
RESULTS
1. Among benign ovarian tumors, endometrial cyst (211 cases, 30.1%) was most common and had the highest preoperative CA 125 (76.07 U/mL). 2. Among borderline ovarian tumors, mucinous type (16 cases, 62.5%) was most common, but preoperative CA 125 was higher in serous type (144.38 U/mL) than mucinous type (82.59 U/mL). 3. Among malignant ovarian tumors, serous adenocarcinoma (14 cases, 29.8%) was most common, and undifferentiated carcinoma had the highest preoperative CA 125 (500.0 U/mL). 4. The preoperative CA 125 showed a tendency to increase in relation to stage in malignant ovarian tumors. 5. Age, preoperative CA 125, menopausal status and ultrasound finding were identified as discriminating factors for malignancy and relative risk of them were 7.19, 7.90, 5.56 and 61.43, respectively.
CONCLUSION
Using the combination of age, menopausal status, preoperative CA 125 and ultrasound to diagnose ovarian tumors before the operation will be a help to early diagnosis and determining the treatment and improve prognosis.

Keyword

Benign ovarian tumor; CA-125 antigen; Malignant ovarian tumor

MeSH Terms

Adenocarcinoma
CA-125 Antigen
Carcinoma
Early Diagnosis
Female
Gynecology
Humans
Mucins
Obstetrics
Parity
Prognosis
Retrospective Studies
CA-125 Antigen
Mucins

Figure

• 

  Fig. 1 Incidence of benign (A), borderline (B), and malignant (C) ovarian tumors.

• 

  Fig. 2 Receiver operating characteristic (ROC) curve for preoperative cancer antigen (CA) 125 (A) and age (B) in discriminating between benign and malignant ovarian tumors.

Reference

1. Morrow CP, Townsend DE, Di Saio PJ. Synopsis of gynecologic oncology. 1981. 2nd ed. New York: Wiley.

2. Kim BS, Lee CC, Sung YM, Hong SY. Clinicopathological studies on ovarian tumors. Korean J Obstet Gynecol. 1991. 34:81–90.

3. Wingo PA, Tong T, Bolden S. Cancer statistics, 1995. CA Cancer J Clin. 1995. 45:8–30.

4. Chen DX, Schwartz PE, Li XG, Yang Z. Evaluation of CA 125 levels in differentiating malignant from benign tumors in patients with pelvic masses. Obstet Gynecol. 1988. 72:23–27.

5. Gadducci A, Capriello P, Bartolini T, Barale E, Cappelli N, Facchini V, et al. The association of ultrasonography and CA-125 test in the preoperative evaluation of ovarian carcinoma. Eur J Gynaecol Oncol. 1988. 9:373–376.

6. Kabawat SE, Bast RC, Welch WR, Knapp RC, Colvin RB. Immunopathologic characterization of a monoclonal antibody that recognizes common surface antigens of human ovarian tumors of serous, endometrioid, and clear cell types. Am J Clin Pathol. 1983. 79:98–104.

7. Kabawat SE, Bast RC Jr, Bhan AK, Welch WR, Knapp RC, Colvin RB. Tissue distribution of a coelomic-epithelium-related antigen recognized by the monoclonal antibody OC125. Int J Gynecol Pathol. 1983. 2:275–285.

8. Bast RC Jr, Feeney M, Lazarus H, Nadler LM, Colvin RB, Knapp RC. Reactivity of a monoclonal antibody with human ovarian carcinoma. J Clin Invest. 1981. 68:1331–1337.

9. Bast RC Jr, Klug TL, St John E, Jenison E, Niloff JM, Lazarus H, et al. A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer. N Engl J Med. 1983. 309:883–887.

10. Bast RC Jr, Hunter V, Knapp RC. Pros and cons of gynecologic tumor markers. Cancer. 1987. 60:1984–1992.

11. Lee JG, Song ES, Choi SJ, Chu YC, Hwang SO, Im MW, et al. Clinical and histopathological studies on ovarian tumors. Korean J Obstet Gynecol. 2005. 48:919–928.

12. Kim JH, Ma SY, Shin WG, Bae SN, Namkoog SE, Kim SJ. Clinico-pathological survey on ovarian tumors. Korean J Obstet Gynecol. 1985. 28:605–614.

13. Kim JZ, Chun SH, Yoon SH, Kim JI, Woo BH, Kang SM. Ovarian tumors, 240 cases. Korean J Obstet Gynecol. 1980. 23:957–966.

14. Hong SK, Park MW, Chang BY, Kim YS, Cho JH, Lee YH. Clinico-pathologic studies on ovarian tumors. Korean J Obstet Gynecol. 1982. 25:377–388.

15. Niloff JM, Klug TL, Schaetzl E, Zurawski VR Jr, Knapp RC, Bast RC Jr. Elevation of serum CA 125 in carcinomas of the fallopian tube, endometrium, and endocervix. Am J Obstet Gynecol. 1984. 148:1057–1058.

16. Barbieri RL, Niloff JM, Bast RC Jr, Scaetzl E, Kistner RW, Knapp RC. Elevated serum concentrations of CA-125 in patients with advanced endometriosis. Fertil Steril. 1986. 45:630–634.

17. Nakashima N, Nagasaka T, Oiwa N, Nara Y, Fukata S, Fukatsu T, et al. Ovarian epithelial tumors of borderline malignancy in Japan. Gynecol Oncol. 1990. 38:90–98.

18. Rice LW, Berkowitz RS, Mark SD, Yavner DL, Lage JM. Epithelial ovarian tumors of borderline malignancy. Gynecol Oncol. 1990. 39:195–198.

19. Mok JE, Nam JH. Ovarian tumors of low malignant potential. Korean J Gynecol Oncol Colposc. 1993. 4(4):97–109.

20. Schilthuis MS, Aalders JG, Bouma J, Kooi H, Fleuren GJ, Willemse PH, et al. Serum CA 125 levels in epithelial ovarian cancer: relation with findings at second-look operations and their role in the detection of tumour recurrence. Br J Obstet Gynaecol. 1987. 94:202–207.

21. Jung WN, Chung KW, Lee TS, Han GT, Song KC, Kim CY, et al. Clinical significance of CA 125 level in patients with ovarian carcinoma. Korean J Obstet Gynecol. 1989. 32:1532–1540.

22. Klug TL, Bast RC Jr, Niloff JM, Knapp RC, Zurawski VR Jr. Monoclonal antibody immunoradiometric assay for an antigenic determinant (CA 125) associated with human epithelial ovarian carcinomas. Cancer Res. 1984. 44:1048–1053.

23. Niloff JM, Knapp RC, Schaetzl E, Reynolds C, Bast RC Jr. CA 125 antigen levels in obstetric and gynecologic patients. Obstet Gynecol. 1984. 64:703–707.

24. Einhorn N, Bast RC Jr, Knapp RC, Tjernberg B, Zurawski VR Jr. Preoperative evaluation of serum CA 125 levels in patients with primary epithelial ovarian cancer. Obstet Gynecol. 1986. 67:414–416.

25. Yabushita H, Masuda T, Ogawa A, Noguchi M, Ishihara M. Combination assay of CA 125, TPA, IAP, CEA, and ferritin in serum for ovarian cancer. Gynecol Oncol. 1988. 29:66–75.

26. Beck RP, Latour JP. Review of 1019 benign ovarian neoplasms. Obstet Gynecol. 1960. 16:479–482.

27. Davis BA, Latour JP, Philpott NW. Primary carcinoma of the ovary. Surg Gynecol Obstet. 1956. 102:565–573.

28. Wynder EL, Dodo H, Barber HR. Epidemiology of cancer of the ovary. Cancer. 1969. 23:352–370.

29. Trimble CL, Trimble EL. Management of epithelial ovarian tumors of low malignant potential. Gynecol Oncol. 1994. 55:S52–S61.

30. Novak ER, Woodruff JD, Linthicum JM. Evaluation of the unclassified tumors of the ovarian tumor registry, 1942-1962. Am J Obstet Gynecol. 1963. 87:999–1007.

31. Donald I, Macvicar J, Brown TG. Investigation of abdominal masses by pulsed ultrasound. Lancet. 1958. 1:1188–1195.

32. Park KH, Lee SK, Suh BH, Lee JH, Mok JE. The clinical value of the ultrasonography in the diagnosis of the malignant ovarian ca. Korean J Obstet Gynecol. 1993. 36:543–552.

33. Han SW, Park YW, Park TK. The efficacy of ultrasonography in diagnosis of ovarian tumor. Korean J Obstet Gynecol. 1985. 28:1667–1674.

34. Joly DJ, Lilienfeld AM, Diamond EL, Bross ID. An epidemiologic study of the relationship of reproductive experience to cancer of the ovary. Am J Epidemiol. 1974. 99:190–209.

35. McGowan L, Parent L, Lednar W, Norris HJ. The woman at risk for developing ovarian cancer. Gynecol Oncol. 1979. 7:325–344.