PREDICTIVE VALUE OF THE COMBINATION OF SERUM MARKERS, CA125, CASA ANDTPS IN OVARIAN-CANCER

The serum markers CA125, CASA and TPS were compared, with particular r eference to the clinical applications of these tumor markers in the ma nagement of patients with ovarian cancer (discrimination of benign and malignant disease; indicating prognosis; predicting preclinical recur rence). (i) Using recommended cut-off points, CASA (greater than or eq ual to 4 U ml(-1)) and TPS (greater than or equal to 80 U l(-1))showed similar sensitivities in ovarian carcinoma (56% and 57% respectively) , though these were lower than with CA125 (85% greater than or equal t o 35U m l(-1)). The combined use of CA125 with either CASA or TPS at h igher cut-off points excluding benign disease (CA125 >345 U ml(-1); CA SA >6 U ml(-1); TPS>359 Ul(-1)) improved the discrimination of ovarian cancer from benign adnexal masses (100% positive predictive value wit h 65% of ovarian cancers detected with CA125-CASA, 61% with CA125-TPS vs 46% with CA125 alone). The combined preoperative use of these marke rs may therefore assist the general gynecologist in avoiding potential ly difficult oncologic surgery. (ii) TPS was the best preoperative ind icator of prognosis, possibly due to its association with cell prolife ration, while CASA was superior as a postoperative prechemotherapeutic prognostic indicator, possibly due to it being a more accurate indica tor of residual disease than the other markers, or the surgeons' asses sment. Similarly, CASA gave the best differentiation of patients with minimal residual disease (<1 cm) into those with a good or poor progno sis. (iii) CA125 and CASA each detected preclinical recurrence after s urgery and adjuvant therapy in seven of 11 patients (mean lead times 4 .6 and 3.1 months respectively) while TPS detected four of these patie nts (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 combina tion.