TUMOR-MARKERS CA-125 AND CA-19-9 IN CORD-BLOOD AND DURING INFANCY - DEVELOPMENTAL-CHANGES AND USE IN PEDIATRIC GERM-CELL TUMORS

Tumor markers CA 125 and CA 19-9 are elevated in a variety of malignan cies in adult patients, but only little is known of their biology duri ng gestation or infancy. We have addressed the developmental pattern o f these carbohydrate antigens in pediatric patients by measuring their serum levels in 133 cord blood samples from the second through third trimester of gestation and in 39 infants aged less than 1.5 y. The ser um concentrations of both markers revealed developmental changes, the levels being higher at earlier gestation (wk 24 through 37) than at te rm or during infancy. The clinical value of the markers was evaluated by monitoring 26 children with germ cell tumors; 14 benign and 2 immat ure teratomas, and 11 malignant germ cell tumors. Patients with immatu re sacrococcygeal teratomas showed constant and prolonged elevations o f serum CA 125 and CA 19-9. In contrast, all but two children with mat ure teratomas had normal marker levels; these two patients with abnorm ally high serum CA 125 and CA 19-9 values for the first 4 postoperativ e weeks had a beni,on ovarian and ventricular teratoma, respectively. Of the 11 children with malignant germ cell tumors, serum CA 125 or CA 19-9 concentration was elevated in four patients at diagnosis and dec lined to normal within 2 wk after institution of therapy. Malignant re currence in two patients was not associated with a reelevation of the CA 125 level. Taken together, our results demonstrate a developmentall y regulated pattern of serum CA 125 and CA 19-9. The carbohydrate mark ers were usually inferior to alpha-fetoprotein in monitoring of germ c ell tumors, but may be a useful adjunct in the follow-up of immature t eratomas.