Predictive value of preoperative inflammatory markers and serum CA 125 level for surgical outcome in Indonesian women with epithelial ovarian cancer

BACKGROUND: It is essential in the management of ovarian cancers to identify the patients who will benefit from primary complete cytoreductive surgery and those who will rather benefit from neoadjuvant chemotherapy. OBJECTIVE: To evaluate the predictive value of preoperative inflammatory markers, i.e. platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), red cell distribution width (RDW), and serum CA125 level for surgical outcome in epithelial ovarian cancer. METHODS: A retrospective study was carried out in Sanglah Hospital, Denpasar, Bali. A total of 54 patients with epithelial ovarian cancer who underwent primary exploratory laparotomy from January 2018 to November 2019 was recruited. Data about clinical characteristics, preoperative inflammatory markers, serum CA125 level, and surgical outcome (optimal vs. suboptimal) was collected from the medical records. Predictive value of the markers were evaluated using ROC curve to determine their accuracy (area under the curve, sensitivity, specificity, positive and negative predictive value). RESULTS: Mean age, parity, and tumor size did not differ between the study groups (p> 0.05). The group with suboptimal outcome had significantly higher PLR, NLR, MLR, and RDW value (p< 0.05). Using the ROC curve, a cut off value was determined for each predictor, i.e. PLR: 196.50, NLR: 3.34, MLR: 0.24, RDW: 13.19, CA125: 300.85. AUC for each predictor were as follows: PLR 0.718 (95% CI: 0.578–0.859), NLR 0.676 (95% CI: 0.529–0.823), MLR 0.700 (95% CI: 0.560–0.839), RDW 0.712 (95% CI: 0.572–0.852), CA125 0.593 (95% CI: 0.436–0.750). Sensitivity, specificity, and accuracy for predicting suboptimal outcome were as follows: PLR (74.2%, 69.6%, 72.2%), NLR (64.5%, 60.9%, 62.9%), MLR (74.2%, 59.1%, 66.7%), RDW (74.2%, 60.9%, 68.5%), CA125 (54.8%, 60.9%, 57.4%). We have some limitations such as small numbers of sample, we generalized whole kinds of ovarian cancer, and this study does not describe follow-up features. CONCLUSION: Preoperative serum inflammatory markers (PLR, MLR, and RDW) may serve as useful markers to predict the surgical outcome with fair accuracy in patients with epithelial ovarian cancer.

Download Full-text

Serum CA125, CA199 and CEA combined detection for epithelial ovarian cancer diagnosis: A meta-analysis

Open Medicine ◽

10.1515/med-2017-0020 ◽

2017 ◽

Vol 12 (1) ◽

pp. 131-137 ◽

Cited By ~ 15

Author(s):

Junhong Guo ◽

Jiangtao Yu ◽

Xiaojie Song ◽

Haixia Mi

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Cancer Diagnosis ◽

Odds Ratio ◽

Meta Analysis ◽

Random Effect Model ◽

Diagnostic Odds Ratio ◽

Diagnostic Sensitivity ◽

Serum Ca125 ◽

Sensitivity Specificity

AbstractObjectiveTo evaluate the diagnostic value of combination detection of serum cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA199) and carci noembryonic antigen(CEA) in patients with epithelial ovarian cancer by pooling the open published studies according to meta-analysis method.MethodsDiagnostic studies related to combination detection of serum CA125, CA199 and CEA in patients with epithelial ovarian cancer were electronic searched in the databases of PubMed, Cochrane, Google scholar, EMBASE, ISI Web of Knowledge and CNKI by two independent reviewers. The combined diagnostic sensitivity, specificity, positive likely hood ratio (+LR), negative likely hood ratio (-LR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) were pooled by Med DiSc1.4 software.ResultsTwelve prospective diagnostic publications were finally fulfilled the inclusion criteria and were included in this meta-analysis. The pooled diagnostic sensitivity specificity, positive likely hood ratio, negative likely hood ratio, diagnostic odds ratio, and AUC were 0.90 (95%CI: 0.80 to 0.92), 0.83 (95%CI: 0.80 to 0.86), 5.35(95%CI:3.90 to 7.33), 0.13 (95%CI: 0.10 to 0.16), 48.53 (95%CI: 29.91 to 78.72) and 0.92 (95%C: 0.89 to 0.94) respectively by fixed or random effect model. No publication bias was found according to the funnel plot and line regression test (t=-1.34, P=0.21).ConclusionCombination detection serum CA125, CA199 and CEA was a promising biomarker forepithelial ovarian cancer diagnosis with relative high sensitivity and specificity.

Download Full-text

The Combination of Serum Biomarker (CA-125, FASN, and GLS) as a Predictor Suboptimal Cytoreduction in Epithelial Ovarian Cancer

10.21203/rs.2.21972/v1 ◽

2020 ◽

Author(s):

Gatot Nyarumenteng Adhipurnawan Winarno ◽

Yudi Mulyana Hidayat ◽

Setiawan Soetopo ◽

Sofie Rifayani Krisnadi ◽

Maringan Diapari Lumban Tobing ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Cytoreductive Surgery ◽

Cross Sectional Study ◽

Ca 125 ◽

Cross Sectional ◽

Average Value ◽

Preoperative Serum ◽

Serum Ca125 ◽

Sensitivity Specificity

Abstract Purpose. Cytoreduction has an important role in improving the survival rate of epithelial ovarian cancer (EOC) patients. The use of preoperative CA-125 as an optimal predictor cytoreduction in patients with ovarian cancer is still controversial. This study aimed to assess the ability of preoperative serum CA125, FASN and GLS as a predictor of cytoreductive surgery in epithelial ovarian cancer (EOC). This observational-analytic cross-sectional study included 109 women diagnosed with epithelial ovarian cancer (EOC) between 2017-2019, who had serum CA-125, GLS, FASN measured preoperatively and underwent cytoreductive surgery. Result. The average value of serum CA-125, FASN, and GLS in the suboptimal cytoreduction were higher than the optimal cytoreduction group. The cut off point (COP) of CA-125 was 248.55 (p=0.0001) with 73.2% sensitivity and 73.6% specificity, FASN was 0.445 (p=0.017) with 62.5% sensitivity and 60.4% specificity, and GLS was 22.895 (p=0.0001) with 73.2% sensitivity and 75.5% specificity. The COP value of CA-125 and GLS combined was 29.16 (p=0.0001) with sensitivity 82.1% and spesificity 73.6%, while the COP of CA-125, GLS, and FASN combined was 0.83 (p=0.0001) with 87.5% sensitivity and 73.6% specificity. If the value of biomarker serum more than COP will more likely have suboptimal cytoreductive surgery. Conclusion. The role of CA125, FASN and GLS levels in predicting suboptimal cytoreductive surgery for patients with ovarian cancer seems questionable. However, the combination of CA-125 and GLS or CA-125, FASN and GLS are able to increase the sensitivity, specificity, and accuracy classification to predict suboptimal cytoreductive surgery.

Download Full-text

Differential blood count as triage tool in evaluation of pelvic masses

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-001103 ◽

2020 ◽

pp. ijgc-2019-001103

Author(s):

Daniel W Cramer ◽

William J Benjamin IV ◽

Allison F Vitonis ◽

Ross Berkowitz ◽

Annekathryn Goodman ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Postmenopausal Women ◽

Menopausal Status ◽

Premenopausal Women ◽

Benign Disease ◽

Lymphocyte Ratio ◽

Lymphocyte To Monocyte Ratio ◽

Pelvic Masses ◽

Serum Ca125

ObjectiveTriaging patients with presumptive ovarian cancer to the appropriate specialist may improve survival. Therefore, there is increasing interest in complementary diagnostic markers to the standard serum CA125. In patients with pelvic masses, we examined the ability of epidemiologic variables and preoperative differential blood counts to improve detection of ovarian cancer over CA125 alone.MethodsFrom pathology reports, patients were classified as having: epithelial ovarian cancer (n=743), including fallopian tube and primary peritoneal cancer, non-epithelial ovarian cancers (n=46), non-ovarian cancers (n=122), or benign disease (1,129). From women with epithelial ovarian cancer, we excluded those who received prior neoadjuvant chemotherapy (n=19). Women were also excluded if they did not have a serum CA125 or complete blood count measured within 180 days prior to surgery (n=1099) or did not have both tests within 90 days of each other (n=13). Categorizing patients by menopausal status, we calculated Pearson correlations between differential counts or ratios and CA125, and used t tests to identity univariate predictors of malignancy and stepwise logistic regression and likelihood ratio tests to create models best distinguishing epithelial ovarian cancer from benign disease.Results337 women with epithelial ovarian cancer and 365 with benign disease were included in the analysis. Compared with cancers, women with benign disease had lower average: age, 52.5 versus 58.4 years (p<0.0001); serum CA125, 20 versus 239 U/mL (p<0.0001), neutrophil-to-lymphocyte ratio, 2.4 versus 3.5 (p<0.0001); and platelet-to-lymphocyte ratio, 158 versus 222 (p<0.0001); but greater average body mass index, 28.5 versus 26.8 kg/m2 (p=0.004), and lymphocyte-to-monocyte ratio, 5.6 versus 3.9 (p<0.0001). Correlations between counts and ratios and serum CA125 were seen in both epithelial ovarian cancer and benign disease groups and differed by menopausal status. In premenopausal women, a multivariate model including serum CA125, smoking, family history, lymphocytes, and monocytes performed similarly to the model with lymphocyte-to-monocyte ratio replacing counts. In postmenopausal women, a model including body mass index, parity, monocytes, and basophils performed similarly to the model replacing counts with platelet-to-lymphocyte ratio and lymphocyte-to-monocyte ratio. Models including epidemiologic variables and either counts or ratios were better at fitting data than models with serum CA125 and menopausal status alone. A single model applying to all women overstated performance for premenopausal women and understated performance for postmenopausal women.ConclusionsEpidemiologic variables and differential counts or ratios better distinguished between benign and malignant disease when compared with serum CA125 alone using separate models for pre- and postmenopausal women.

Download Full-text