The Evaluation Of Serum CA125, CEA, AFP, HCG In Clinical Diagnosis And Treatment Of Ovarian Malignant Tumor

Objective: To analyze the significance of serum CA125, CEA, AFP and HCG in the diagnosis, theatment, illness monitoring and prognosis evalution of ovarian malignant tumor in the Fourth Hospital of Hebei Medical University, 195 cases were chosen to be used in the retrospective study. The clinical laboratory examinations, pathological data, and prognosis of 195 patients were collected.Methods:The clinical data were collected from January 2009 to December 2010. 195 patients were first time to be treated and to be diagnosed by surgery without other malignant tumors, including 166 patients with epithelial ovarian cancer, 10 patients with sex cord-stromal tumors, 12 patients with germ cell tumors, 2 patients with miscellaneous tumors of ovary and 5 patients with metastasis ovarian cancer. The clinical data was reviewed and the follow-up data collected. The deadline of follow-up was Dec. 31, 2013. The actual number of follow-up case was 190, and the number of the lost case was 5. The follow-up rate was 97.4%. The normal values were defined as serum CA125≤35U/ml, CEA≤5ng/ml, AFP≤7ng/ml and HCG≤5m Iu/ml, and any one or more than one that exceeded the mentioned value as the positive standard. It was defined as negative-transfer that the four serum ovarian tumor markers were positive before the initial management, then turned to be negative after effective therapy.SPSS 19.0 software was used for data analysis. The survival curve was drawn by Kaplan-Meier. Survival rate was calculated. The comparison of the measurement data used rank- sum test. The comparison of rate used Chi- squared test, Fisher’s exact test. P<0.05 was significant.1 The positive rates for diagnosing ovarian malignant tumor with serum CA125, CEA, AFP and HCG alone were 88.7%, 3.1%, 4.6%, 0.5%. The positive rate of combined detection of the four markers was 90.3%, which proved that the sensitivity of combined detection was higher for diagnosing ovarian malignant tumor.2 The positive rates of serum CA125 in epithelial ovarian cancer, sex cord-stromal tumor, germ cell tumor, serous cancer and mucinous cancer were 92.8%, 50.0%, 58.3%, 98.5%, 70.0%, respectively. The statistical analysis showed that the difference of the positive rates was significant. Serum CA125 The sensitity of serum CA125 in epithelial ovarian cancer was more than sex cord-stromal tumor and germ cell tumor, and that in serous cancer was more than mucinous cancer. The sensitivity of serum CEA was 40.0% in mucinous cancer, 20.0% in metastastic ovarian cancer. The sensitivity of serum AFP in germ cell tumor was 75.0%.3 The positive rates of CA125 in stage I-IV patients with primary ovarian cancer were 63.2%, 85.7%, 96.1% and 88.9%. The average values of CA125 in stage I-IV patients were 225.79±205.394U/ml, 726.77±767.190U/ml, 1087.80 ± 1027.138U/ml and 2095.71 ± 1781.201U/ml, respectively. The statistical analysis showed that serum CA125 was different in different stage, and the sensitivity of serum CA125 in advanced stage was more than that in early cases.4 The incidence of ascites was higher in patients with positive serum CA125, but the correlation between the value of serum CA125 and ascites was not found.5 In this study, the 3-year overall survival rate was 67.4%, and the 3-year overall recurrence rate was 45.7%. For the patient with positive serum CA125, the 3-year survival rate(64.2%) was lower than that in patients with negative serum CA125. And the 3-year recurrence rate(50.6%) was higher. It was proven that the prognosis of patients with positive serum CA125 was worse than that with negative serum CA125. Results:6 For the patients whose serum CA125 level was less than 662.6U/ml, the 3-year survival rate was lower than the patients whose serum CA125 level was more than 662.6U/ml. For the patient whose serum CA125 was still positive after 3 routine chemotherapy, the 3-year survival rate was lower, and 3-year recurrence rate was higher, than the patient whose serum CA125 was negative after 3 routine chemotherapy. For patients whose serum CA125 was always positive after the initial treatment, the 3-year mortality was 66.7%.7 It suggested the recurrence of the tumor when the negative-transfered serum CA125 became positive again, but the situation of false positive existed.Conclusion:1 The combined detection of serum CA125, CEA, AFP and HCG has a certain significance in the clinical diagnosis, illness monitoring and prognostic evaluation. But the value of CEA, HCG needs to be considered further.2 The sensitivity of serum CA125 and the average value of serum CA125 are higher, in advanced cases than in early cases, respectively.3 The incidence of ascites is higher and the prognosis is worse in patients with positive serum CA125 than in patients with negative serum CA125.4 For the patients whose serum CA125 level is equal or more than 662.6U/ml, 3-year survival rate was worse than patients whose serum CA125 is less than662.6U/ml. For the patient whose serum CA125 was still positive after 3 routine chemotherapy, the prognosis is worse than the patient whose serum CA125 is negative after 3 routine chemotherapy.5 It suggests the recurrence of the tumor when the negative-transfered serum CA125 become positive again.