Predictive value of the combination of serum markers, CA125, CASA and TPS in ovarian cancer

The serum markers CA125, CASA and TPS were compared, with particular reference to the clinical applications of these tumor markers in the management of patients with ovarian cancer (discrimination of benign and malignant disease; indicating prognosis; predicting preclinical recurrence). (i) Using recommended cut-off points, CASA (greater than or equal 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 to 35U m l(-1)). The combined use of CA125 with either CASA or TPS at higher cut-off points excluding benign disease (CA125 >345 U ml(-1); CASA >6 U ml(-1); TPS>359 Ul(-1)) improved the discrimination of ovarian cancer from benign adnexal masses (100% positive predictive value with 65% of ovarian cancers detected with CA125-CASA, 61% with CA125-TPS vs 46% with CA125 alone). The combined preoperative use of these markers may therefore assist the general gynecologist in avoiding potentially difficult oncologic surgery. (ii) TPS was the best preoperative indicator of prognosis, possibly due to its association with cell proliferation, while CASA was superior as a postoperative prechemotherapeutic prognostic indicator, possibly due to it being a more accurate indicator of residual disease than the other markers, or the surgeons' assessment. Similarly, CASA gave the best differentiation of patients with minimal residual disease