Clinical significance of serum CA125 in diffuse malignant mesothelioma

Our plain-English summary of Clinical significance of serum CA125 in diffuse malignant mesothelioma, by X. Cheng, H.F. Gou, J.Y. Liu, et al (SpringerPlus, 2016).

The study

• Authors: X. Cheng, H.F. Gou, J.Y. Liu, D.Y. Luo, M. Qiu
• Journal: SpringerPlus
• Published: 2016;5:368
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma (MM) is a rare and fatal neoplasm. For diffuse malignant mesothelioma (DMM) patients that were not suitable for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, systemic chemotherapy is the main treatment. There are no convenient tumor markers to predict the efficacy of treatment and disease progression. This study aimed to evaluate serum CA125 level as a biochemical marker of response to therapy and prognosis in patients with DMM.

Methods: A retrospective study was performed in a single medical institution from April 2008 to April 2014. Overall survival (OS) and prognostic factors were assessed.

Results: Forty-one patients were included with a median age of 53 years. The median OS of all patients was 10 months. Patients with baseline CA125 > 280 U/ml had worse OS compared with the patients that baseline CA125 ≤ 280 U/ml. Baseline level of CA125, stage of disease, primary tumor location and systemic chemotherapy were independent prognostic factors associated with OS. In patients who received systemic chemotherapy, the decline in serum CA125 was associated with favorable OS and objective response according to modified Response Evaluation Criteria in Solid Tumors criteria.

Conclusions: The baseline level of serum CA125, accompanied with stage of disease, primary tumor location and systemic chemotherapy, could be regarded as independent prognostic factors for DMM patients. Otherwise, the change in serum CA125 can predict OS and response to systemic chemotherapy.

In plain English

This was a retrospective study of 41 patients with diffuse malignant mesothelioma treated at the Cancer Center of West China Hospital, Sichuan University, between April 2008 and April 2014. Twenty-three had pleural and 18 had peritoneal mesothelioma, all at stage III or IV. The article does not report asbestos exposure. The authors examined whether blood levels of CA125, a protein marker, were related to survival and to response to chemotherapy. Median overall survival for all 41 patients was 10 months. Patients with a starting CA125 above 280 U/ml had worse survival than those at or below 280 U/ml. In the multivariate analysis the hazard ratio for this comparison was 3.412 (95% CI 1.265 to 9.208). Tumor location, disease stage and receiving systemic chemotherapy were also independent factors. Among 12 patients whose CA125 was monitored during chemotherapy, changes in CA125 correlated with response on scans (r = 0.857), and a decline was associated with better survival. The authors concluded that baseline CA125 was an independent prognostic factor. They noted that the study was retrospective and small.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-institution study of survival and prognostic factors
• Who was studied: 41 patients with diffuse malignant mesothelioma (23 pleural, 18 peritoneal), stage III or IV and unsuitable for curative surgery, attending the Cancer Center of West China Hospital, Chengdu, China, from April 2008 to April 2014. Median age was 53 years (range 24 to 80); 28 were male and 13 female.
• Exposure: The article does not report asbestos exposure or fiber types. The factor studied was the serum level of CA125 (a blood tumor marker), measured before treatment and, in a chemotherapy subgroup, during systemic chemotherapy. It was measured with the CanAg CA125 assay; the upper limit of normal was 35 U/ml.
• Main results:
  • Median overall survival for all 41 patients was 10 months (range 1 to 48 months, 95% CI 4.633 to 15.367).
  • Median survival was 6 months for patients with pleural mesothelioma. It was longer than 24 months for patients with peritoneal mesothelioma (P = 0.003).
  • The authors identified 280 U/ml as the best cut-off for baseline CA125. In univariate analysis, baseline CA125 of 280 U/ml or below was associated with better overall survival (HR 2.214, 95% CI 1.080 to 5.091, P = 0.045).
  • In multivariate analysis of all patients, baseline CA125 (280 or below versus above 280 U/ml) remained an independent prognostic factor (HR 3.412, 95% CI 1.265 to 9.208, P = 0.015). Tumor location in the peritoneum, stage III disease and receiving systemic chemotherapy were also independent prognostic factors.
  • Patients who received systemic chemotherapy had a median survival of 43 months, compared with 4 months for patients who did not (P = 0.015).
  • In the 12 patients whose CA125 was monitored during systemic chemotherapy, the change in CA125 correlated with response on scans by modified RECIST criteria (r = 0.857, P less than 0.001).
  • In the systemic chemotherapy subgroup, mean CA125 fell from 303.8 U/ml at baseline to 96 U/ml after chemotherapy.
  • In patients who received systemic chemotherapy, a decline in CA125 was associated with better overall survival (P = 0.017).
• The authors' conclusion: The authors concluded that baseline serum CA125, together with stage of disease, primary tumor location and systemic chemotherapy, is an independent prognostic factor for patients with diffuse malignant mesothelioma. They also concluded that, in patients receiving systemic chemotherapy, the change in CA125 could reflect chemotherapy efficacy and predict survival. They called for validation in larger, multicenter prospective studies.
• Limitations the authors state:
  • The study was retrospective and had a small sample size.
  • Some patients had no specific pathological subtype recorded, which may affect the assessment of subtype's role in prognosis.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Neoplasm, Cytoreductive Surgery, HIPEC, Chemotherapy, Tumor Marker, Disease Progression, Prognosis.

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