Jacobs I J, Oram D H, Bast R C
Department of Obstetrics and Gynecology, University of Cambridge, Rosie Maternity Hospital, United Kingdom.
Obstet Gynecol. 1992 Sep;80(3 Pt 1):396-9.
To assess different strategies for improving the specificity of screening for ovarian cancer with tumor-associated antigens, including concomitant measurement of multiple tumor markers and serial measurement of CA 125.
A combination of CA 125, CA 15-3, and TAG 72.3 was evaluated in serum samples from 217 of 1010 apparently healthy postmenopausal women who had participated in a study of screening for ovarian cancer and who had a serum CA 125 level of 20 U/mL or greater. In addition, serial serum CA 125 levels were determined in 30 women with an initially elevated CA 125 level (30 U/mL or more) and 30 women with a CA 125 level less than 30 U/mL.
The specificity of CA 125 at upper limits of 30 and 50 U/mL was increased from 97.0 and 99.5%, respectively, to 98.9 and 99.9% when a positive test was defined as an elevated serum CA 125 level in combination with either a CA 15-3 greater than 30 U/mL or a TAG 72.3 greater than 10 U/mL. Definition of a positive result as a serum CA 125 level greater than 50 U/mL at the initial test and greater than 30 U/mL at 3-month follow-up achieved a specificity of 99.6%.
Levels of specificity suitable for screening asymptomatic postmenopausal women can be achieved using tumor-associated antigens measured serially or in combination. Further studies are required to determine the sensitivity of these strategies for preclinical ovarian cancer.
评估采用肿瘤相关抗原提高卵巢癌筛查特异性的不同策略，包括同时检测多种肿瘤标志物以及连续检测CA 125。
对1010名明显健康的绝经后女性中的217名进行研究，这些女性参与了卵巢癌筛查研究且血清CA 125水平≥20 U/mL，评估血清中CA 125、CA 15 - 3和TAG 72.3的组合。此外，对30名初始CA 125水平升高（≥30 U/mL）的女性和30名CA 125水平<30 U/mL的女性连续测定血清CA 125水平。
当将阳性检测定义为血清CA 125水平升高同时伴有CA 15 - 3>30 U/mL或TAG 72.3>10 U/mL时，CA 125在30 U/mL和50 U/mL上限时的特异性分别从97.0%和99.5%提高到98.9%和99.9%。将阳性结果定义为初始检测时血清CA 125水平>50 U/mL且3个月随访时>30 U/mL，特异性达到99.6%。
采用连续或联合检测肿瘤相关抗原可实现适合筛查无症状绝经后女性的特异性水平。需要进一步研究以确定这些策略对临床前期卵巢癌的敏感性。
