Simultaneous Measurement of CA 125, CA 19-9, Tissue Polypeptide Antigen, and Immunosuppressive Acidic Protein to Predict Recurrence of Ovarian Cancer

We studied the utility and limitations of CA 125 for the early diagnosis of recurrence of ovarian cancer and investigated whether the precision of diagnosis could be enhanced by combining CA 125 with other tumor markers. Of 181 patients with epithelial ovarian cancer, 149 were in clinical remission and 35 had developed recurrence. Thirty-four women with recurrence had preoperative CA 125 values of 35 U/mL or more, and 21 (62%) had CA 125 levels of 35 U/mL or more at the time of detection of clinical recurrence. Eleven had levels that remained elevated 3 months before identification of the recurrence. However, in 13 cases CA 125 was below 35 U/mL at the time recurrence was detected. To enhance the efficacy of tumor markers to predict recurrence, patients in whom multiple tumor markers had been measured were studied retrospectively. At the time of clinical recurrence and 3 months earlier, the diagnostic sensitivity of CA 125 alone for recurrence was 64 and 33%, respectively, whereas the sensitivity of a combination of tumor markers (CA 125, CA 19-9, tissue polypeptide antigen, and immunosuppressive acidic protein) was 89 and 66%. Thus, prediction of recurrence of ovarian cancer can be improved by the use of a combination of these tumor markers.