In work up of adnexal masses, values of CA 19-9 have been used in conjunction with CA 125 to improve preoperative diagnostic accuracy and as a predictor of recurrence, especially in Mucinous Adenocarcinomas. Although raised levels of serum CA 19-9 are seen in Epithelial Ovarian Cancers (EOC), including HGSOC, but the clinical significance of such findings is unknown. The present study was conducted to evaluate the prognostic implication of raised CA19-9 levels in EOC patients.
A hospital based, retrospective study undertaken at tertiary Cancer Institute in North East India. The primary objective was to determine the prognosis of raised CA19-9 levels on survival in EOC patients in terms of DFS and OS. The secondary objectives were to estimate the prevalence of raised CA19-9 levels in patients with adnexal masses, and correlate with final histopathology.
The study included patients presenting to Gynaecological Oncology OPD with adnexal masses between September 2019 to December 2021. The relevant data was accrued from the electronic medical records. This study was done according to REMARK guidelines.
827 patient records were analysed, of which 136 patients had raised CA 19-9 levels (16.4%). 73.5% (n=100) cases had malignant histology, 54.4% patients (n=74) cases were EOC, comprising of HGSOC histology in 36.7% (n=50), followed by Mucinous (13.2%, n=18).
| CA 19-9 LEVELS | Median RFS in months (95% CI) | Mean OS in months (95% CI) |
| < 37 U/ml | 15.0 (11.083-18.917) | 47.127 (37.862-56.392) |
| >37 U/ml | 12.0 (7.406- 16.594) | 32.816 (23.855- 41.776) |
26.4% Patients with raised CA 19-9 had platinum refractory disease vs 14.7% with normal CA 19-9 levels. Pearson's r value for association with CA 125 was -.133 (p=0.1). The mean values of CA 19-9 levels in HGSOCs was 215.286 U/mL versus 472.888 U/mL (p=0.01) in patients with Mucinous Adenocarcinoma.
Raised levels of CA 19-9 were associated with higher platinum refractoriness and poorer Overall Survival (p=0.008). These novel findings need to be validated in a prospective trial. Our study reinforces the utility of CA 19-9 as a mandatory marker in both diagnosis, as well as prognostication of EOC patients.