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Letters |
1 University of Pennsylvania, Medical Center, Department of Pathology, and Laboratory Medicine, 7th Floor, Founders Bldg., 3400 Spruce St., Philadelphia, PA 19104
2 University of Pennsylvania Medical Center, Department of Medicine, Cardiology Division, 6 Penn Tower, 3400 Spruce St., Philadelphia, PA 19104
3 University of Pittsburgh, Department of Pathology, and Laboratory Medicine, 200 Lothrop St., Pittsburgh, PA 15213
aAuthor for correspondence. Fax 215-615-0828; e-mail andrew.kao{at}uphs.upenn.edu.
To the Editor:
CA-125 (cancer antigen or carbohydrate antigen) is a high-molecular weight glycoprotein most appropriately used for monitoring treatment response and recurrence of ovarian carcinoma, with concentrations >35 units/mL indicating residual tumor. Serum concentrations have also been shown to correlate with ovarian tumor mass. Increases, although usually not as marked, have been seen in other conditions such as lung cancer, gastrointestinal cancer, abdominal miliary tuberculosis, endometriosis, pelvic inflammatory disease, and during ovulation in 1–2% of healthy women. Therefore, this serum marker is not recommended as a screening test for ovarian carcinoma (1)(2)(3).
Recently, at the University of Pennsylvania Medical Center, CA-125 was inadvertently ordered on a male heart failure (HF) patient awaiting cardiac transplantation, and was found to be markedly increased at 1060 units/mL. The test was repeated and confirmed the marked increase. The patient was also tested for human anti-mouse antibody (HAMA) to rule out possible interference causing a false-positive result. The results of the HAMA test were negative. The CA-125 concentrations decreased after transplantation with improvement in clinical status (538 units/mL). We analyzed multiple sections of the patient’s explanted native heart by use of immunohistochemical staining for CA-125 (1:50 dilution; positive control = ovarian adenocarcinoma; Dako) to determine the source of CA-125 production. No positive staining was detected in the tissue (cardiac, vascular, and mesothelial cells).
A subsequent literature search revealed one study pertaining to CA-125 in HF patients. That study included 71 patients of all New York Heart Association (NYHA) classes and showed a relationship between advancing HF and progressive increases in CA-125 concentrations [mean CA-125 for NYHA classes: class I = 36 units/mL; class II = 79 units/mL; class III = 210 units/mL; class IV = 502 units/mL (4)].
The authors of this study felt that the elaboration of CA-125 could be from the pericardial mesothelium; however, the exact mechanism is unclear (4)(5)(6)(7). In clinical practice, augmentation of HF therapy is based solely on worsening symptoms and echocardiographic findings. However, on the basis of this initial encouraging report and our experience, this pilot study investigated the possibility of using the CA-125 marker to identify patients with worsening HF before they develop clinical symptomatology.
We analyzed serum CA-125 concentrations using the CENTOCOR CA-125 II RIA from blood obtained during a 6-month period from 35 patients (33 males; 30 Caucasians) with NYHA class III or IV HF awaiting cardiac transplantation. Blood was drawn during their routine clinic visits and while they were hospitalized. This study was approved by the Institutional Review Board, and informed consent was obtained from all patients. Clinical stability was based on examination by a HF cardiologist, as well as invasive hemodynamic measurements. Patients with markedly abnormal hemodynamics, or those with signs of low output failure, were considered unstable. Although many of the patients did show increases in CA-125 concentrations, some being quite marked, there was no correlation between clinical status and the concentration of CA-125 (Table 1
). There was also no correlation between "confounding" factors, such as pericardial, pleural, or peritoneal effusions.
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We were unable to confirm the published correlation and conclude that CA-125 is not a useful marker in predicting cardiac status or managing pretransplant patients. However, perhaps a larger and longer-term study may be able to show a meaningful relationship.
References
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