CA-125 ve Over Kanseri Haricindeki Klinik Kullanımları
Özet
Kanser Antijeni 125 (CA-125), over kanserinin prognozunda, tedavi etkinliğinin takibinde ve nükslerin tespitinde yaygın olarak kullanılan bir tümör belirtecidir. Ancak spesifitesinin düşük olması nedeniyle over dışı malignitelerin yanı sıra benign hastalıklarda da yüksek serum düzeyleri görülebilir. MUC16 geni tarafından kodlanan bu glikoprotein; mekanik stres, konjesyon ve TNF-α ile IL-6 gibi inflamatuar sitokinlerin uyarısıyla mezotelyal hücreler tarafından sentezlenir. Akut ve kronik kalp yetmezliğinde CA-125, ekstravasküler ve interstisyel sıvı birikimi ile konjesyon şiddetini yansıtan önemli bir kardiyak biyobelirteçtir. Natriüretik peptitlerin aksine yaş, böbrek fonksiyon bozukluğu ve vücut kitle indeksinden etkilenmeyen CA-125 seviyeleri; NYHA fonksiyonel sınıfı, hastanede kalış süresi, yeniden yatış ve mortalite riski ile güçlü pozitif korelasyon gösterir. Bu özellikleriyle tedaviye yanıtın ve dekonjesyonun izlenmesinde potansiyel bir rol üstlenir. Plevral, perikardiyal ve peritoneal efüzyonlar ile asit varlığında serum ve sıvı CA-125 konsantrasyonları belirgin şekilde artmaktadır. Özellikle asitin eşlik ettiği karaciğer sirozunda, sıvı birikiminin erken saptanmasında ultrasonografik değerlendirmeye kıyasla daha duyarlı bir parametredir. Ayrıca lenfoma, nefrotik sendrom, peritonit, tüberküloz ve cerrahi müdahaleler sonrasında da yükselmiş CA-125 seviyelerine rastlanabilir. Sonuç olarak, pelviste belirgin bir tümör kitlesi bulunmaksızın saptanan yüksek serum CA-125 düzeyleri; asit, serozal efüzyonlar ve kalp yetmezliği mevcudiyetinde klinisyenler tarafından over karsinomu dışındaki olası kardiyak, serozal ve benign etiyolojiler yönünden bütüncül şekilde değerlendirilmelidir.
Referanslar
Faggiano P, D’Aloia A, Canterin FA, et al. Tumour markers in chronic heart failure. Review of the literature and clinical implications. JCM 2006, 7:573–579.
Sevinc A, Camci C, Turk HM, et al. How to interpret serum CA 125 levels in patients with serosal involvement? A Clin. Dilemma. Oncology 2003, 65:1–6.
Frigy A, Belényi B, Kirchmaier A, et al. Elevated CA-125 as Humoral Biomarker of Congestive Heart Failure: Illustrative cases and a short review of literature. Hindawi, Case Reports in Cardio. Vol. 2020, Article ID 1642914, 5 pages.
Llàcer P, Genís AB, Núñez J. Carbohydrate antigen 125 in heart failure. A New era in the monitoring and control of treatment. Med Clin (Barc). 2019, 152(7):266–273.
Santas E, Palau P, Genis AB & Nu´n˜ez J. The emerging role of carbohydrate antigen 125 in heart failure. Biomark.Med. 2020, 14 (4), 249-252.
Nunez J, Minana G, Nunez E, et al. Clinical utility of antigen carbohydrate 125 in heart failure. Heart Fail Rev. 2014, 19:575–584.
Falcão FJ, Oliveira FR, Cantarelli F, et al. Carbohydrate antigen 125 predicts pulmonary congestion in patients with ST-segment elevation myocardial infarction. Braz J Med Biol Res. 2019, 52 (12).
Hung CL, Hung TC, Lai YH, et al. Beyond malignancy: the role of carbohydrate antigen 125 in heart failure. Bio. Research 2013, 1:25.
Wiśniewska AW, Błażejewski J, Bujak R, et al. The value of cancer antigen 125 (Ca 125) and copeptin as markers in patients with advanced heart failure. Folia Cardiol. 2017; 12 (6), 537–542.
Méndez AB, Llanos JO, Ferrero A, et al. Prognostic value of increased carbohydrate antigen in patients with heart failure. World J Cardiol 2014, 26; 6(4): 205-212.
Falcão F, Oliveira F, Cantarelli F, et al. Carbohydrate antigen 125 for mortality risk prediction following acute myocardial infarction. Scien. Reports 2020 10:11016.
Nunez J, Nunez E, Consuegra L, et al. Carbohydrate antigen 125: an emerging prognostic risk factor in acute heart failure? Heart 2007, 93: 716–721.
Miñana G, Espriella R, Mollar A, et al. Factors associated with plasma antigen carbohydrate 125 and amino-terminal pro-B-type natriuretic peptide concentrations in acute heart failure. EHJ-ACVC 2020, 9 (5).
Bedkowska WB, Chelmecka E, Aleksander, Owczarek AJ. CA125 as a Marker of heart failure in the older women: A population-based Analysis. J. Clin. Med. 2019, 8(5), 607.
Nadia M. Hamdy. Relationship between pro-anti-inflammatory cytokines, T-cell activation and CA 125 in obese patients with heart failure. Med Sci Monit, 2011, 17(3), 173-178.
Yoon JY, Yang DH, Cho HJ, et al. Serum levels of carbohydrate antigen 125 in combination with N-terminal pro-brain natriuretic peptide in patients with acute decompensated heart failure. Korean J Intern Med 2019, 34, 811-818.
Kosar F, Aksoy Y, Ozguntekin G, Ozerol I, Varol E. Relationship between cytokinesand tumour markers in patients with chronic heart failure. Eur J Heart Fail. 2006, 8:270–4.
Turgut O, Tandogan I, Yilmaz MB, Gul I, Gurlek A. Ca125 levels among patientswith advanced heart failure: an emerging independent predictor for survival. Int J Cardiol. 2010, 145:71.
Mi˜nana G, Nú˜nez J, Sanchis J, et al. CA 125 and immunoin-flammatory activity in acute heart failure. Int J Cardiol. 2010; 145:547–8.
Zhuang J, Faggiano P, Li Q, et al. Insights into the clinical implications of carbohydrate antigen 125 as a biomarker of heart failure: a meta-analysis and systematic review of published studies. Cardiovasc Med 2014, 15:864–872.
Núñez j, Sanchis j, Bodí V, et al. Improvement in risk stratification with the combination of the tumour marker antigen carbohydrate 125 and brain natriuretic peptide in patients with acute heart failure. EHJ 2010, 31 (14), 1752–1763.
Chen X, Wu M, Xu K, Huang M et al. Prognostic value of carbohydrate antigen 125 combined with N-terminal pro B-type natriuretic peptide in patients with acute heart failure. Acta Cardio., https://doi.org/10.1080/00015385.2020.1769347.
Mădălina Ababei, Alexandru Câmpeanu, Diana Nistorescu, Ondin Zaharia, Paul Portelli, Tiberiu Nanea. A New Biomarker in Acute-Decompensated Heart Failure. Preliminary Study. Int. Medicine 2019, 16 (3).
Ghayumi SM, Mehrabi S, Doroudchi M and Ghaderi A: Diagnostic value of tumor markers for differentiating malignant and benign pleural effusions of Iranian patients. Pathol Oncol Res 2005, 11(4): 236-241.
Shitrit D, Zingerman B, Shitrit AB, Shlomi D and Kramer MR: Diagnostic value of CYFRA 21-1, CEA, CA 19-9, CA 15-3, and CA 125 assays in pleural effusions: analysis of 116 cases and review of the literature. Oncologist 2005, 10(7): 501-507.
Ustun H, Borazan A, Bilgicli N and Yilmaz A: Diagnostic value of tumoural markers in pleural effusions. Int J Clin Pract 2004, 58(1): 22-25.
Cascinu S, Del Ferro E, Barbanti I, et al. Tumor markers in the diagnosis of malignant serous effusions. Am J Clin Oncol 1997, 20(3): 247-250.
Topolcan O, Holubec L, Polivkova V, et al. Tumor Markers in Pleural Effusions. AR. 2007, 27 (4A) 1921-1924.
Yang Y, Liu Y, Shi HZ. Diagnostic Accuracy of Combinations of Tumor Markers for Malignant Pleural Effusion: An Updated Meta-Analysis. Respiration 2017; 94:62–69.
Faggiano P, D’Aloia A, Canterin FA, et al. Tumour markers in chronic heart failure. Review of the literature and clinical implications. JCM 2006, 7:573–579.
Topalak O, Saygili U, Soyturk M, et al. Serum, Pleural Effusion, and Ascites CA-125 Levels in Ovarian Cancer and Nonovarian Benign and Malignant Diseases: A Comparative Study. Gynecol Oncol. 2002, 85, 108–113.
Kimura Y, Fujii T, Hamamoto K, et al. Serum CA-125 level is a good prognostic indicator in lung cancer. Br J Cancer 1990, 62:676–8.
Lindgren J, Kuusela P, Hellstrom PE, et al. The ovarian cancer associated antigen CA 125 in patients with pleural effusions. Eur J Cancer Clin Oncol 1988, 24:737–739.
Sarı R, Yildirim B, Sevinc A, Hilmioglu F: Sensitivity of CA-125 in patients with liver cirrhosis in the presence of ascites. Am J Gastroenterol 2001; 96:253–254.
Sevinc A, Buyukberber S, Sarı R, Kiroglu Y, Turk HM, Ates M: Elevated serum CA-125 levels in hemodialysis patients with peritoneal, pleural, or pericardial fluids. Gynecol Oncol 2000, 77:254–257.
Sevinc A, Buyukberber S, Sarı R, Turk HM, Ates M: Elevated serum CA-125 levels in patients with nephrotic syndrome-induced ascites. Anticancer Res 2000, 20:1201–1204.
Zuckerman E, Lanir A, Sabo E, et al. Cancer Antigen 125: A sensitive marker of ascites in patients with liver cirrhosis. Am J Gastroenterol 1999; 94:1613–1618.
Ruibal A, Encabo G, Martinez-Miralles E, Murcia C, et al. CA-125 seric levels in non malignant pathologies. Bull Cancer 1984, 71:145–8.
Sarı R, Camci C, Sevinc A, et al. The effect of abdominal surgery on serum CA-125 levels. Clin Exp Obstet Gynecol 2000, 27:244–245.
Talbot RW, Jacobsen DJ, Nagorney DM, et al. Temporary elevation of CA 125 after abdominal surgical treatment for benign disease and cancer. Surg Gynecol Obstet 1989, 168:407–412.
Zee AG, Duk JM, Aalders JG, et al. The effect of abdominal surgery on the serum concentration of the tumour-associated antigen CA 125. Br J Obstet Gynaecol 1990, 97:934–938.
