Levels of CA-19.9, CA-125, and CA-195 in seminal plasma and in vitro fertilization rates.

OBJECTIVE: To assess the relationship between carbohydrate tumor markers in seminal plasma and fertilization rates in IVF cycles. DESIGN: Prospective study. SETTING: Academic tertiary hospital. PATIENTS: Forty-six consecutive couples subjected to IVF in which at least one oocyte was obtained. MAIN OUTCOME MEASURES: Determination of CA-19.9, CA-125, and CA-195 in seminal plasma 1 week before IVF. RESULTS: CA-125 was higher in the group without fertilization (321 +/- 198 U/mL, mean +/- SD) than in the group in which at least one oocyte was fertilized (155 +/- 165 U/mL), whereas CA-19.9 and CA-195 were similar in both groups. However, at the cutoff 66%, lower values of CA-19.9 were found in the fertilization group rate < 66% (707 +/- 1,217 versus 1,069 +/- 1,084) and of CA-195 (67 +/- 44 versus 218 +/- 274). No correlation was found between tumor marker levels and fertilization rates. CONCLUSION: CA-125 seems to be an indicator of sperm fertilization capacity, whereas the importance of CA-195 and CA-19.9 will require further studies.

CA 19-9 in non-neoplastic liver diseases. A clinical and laboratory study.

CA 19-9 is a tumor marker with frequent false-positive results in pancreatic and hepatobiliary diseases. This study was carried out to evaluate the behaviour of CA 19-9 in 159 patients with benign diffuse hepatic disease, 85 cirrhotics and 74 non-cirrhotics, who underwent a thorough clinical and laboratory evaluation. CA 19-9 was correlated with numerous clinical and biochemical features of liver diseases: bilirubin and alkaline phosphatase activity were the most reliable predictors of the CA 19-9 concentrations. There were abnormal concentrations of CA 19-9 in 34.6% of the 159 patients and in 47.1% of the 85 cirrhotics. Because of the large number of abnormal values and the high concentrations attained in some of them, the cut-off used in patients with diffuse hepatic disease needs to be set at more than twice the basal level, thus allows only 10% of false positives. Even higher values are required for cirrhotic or icteric patients. The results indicate that cholestasis plays an important role in causing the raised CA 19-9 in these patients, although there were also abnormal concentrations in normobilirubinemic patients.

CA 15.3 in nonmalignant liver diseases.

CA 15.3 is a recent tumor marker for a wide range of cancers that is usually used for monitoring breast carcinoma patients. This study was performed to evaluate CA 15.3 behaviour in 161 patients with benign diffuse hepatic diseases who underwent thorough clinical and biochemical evaluation. Abnormal serum levels of this antigen were found in 8.7% of the 161 patients, 11.6% of the 86 cirrhotics, and 5.3% of the 75 noncirrhotic patients. The correlation between CA 15.3 and certain parameters characteristic of liver diseases was checked. IgA showed the most relevant correlation (r = 0.39, p less than 0.00001) and in our series a normal level of IgA was practically determinant of normal CA 15.3 levels. Our results also support the role played by hepatocellular dysfunction in increasing levels of this antigen in spite of the low number of false-positive results. CA 15.3 can be used as a tumor marker in these patients at levels used for healthy subjects.

Evaluation of the behavior of carcinoembryonic antigen in cirrhotic patients.

Benign liver diseases are a cause of increased serum levels of CEA. We studied the behavior of CEA in 86 patients with liver cirrhosis who underwent extensive clinical and laboratory evaluation. We found abnormal CEA levels in 38.4% of the patients (28.6% Child's grade A, 40.6% Child's B, and 42.4% Child's C) with a mean of 4.75 ng/ml. Significant differences were found between patients and controls. There was a trend towards higher levels of CEA in more severe cirrhosis according to Child's classification, although this was not significant. We found significant correlations between CEA and some liver tests, including glycocholic acid (r = 0.264., p = 0.012), a marker of severity in liver diseases. The increase of CEA in these patients is probably due to alterations in its metabolic processing caused by hepatocellular dysfunction. Moderate elevations of serum CEA can be expected in cirrhotic patients independently of malignancy.

Tissue polypeptide antigen (TPA) in chronic active hepatitis and mild liver diseases.

Tissue polypeptide antigen (TPA) is a non-specific tumor marker with a broad reactivity. Increases in TPA are also observed in benign liver diseases. We conducted this study to evaluate the usefulness of TPA serum level determination in 15 patients with chronic active hepatitis (CAH) and in 30 patients with mild liver diseases (MLD) diagnosed at the time of evaluation. TPA levels were abnormal in 73.3% of CAH patients and in 40% of MLD patients. CAH patients had significantly higher TPA levels than MLD patients (p = 0.006). There was a significant correlation between TPA and ASAT (r = 0.581 p < 0.00001), suggesting that cytolysis plays an important role in the increase in TPA. A TPA value of twice the normal level will unlikely be due to MLD (specificity 90%). TPA can be used in the clinical characterization of these patients and in the selection of patients for biopsy.

Preliminary study of alpha-fetoprotein in nonmalignant liver diseases. A clinico-biochemical evaluation.

This preliminary study was carried out to evaluate the behavior of AFP in 155 patients with benign diffuse liver diseases who underwent thorough clinical and laboratory evaluation. We found correlations between AFP and some clinical and biochemical parameters characteristic of liver diseases; serum glutamic oxalacetic transaminase (GOT) proved the most relevant (r = 0.27 p = 0.0004) and most reliable marker to predict AFP levels. 22.6% of the patients as a whole, 25.6% of the 86 cirrhotics and 18.8% of the 69 non-cirrhotics, had increased levels of AFP. Patients with active liver disease as measured by increased GOT, had higher AFP levels than patients with quiescent liver diseases (p = 0.0048), suggesting that cytolysis and/or regeneration plays a role in the increase in AFP. Elevation of the cut-off level was necessary to improve the specificity of AFP as a tumor marker. In our series, the cut-off of 9 ng/ml was exceeded by only 10% of the patients.

Total immunoreactive alpha-inhibin in human seminal plasma, sperm quality, and in vitro fertilization rates.

OBJECTIVE: To assess the relationship between the concentrations of total immunoreactive alpha-inhibin in human seminal plasma, sperm quality, and in vitro fertilization (IVF) rates. SETTING: Medical school hospital. DESIGN: Prospective study. PATIENTS: 72 consecutive couples undergoing IVF with husband's sperm in which at least 4 oocytes were obtained. MAIN OUTCOME MEASURES: Alpha-inhibin determination by means of enzyme-linked immunosorbent assay, sperm analysis for density and motility, IVF rates. RESULTS: Total immunoreactive alpha-inhibin levels were not correlated with IVF rates. Nor were there any differences in fertilization rates in the different groups. Lower inhibin levels were found in oligozoospermic cases. Lower sperm counts were found in cases with inhibin values below the median value, and also with respect to various other cutoffs. No correlation was found between inhibin levels and any of the sperm variables measured. CONCLUSION: Total immunoreactive alpha-inhibin is not a prognostic factor in IVF cycles. However, an association was found between inhibin and sperm concentration, suggesting that alpha-inhibin in the human seminal fluid could be a marker for some aspects of spermatogenesis.

Study of the tumor marker carbohydrate antigen 50 in liver cirrhosis. Pathogenetic considerations.

Carbohydrate antigen 50 (CA 50) is a tumor marker that increases in many malignancies, especially in carcinoma of the digestive tract. False-positive results occur in benign liver disease. The behavior of CA 50 in 86 cirrhotic patients was studied, with thorough clinical and laboratory evaluations. There were abnormal values in 75.6% of the patients without significant differences among the different Child's grades. Significant correlations with some liver tests were found, especially transaminases, and at lower degrees with cholestatic parameters. Despite the previously reported relation with cholestasis, especially in biliary diseases, the CA 50 serum levels of the authors' cirrhotic patients appeared to be more closely related to cytolysis, according to the results of several statistical tests, including multivariate analysis. Because of the percentage and the levels of the abnormal results, this antigen cannot be used as a tumor marker in cirrhotic patients. Cytolysis seems to have a pathogenetic role in the increase of CA 50, at least in cirrhosis.