UDK: 618.11-006.6:616.33/.34-006.6]-079.4(497.7)
Asani P.1, Alulovski I.1,Tanturovski M.1,Joksimovikj M.1,Abdija P.1, Asani D.2
1University Clinic for Gynecology and Obstetrics, Mother Theresa Clinic, Skopje, North Macedonia
2University Clinic for Orthopedics, Mother Theresa Clinic, Skopje, North Macedonia
Aluloski Igor
https://orcid.org/0000-0002-6482-1014
Tanturovski Mile
https://orcid.org/0000-0002-9837-4806
Joksimovikj Marija
https://orcid.org/0000-0003-1827-6243
Abstract
Background: Differentiating primary ovarian carcinoma from gastrointestinal (GI) malignancies is challenging. The CA-125/CEA ratio, with a cut-off around 25:1, may help distinguishing ovarian from non-ovarian cancers. We evaluated the performance of CA-125, CEA, and their ratio in women treated at a tertiary gynecologic oncology center in North Macedonia.
Methods: A prospective study of 72 women ≥18 years with adnexal masses, ascites, or elevated tumor markers suspicious for malignancy, treated surgically between 2019-2024. Preoperative serum CA-125, CEA, CA19-9, and CA72-4 were measured, and the definitive diagnosis was established histopathologically. Cases were classified as ovarian/gynecologic or GI malignancies. The primary endpoint was the ability of the CA-125/CEA ratio to differentiate ovarian from GI malignancy.
Results: The median age was 61 years, and 79.2% of patients were postmenopausal. Ovarian/gynecologic malignancy was diagnosed in 69/72 (95.8%), and 3/72 (4.2%) had GI malignancies. The CA-125/CEA ratio was significantly higher in ovarian malignancies (101.0 vs 11.4, p=0.033). A cut-off of ≤25 identified all 3 GI cancers (100% sensitivity), but misclassified 15 ovarian cancers (72.7% specificity). The ROC AUC was 0.86 for the CA-125/CEA ratio, compared to 0.61 for CA-125 alone.
Conclusions: A CA-125/CEA ratio ≤25 identified GI malignancies with high sensitivity but modest specificity. This approach may reduce unnecessary GI endoscopies in resource-limited settings like North Macedonia, though larger studies are needed.
Keywords:CA-125; CEA; gastrointestinal metastasis; North Macedonia; ovarian cancer; tumor markers.
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