育齡婦女血清CA-125篩檢異常追蹤結果分析

Clinical Outcome in Women of Childbearing Age with an Elevated CA-125

背景：利用血清CA-125檢驗對於卵巢癌的高特異性，已經廣泛運用於各項健康檢查並被列為癌症篩檢的腫瘤標記之一。但CA-125的上升也跟許多良性婦科疾病、非婦科疾病及一些非卵巢惡性腫瘤的疾病等有關。而目前國內相關的本土資料並不多。方法：以回溯性資料分析，收集女性勞工的年度健檢完成後所發現血清CA-125異常之個案資料，以及經轉介至本院門診之臨床追蹤的結果加以探討。依下列步驟進行研究：(1)收集某公司於2007年女性員工於工廠內健康檢查結果血清CA-125值異常個案，資料項目包含性別、年齡、血清CA-125值、月經期與否、懷孕與否(2)經由搜尋本院病歷血清CA-125值異常的女性員工，追蹤其複檢的血清CA-125值與各項檢查結果，針對血清CA-125值，過去病史、月經期與否、懷孕與否、婦科超音波及手術之病理報告進行分析。結果：全部8,493名女性受檢者中有398位CA-125異常（異常率4.7%）。在398位個案中（15-49歲），平均年齡為27.34歲。166位個案在本院完成追蹤複診，其中有60位在回診中接受血清CA-125的複檢，有36位為正常(60%)，24位持續異常(40%)。回診後臨床診斷結果如下：34位(20.5%)為正常，35位(21.1%)為月經所致，20位(12.0%)為懷孕，20位(12.0%)為子宮內膜異位症或子宮內膜異位瘤，6位(3.6%)為平滑肌瘤，13位(7.8%)為子宮腺肌症／腺肌瘤，24位(14.5%)為功能性卵巢囊腫，8位(4.8%)為良性卵巢腫瘤，有1位(0.6%)為卵巢惡性腫瘤，診斷未定者有5位(3.0%)，其中2位超音波追蹤無異常發現，但複檢之血清CA-125仍屬異常，仍待繼續追蹤。結論：月經及懷孕為影響育齡婦女血清CA-125異常最常見原因。但較高的血清CA-125異常值，仍有較高的機率為惡性疾病。本研究以大規模追蹤血清CA-125篩檢之臨床診斷結果，希望提供臨床醫療參考及預防醫學之運用。

An elevated serum CA-125 is associated with epithelial ovarian cancer, along with many other benign gynecologic diseases. We collected the clinical follow-up results of women with increased serum CA-125 levels on health screening examinations to determine the final diagnoses and prevalence of their gynecologic diseases. Methods: We conducted a retrospective study to collect follow-up results of women with elevated CA-125 levels who underwent a company-sponsored annual health examination in 2007 in southern Taiwan. We collected data on gender, age, serum CA-125 level, menstruation pattern, and pregnancy history. Women with an elevated CA-125 were referred to our hospital for further evaluation. The medical histories, menstruation status, and pregnancy status were recorded and the serum CA-125 levels were rechecked. If indicated, ultrasonography was performed. We analyzed the data to calculate the prevalence of elevated CA-125 levels and the final gynecologic diagnoses. Results: Among the women screened, 398/8493 (4.7%) had elevated CA-125 levels. The mean age of the women with elevated CA-125 levels was 27.34 years. Of the 398 women, 166 completed gynecologic evaluations; 60 women had the serum CA-125 levels rechecked and 36/60 (60%) were normal. Women who were menstruating had higher CA-125 levels than women who were not menstruating. The final clinical diagnoses among the 166 women who were reevaluated based on their initial elevated CA-125 levels were as follows: 34 (20.5%), normal; 35 (21.1%), menstruation-related, 20 (12.0%), pregnancy-related, 20 (20.0%), endometriosis or endometrioma; 6 (3.6%), uterine myoma; 13 (7.8%), adenomyosis; 24 (14.5%), functional ovarian cyst; 8 (4.8%), benign ovarian cyst; and 1 (0.6%), proven ovarian malignancy; the remaining cases were undetermined. Conclusion: While the most common causes of elevated serum CA-125 levels are related to menstruation and pregnancy, elevated CA-125 occurs in many gynecologic diseases, including malignancies. We determined the clinical outcomes of elevated serum CA-125 levels among young women in this southern Taiwan community. These results have application for preventive medicine and clinical practice. A cost-benefit analysis of CA-125 screening is warranted.