LETTER TO THE EDITOR

Evaluation of Relationship
Between CA-125 Levels and
Ascites in Patients with Liver
Cirrhosis
Sir,

We read a published article by Qureshi et al. in JCPSP

2014, Vol. 24 (4): 232-235 with great interest.1 In this
study, it was aimed to evaluate Cancer Antigen-125
(CA-125) levels in patients with liver cirrhosis and the
probable relation between the high levels and the
amount of ascites. In conclusion, a moderate correlation
was found between CA-125 levels and presence and
amount of ascites. However, we would like to ask some
questions from authors and their comments on this
study.

First, there are many studies found in literature

indicating elevation of CA-125 levels specific to ascites
in patients with liver cirrhosis.2,3 Although encountering
different CA-125 levels in patient groups of these
studies, any cut-off value except 35 U/mL has not been
suggested to predict severity of the diseases yet, as
indicated in the original study, a level above 35 U/mL is
considered abnormal.4 In the methodology section of the
original article, it is mentioned that patients were divided
into four groups as between 35 - 100, 100 - 500, 500 1000 and above 1000 U/L. However, any literature
and/or clinical reason is not specified in grouping
patients according to their CA-125 levels. Referring a
literature, if any, could increase the value and reliability
of results.
Second, after dividing cirrhotic patients into two groups,
those with and without ascites, univariate logistic
regression analysis should be performed to assume
CA-125 as a marker of ascites in patients with liver
cirrhosis. Moreover, assessing power of CA-125 to
determine the severity of ascites by performing ordinal
logistic regression analysis including all four groups of
patients could provide more significant results. After
performing these analyses you can conclude whether or
not CA-125 is useful for the prediction of ascites.
CA-125 may be a useful marker for the prediction of
ascites, but regression analysis should be performed for
this decision.

REFERENCES

1. Qureshi MO, Dar FS, Khokhar N. Cancer antigen-125 as a

marker of ascites in patients with liver cirrhosis. J Coll Physicians
Surg Pak 2014; 24:232-5.

2. Xiao WB, Liu YL. Elevation of serum and ascites cancer

antigen-125 levels in patients with liver cirrhosis. J Gastroenterol
Hepatol 2003; 18:1315-6.

3. Chowdhury MA, Xiubin Z, Wei H, Chenghao G. Cancer antigen125 and ICAM-1 are together responsible for ascites in liver
cirrhosis. Clin Lab 2014; 60:653-8.

4. Mayo Clinic, Mayo Medical Laboratories. Tests and procedures:

cancer antigen-125 (CA-125) [Internet]. [cited June 06, 2014].
Available from: http://www.mayomedicallaboratories.com/testcatalog/Clinical+and+Interpretive/9289
1
2
3

Huseyin Kayadibi1, Erdim Sertoglu2 and Metin Uyanik3

Department of Medical Biochemistry, Adana Military Hospital,

Adana, Turkey.
Department of Medical Biochemistry, Ankara Mevki Military
Hospital, Anittepe Dispensary, Ankara, Turkey.
Department of Medical Biochemistry, Gulhane School of
Medicine, Ankara, Turkey.
Correspondence: Dr. Huseyin Kayadibi, Adana Military
Hospital, Department of Medical Biochemistry, 01150,
Adana, Turkey.
E-mail: mdkayadibi@yahoo.com
Received: June 09, 2014; Accepted: June 26, 2014.

Authors Reply:

We appreciate the thoughts shared on our study. The

aim of our study was to evaluate the correlation between
Cancer Antigen (CA-125) level with the amount of
ascites in patients with liver cirrhosis.1 We found that
there was a moderate correlation between CA-125
levels and amount of ascites.1 We mentioned in our
study that there are reports which showed that the
presence of ascites appears to play a key role in the
mechanism responsible for the increased levels of
CA-125 in the patients of liver cirrhosis.2 Few studies are
suggestive of correlation between ascites and increased
CA-125 levels.3 However, will levels of CA-125 also
increase simultaneously with increasing amount of
ascites? This question was answered in the present
study.1

In previous studies, increases of CA-125 levels meant

any value greater than 35 U/ml.2,4 We also took values
greater than 35 U/ml as abnormal, but we also divided
CA-125 in four groups according to values between 35
U/ml to 1000 U/ml. All groups have increased values in
the last group. After dividing in groups, we compared
these values with the amount of ascites, and found a
better picture that would have not been possible by
taking all the patients as one group. For instance, we
found 14 patients of tense ascites with CA-125 levels
greater than 500 U/ml, while only 3 patients had CA-125
levels above 500 U/ml with mild ascites. Similarly, 10
patients had CA-125 levels between 35 to 100 U/ml, and
none were in this range with severe ascites.1

Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (11): 873-874

873

Letter to the editor

There are many aspects of this study, multiple

inferences could be drawn by applying different test. We
applied the tests according to our objectives. This is in
accordance with international literature.3-5 However, the
tests pointed out could be applied to extract more
detailed results out of this study.

REFERENCES

1. Qureshi MO, Dar FS, Khokhar N. Cancer antigen-125 as a

marker of ascites in patients with liver cirrhosis. J Coll Physicians
Surg Pak 2014; 24:232-5.

2. Zuckerman E, Lanir A, Sabo E, Rosenvald-Zuckerman T,

Matter I, Yeshurun D. Cancer antigen-125: a sensitive marker
of ascites in patients with liver cirrhosis. Am J Gastroenterol
1999; 94:1613-8.

3. Algan-cal P, Aksahin A, etin T, Yildirim IS. Cancer antigen-125

874

levels in patients with ascites. Turk J Gastroenterol 2003; 13: 257.

4. Devarbhavi H, Kaesi D, Williams AW, Rakelaaa J, Klee GG,

Kamath PS. Cancer antigen-125 in patients with chornic liver
disease. Mayo Clin Proc 2002; 77:538-41.

5. Jablkowski M, Bialkowska J, Koktysz R, Bartkowiak J,

Stankiewicz W, Dworniak D. Cancer antigen-125 as a marker
of ascites in patients with liver cirrhosis. Pol Merkur Lekarski
2004; 17:149-52.

Muhammad Omar Qureshi, Faisal Saud Dar and Nasir Khokhar

Department of Gastroenterology, Shifa International Hospital,

Islamabad.
Correspondence: Prof. Nasir Khokhar, Department of
Gastroenterology, Shifa International Hospital, H-8/4,
Islamabad.
E-mail: drnkhokhar@yahoo.com

Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (11): 873-874