الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
NHL is a heterogeneous group of malignancies of lymphoid tissues derived from clonal expansion of B cells, T cells, natural killer (NK) cells or precursors of these cells and represents a high burden in malignancy globally, which translates to universally high economic burden at the patient, family and society level. Since treatment failure is the most expensive pattern in NHL healthcare cost, strategies to delay or prevent treatment failure via enhancing diagnosis, staging and proper risk stratification should greatly reduce the economic burden of NHL. CA 125 as a marker was considered to achieve this since we have data to support its production either directly or indirectly by NHL cells and this was evidenced by epidemiological data showing its consistent elevation in the range of 40-77%. The data regarding high levels of CA 125 in NHL in its clinical utility (staging and proper risk stratification) has been controversial. To answer the questions of clinical utility with the aim of enhancing staging and risk stratification so as to delay or prevent treatment failure and finally, to indirectly reduce the cost of treatment in NHL, we rolled a cross-sectional comparative study.
The study group was subjected to inclusion and exclusion criteria and sixty adult individuals aged eighteen years and older met the eligibility criteria. They were divided into group I: 45 newly diagnosed Non-Hodgkin’s Lymphoma patients and group II: 15 age and sex matched healthy individuals with no morbidity serving as a control group. The cases were staged as per Lugano staging system and risk stratified as per age adjusted International Prognostic Index score. Second-generation CA 125 assay was performed using direct chemiluminescent immunoassay (ADVIA Centaur® CA 125 II assay) for both groups and the levels were statistically compared. Since LDH and B2M are well established, widely accepted and widely used the levels were measured only in group I (cases) and statistically correlated to CA 125. Each of the three markers was tested for its clinical performance in staging and risk stratification. Although not preplanned in our study’s objectives, we tested the diagnostic utility of CA 125 due to lack of published data on this function. For the same performance the three markers were also tested in combination.
Our results were as follows:
The mean CA 125 levels were significantly different between the two groups with high levels in cases as compared to controls at 70.90 ± 52.99 and 35.86 ± 67.35 respectively(p=0.001). Of the 45 patients evaluated at diagnosis (median CA 125: 53.0; range, 2.20 – 248.0 U/mL), 37 (82.2%) had increased CA 125 values and this adds to the existing data that CA 125 is elevated in NHL. Lugano stage was significantly associated and moderately positively correlated with CA 125. The presence of extranodal disease was significantly associated with high CA 125 levels. The high CA-125 levels were also significantly associated with high IPI score (risk). Although the positive association of CA125 with the widely accepted and used LDH and B2M was weak, it was significant. After CA 125 showed significant association with Lugano staging system and IPI, and significant correlation with these 2 markers, the performance of CA 125 together with the 2 markers was tested individually for diagnosis, staging and risk stratification and was found to be acceptable and significant. In combination, the CA 125 enhanced the performance of the other 2 markers in diagnosis, staging and risk stratification. The effect of stage of NHL and risk of the patient as per IPI was found to independently affect the CA 125 levels on univariate analysis. On multivariate analysis extranodal disease status was the most independent variable affecting IPI the most.
In conclusion, based on the data from the present study, CA-125 levels are elevated in NHL and are useful in and can enhance diagnosis, staging & risk stratification