Ovarian cancer early detection by circulating CA125 in the context of anti-CA125 autoantibody levels: Results from the EPIC cohort.
Fortner RT., Schock H., Le Cornet C., Hüsing A., Vitonis AF., Johnson TS., Fichorova RN., Fashemi T., Yamamoto HS., Tjønneland A., Hansen L., Overvad K., Boutron-Ruault M-C., Kvaskoff M., Severi G., Boeing H., Trichopoulou A., Papatesta E-M., La Vecchia C., Palli D., Sieri S., Tumino R., Sacerdote C., Mattiello A., Onland-Moret NC., Peeters PH., Bueno-de-Mesquita HBA., Weiderpass E., Quirós JR., Duell EJ., Sánchez M-J., Navarro C., Ardanaz E., Larrañaga N., Nodin B., Jirström K., Idahl A., Lundin E., Khaw K-T., Travis RC., Gunter M., Johansson M., Dossus L., Merritt MA., Riboli E., Terry KL., Cramer DW., Kaaks R.
CA125 is the best ovarian cancer early detection marker to date; however, sensitivity is limited and complementary markers are required to improve discrimination between ovarian cancer cases and non-cases. Anti-CA125 autoantibodies are observed in circulation. Our objective was to evaluate whether these antibodies (1) can serve as early detection markers, providing evidence of an immune response to a developing tumor, and (2) modify the discriminatory capacity of CA125 by either masking CA125 levels (resulting in lower discrimination) or acting synergistically to improve discrimination between cases and non-cases. We investigated these objectives using a nested case-control study within the European Prospective Investigation into Cancer and Nutrition cohort (EPIC) including 250 cases diagnosed within 4 years of blood collection and up to four matched controls. Circulating CA125 antigen and antibody levels were quantified using an electrochemiluminescence assay. Adjusted areas under the curve (aAUCs) by 2-year lag-time intervals were calculated using conditional logistic regression calibrated toward the absolute risk estimates from a pre-existing epidemiological risk model as an offset-variable. Anti-CA125 levels alone did not discriminate cases from controls. For cases diagnosed <2 years after blood collection, discrimination by CA125 antigen was suggestively higher with higher anti-CA125 levels (aAUC, highest antibody tertile: 0.84 [0.76-0.92]; lowest tertile: 0.76 [0.67-0.86]; phet = 0.06). We provide the first evidence of potentially synergistic discrimination effects of CA125 and anti-CA125 antibodies in ovarian early detection. If these findings are replicated, evaluating CA125 in the context of its antibody may improve ovarian cancer early detection.