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High Concentrations of Activin A in the Peritoneal Fluid of Women With Epithelial Ovarian Cancer

Fernando M. Reis

Stefano Luisi

Secondo Danero

Luigi Pirtoli

Giovanni Scambia

Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy; Department of Obstetrics and Gynecology, University of Minas Gerais, Belo Horizonte, Brazil; Department of Gynecology, Catholic University of Rome, Rome, Italy

Felice Petraglia

Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy; Department of Obstetrics and Gynecology, University of Minas Gerais, Belo Horizonte, Brazil; Department of Gynecology, Catholic University of Rome, Rome, Italy; University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy; petraglia{at}unisi.it

Objective: The aim of the present study was to evaluate the conentrations of activin A in the peritoneal fluid of women with epithelial (serous) ovarian cancer.

Methods: A group of 160 women was studied and divided in four subgroups as follows: 1) serous ovarian carcinoma (n = 32); 2) serous ovarian cystadenoma (n = 20); 3) endometriosis (n = 53); and 4) healthy controls (n = 55), including both fertile (n = 32) and postmenopausal women (n = 23). Specimens of peritoneal fluid were collected during surgical interventions, and active A was quantified using a specific two-site enzyme immunoassay.

Results: Peritoneal fluid activin A concentrations in women with ovarian carcinoma were about five-fold higher than those found in the control group (median [interquartile range] = 7.60 [2.85-10.15] and 1.50 [1.00-2.50] ng/mL, respectively, P < .001). In contrast, the women with benign serous cystadenoma had peritoneal fluid activin A concentrations (1.50 [1.0-2.70] ng/mL) similar to those of the control group. High peritoneal fluid activin A levels (> 2 multiples of the mean) distinguished carcinoma from cystadenoma with a sensitivity of 72% and a specificity of 80%. The follow-up of nine patients with stage IIIc ovarian cancer showed no apparent relationship between the peritoneal fluid activin A levels and overall survival. No significant difference in peritoneal fluid activin A concentrations between patients with endometriosis and control women was observed.

Conclusion: Most women with serous ovarian carcinoma had high concentrations of activin A in the peritoneal fluid, supporting a possible role of this growth factor in ovarian cancer.

Key Words: Activin • ovarian cancer • ovarian cyst • peritoneal fluid

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