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Yan Xu, PhD; Zhongzhou Shen, PhD; Donald W. Wiper, MD; Minzhi Wu, MS; Richard E. Morton, PhD; Paul Elson, ScD; Alexander W. Kennedy, MD; Jerome Belinson, MD; Maurie Markman, MD; Graham Casey, PhD

JAMA. 1998;280:719-723.

Context.— Lysophosphatidic acid (LPA) has been shown to stimulate proliferation of ovarian cancer cells and is present in the ascitic fluid of patients with ovarian cancer.

Objectives.— To determine whether elevated levels of LPA are present in plasma from patients with ovarian cancer and other gynecologic malignancies compared with healthy controls and to evaluate whether an elevated LPA plasma level may be a biomarker for these diseases.

Design.— A research assay was used to measure total LPA levels in plasma from healthy women and women with different diseases. All LPA assays and comparison of LPA levels and CA125 (an ovarian cancer biomarker) levels were performed by observers blinded to patient status or group.

Setting.— The Cleveland Clinic Foundation.

Participants.— A convenience sample of 48 healthy control women, 48 women with ovarian cancer, 36 women with other gynecologic cancers, 17 women with benign gynecologic diseases, 11 women with breast cancer, and 5 women with leukemias.

Main Outcome Measures.— Total LPA levels in plasma samples from patients and controls.

Results.— Patients in the ovarian cancer group had significantly higher plasma LPA levels (mean, 8.6 µmol/L; range, 1.0-43.1 µmol/L) compared with the healthy control group (mean, 0.6 µmol/L; range, <0.1-6.3 µmol/L) (P<.001). Elevated plasma LPA levels were detected in 9 of 10 patients with stage I ovarian cancer, 24 of 24 patients with stage II, III, and IV ovarian cancer, and 14 of 14 patients with recurrent ovarian cancer. Of 36 patients with other gynecologic cancers, 33 also showed higher LPA levels (mean, 14.9 µmol/L; range, <0.1-63.2 µmol/L), compared with healthy controls (P<.001). Elevated plasma LPA levels were detected in 5 of 48 controls and 4 of 17 patients with benign gynecologic diseases and in no women with breast cancer or leukemia. In comparison, among a subset of patients with ovarian cancer, 28 of 47 had elevated CA125 levels, including 2 of 9 patients with stage I disease.

Conclusions.— Plasma LPA levels may represent a potential biomarker for ovarian cancer and other gynecologic cancers. However, these findings are preliminary and require confirmation in larger studies.

From the Departments of Gynecology and Obstetrics (Drs Xu, Wiper, Kennedy, Belinson, and Casey), Cancer Biology (Drs Xu, Shen, and Casey and Ms Wu), Cell Biology (Dr Morton), and Biostatistics (Dr Elson) and the Cancer Center (Drs Xu, Markman, Casey, and Elson), Cleveland Clinic Foundation, and the Department of Chemistry, Cleveland State University (Dr Shen), Cleveland, Ohio.

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