The clinical courses of 24 patients with advanced epithelial ovarian cancer were monitored with serial serum CA125, PIIINP and PICP determinations before, during and after treatment. Initial serum CA125, PIIINP and PICP concentrations were pathologic in 93%, 80% and 11% of the cases, respectively. Eight patients responded to therapy with complete remission and 16 patients died of the malignancy. Initial serum PIIINP concentration, but not that of CA125 or PICP, was significantly lower in responders than in nonresponders. The pathologic serum CA125 and PIIINP levels of the responders decreased to normal within two months, whereas in patients with a poor prognosis they remained elevated. Serum CA 125 and PIIINP responded to progression with an increase and to remission with a decrease. The changes in the serum PICP concentration took place predominantly within the reference interval. In seven patients with progressive malignancy, it increased to a pathologic level during the final stage of the disease. Our results indicate that extensive ovarian malignancy strongly affects the metabolism of type I and type III collagens. The PIIINP assay is clinically useful. PIIINP and PICP determinations also have potential to increase our understanding of the mechanisms of invasion and spread of malignant tumours.

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