CEA联合CA19-9检查在胆胰腺癌诊断中的价值

目的探讨CEA联合CA19-9检查在胆胰腺癌诊断中的价值。方法收集2012年8月至2015年7月贵州省人民医院肝胆外科收治的B超、CT、MRI等影像学检查提示胆道梗阻和胆道、胰腺占位,行CEA、CA19-9检查的患者800例,结合病理结果回顾性分析CEA联合CA19-9检查对胆胰腺癌诊断的准确率。结果单独CEA阳性(3.40μg/L)时,胆胰腺癌的诊断准确率为27.78%;单独CA19-9阳性(39.00 U/mL)时,胆胰腺癌的诊断准确率为35.43%;CEA和CA19-9均阳性时,胆胰腺癌的诊断准确率为85.71%;当提高阳性设定值CEA3.50μg/L,CA19-9200.00 U/mL时,胆胰腺癌的诊断准确率为95.42%。CEA和CA19-9同时阳性且持续升高时,依据之前的两组阳性设定值,胆胰腺癌的诊断准确率分别为95.91%和98.41%。结论 CEA联合CA19-9检查能够显著提高胆胰腺癌诊断的准确率,尤其当CEA3.50μg/L同时CA19-9200.00 U/mL,而且二者持续升高时。     

胰腺癌血清CA19-9和CEA的表达及意义

目的:探讨胰腺癌患者手术前后血清CA19-9和CEA变化情况。方法:回顾性分析收治的胰腺疾病患者56例，分为胰腺癌患者组（29例）和胰腺系统良性病对照组（27例），分别测定其CA19-9和CEA指标。结果:胰腺癌组血清CA19-9和CEA较对照组明显升高；胰腺癌术后血清CA19-9和CEA较术前明显下降。结论:血清CA19-9和CEA的检测对胰腺癌的术前诊断和术后疗效判断可能有一定参考意义。     

CT联合血清CEA、CA19-9检测对胰腺癌诊断价值分析

目的:探讨CT联合血清癌胚抗原(CEA)、糖链抗原(CA19-9)检测在胰腺癌诊断中的意义.方法:回顾性分析35例经手术病理证实的胰腺癌患者,对CT及血清CEA、CA19-9检查结果进行比较,分析CT联合血清CEA、CA19～9检测对胰腺癌的诊断价值.结果:联合检测的确诊率明显高于CT影像检查、血清肿瘤标志物CEA、CA19-9单独检测,联合检测与各单项检测之间比较差异均有统计学意义(P＜0.05).结论:CT影像联合血清肿瘤标志物CEA、CA19-9检测有助于胰腺癌的临床诊断.     

血清CA19-9和CEA检测在胰腺癌诊断中的价值

目的 探讨血清CA19-9和CEA检测对胰腺癌诊断的价值.方法 选取西安交通大学医学院第一附属医院2003年1月至2005年12月期间44例胰腺癌病人及同期64例健康查体者,应用免疫放射法检测肿瘤标志物CA19-9和CEA在血清中的水平.采用的正常参考值分别为CA19-9＜39U/ml,CEA＜3.4 ng/ml.结果 胰腺癌病人血清中CA19-9和CEA水平明显高于健康查体者(P＜0.01),而血清中AFP水平无统计学差异(P＞0.05).CA19-9和CEA联合检测对胰腺癌诊断的敏感性高于单一检查,但联合检测与单一检测之间的特异性无明显差异.AFP与CA19-9、CEA的两联或三联检测均不能提高诊断的敏感性和特异性.胰腺癌病人血清中CA19-9和CEA水平在Ⅰ+ⅡA期和ⅡB+Ⅲ+Ⅳ期间均不存在显著型差异.但是,血清中CA19-9和CEA联合检测对ⅡB+Ⅲ+Ⅳ期胰腺癌诊断的敏感性较Ⅰ+ⅡA期胰腺癌升高,差异具有统计学意义(P＜0.05).结论 CA19-9和CEA的联合检测可弥补单项指标检测的不足,明显提高诊断胰腺癌敏感性.同时,CA19-9和CEA检测对提示胰腺癌发生肠系膜血管侵犯、淋巴结或胰外器官转移具有一定意义.     

肿瘤标志物在胃癌患者中的诊断及预后价值

目的 探讨肿瘤标志物CEA、CA19-9、CA72-4及CA242在胃癌诊断及预后判断中的应用价值.方法 回顾性分析2002-2007年间在北京肿瘤医院就诊的160例胃癌患者血清肿瘤标志物、临床病理参数以及预后资料.结果 160例胃癌患者中CEA、CA19-9、CA72-4及CA242的初诊阳性率分别为37.7％、26.7％、37.6％及21.3％,4种标志物联合检测阳性率为62.9％.CEA阳性与淋巴结转移有关（P=0.029）;CA72-4阳性与脉管浸润及Ⅲ、Ⅳ期胃癌有关（P=0.039,P=0.011）.CA19-9阳性和阴性患者中位生存期分别为17.0和32.0个月,CA72-4阳性和阴性患者中位生存期分别为14.8和37.5个月,差异有统计学意义（P＜0.01）.多因素生存分析提示,CA72-4可以作为独立预后因子（P=0.012）,CA72-4阳性患者的死亡危险系数是阴性患者的2.147倍.结论 肿瘤标志物CEA、CA19-9、CA72-4及CA242在胃癌患者的诊断和预后判断中有重要价值,联合检测可提高阳性率;其中CA72-4可以作为独立预后因子,CA19-9及CA72-4与胃癌患者预后相关.     

Lymphoepithelial cyst of the pancreas associated with elevated CA 19-9 levels

An extremely rare case of a lymphoepithelial cyst associated with persistent elevation of serum carbohydrate antigen (CA) 19-9 levels is described. A 72-year-old man was incidentally found to have a cystic tumor in the uncus of the pancreas and to have a high serum CA 19-9 level. At 2-year follow up, the tumor size had gradually increased and the high CA 19-9 level persisted. Because the malignant potential of the tumor could not be ruled out, a laparotomy was performed. The tumor was excised from the pancreas. On pathological examination, the tumor was proven to be a lymphoepithelial cyst. After the operation, the patient’s serum CA 19-9 level decreased to the normal range. Lymphoepithelial cysts of the pancreas are a rare, benign entity. They are true pancreatic cysts, characterized by a mature, keratinizing, squamous lining surrounded by lymphoid tissue. Because the treatment options and the prognosis of these entities are quite different from those of other cystic neoplasms of the pancreas, preoperative differential diagnosis is the main issue. Thus, although they are rare, lymphoepithelial cysts should be considered in the differential diagnosis of cystic tumors of the pancreas.     

血清CA19-9、CEA水平与意外胆囊癌转移的关系研究

目的探讨意外胆囊癌转移与血清CA19-9、CEA水平的关系。方法对2002年8月至2006年6月收治的60例意外胆囊癌患者的临床资料进行回顾性分析,将血清CEA≥10ng/ml及CA19-9≥37U/ml者做为异常（阳性组）,组间比较采用χ^2检验,P〈0.05为差异有统计学意义。结果35例（58%,35/60）意外胆囊癌再手术后发现肿瘤转移。CA19-9阳性组及CA19-9阴性组肿瘤转移率分别为93%（27/29）及26%（8/31）,两组比较差异有统计学意义（P〈0.05）;CEA阳性组及CEA阴性组肿瘤转移率分别为92%（12/13）及49%（23/47）,两组比较差异有统计学意义（P〈0.05）。结论意外胆囊癌转移率与血清CA19-9及CEA水平有关,CA19-9可用于术前判断意外胆囊癌转移,与CEA联合应用可以提高诊断准确率。     

CA 19-9 levels predict results of staging laparoscopy in pancreatic cancer

Laparoscopy has emerged as an important staging procedure for determining resectability of pancreatic cancer. However, a small fraction of patients with pancreatic cancer benefit from its use and therefore the routine application of laparoscopy remains controversial. We hypothesized that serum CA 19-9 levels may identify patients who will or will not benefit by laparoscopy. We retrospectively reviewed our database of 63 patients with pancreatic adenocarcinoma who underwent staging laparoscopy and correlated findings with CA 19-9 levels. Overall, laparoscopy identified metastatic disease in 12 patients (19%). None of those required any further operation. The resectability rate (patients who underwent resection after laparoscopy) was 73.5%. There was one false-negative laparoscopy (1.6%). Patients with higher CA 19-9 levels had significant higher odds of having metastasis identified by laparoscopy (odds ratio, 1.83; 95% confidence interval, 1.03-3.24; P = .04). There was no patient with CA 19-9 levels below 100 U/ml in whom metastatic disease was identified during laparoscopy: 18 patients (28.6%) with CA 19-9 levels below this cutoff point had negative laparoscopy and could have avoided the procedure had this cutoff been used for screening. This would have increased the laparoscopy yield to 26.7%. In patients with adenocarcinoma of the pancreas, low CA 19-9 levels predict low probability of metastatic disease; in those patients, laparoscopy can be spared. On the contrary, patients with elevated CA 19-9 have an increased probability of metastatic disease, and these patients may benefit from diagnostic laparoscopy. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, IL, May 14–18, 2005 (poster presentation).     

Prognostic significance of serum CA19-9 levels in resected pancreatic cancer

Twenty-eight patients with histologically proven pancreatic adenocarcinoma were investigated to evaluate the utility of serum CA19-9 levels as a prognostic indicator after pancreatic resection. Three patients were excluded from the study because their serum CA19-9 levels remained normal throughout the course of the disease. Of the remaining 25 patients, those with preoperative serum CA19-9 levels 200U/ml had a better prognosis than those with serum CA19-9 levels >200 U/ml; however, the difference between the two groups was not significant (P=0.13). Serum CA19-9 levels 30 days after pancreatic resection were normalized (37 U/ml) in 11 patients (group A), and the survival rate of this group was significantly higher than that of the group of patients with persistently elevated CA19-9 levels (>37 U/ml) (group B) (P<0.005). Other factors i.e., preoperative CA19-9 values, tumor size, lymph node metastasis, histology, and stage classification showed no significant differences between group A and group B. Univariate analysis of the findings for the 25 patients showed that the stage classification and postoperative CA19-9 levels were of prognostic significance for prolonged survival. Other factors, i.e., gender, age, histology, preoperative CA19-9 levels, location of the tumor, and mode of operation, had no significance as prognostic indicators. Multivariate analysis showed that postoperative CA19-9 level was the only significant independent predictor of poor survival. Postoperative serum CA19-9 level appears to be useful as a prognostic indicator after resection of pancreatic cancer.     

脂联素、CEA及CA19—9在结直肠癌患者血清中的表达及其意义

通过研究脂联素、CEA及CA19—9在结直肠腺瘤和结直肠癌患者血清中的表达变化及其与临床病理指标的关系,以探讨其在结直肠癌发生、发展和转移中的作用。采用电化学发光法及酶联免疫法分别检测30例结直肠腺瘤患者（A组）和54例结直肠癌患者（B组）血清中脂联素、CEA及CA19—9的含量,对结直肠癌不同临床病理特征下的血清脂联素、CEA及CA19—9水平差异进行统计分析。结果显示,B组血清脂联素水平为（998．28±78．33）pg／ml明显低于A组（1529．59±81．79）pg／ml（P〈0．05）。B组随着肿瘤Dukes分期进展,血清脂联素水平呈现进一步下降的趋势（P〈0．05）,与肿瘤的发病部位、分化程度及有无淋巴结转移的血清脂联素水平无明显差异（P〉0．05）。A组血清CEA、CA19-9的水平明显低于B组（P〈0．05）。结果表明,结直肠癌患者血清的脂联素水平明显低于结直肠腺瘤患者,且随着肿瘤分期进展,血清脂联素水平呈现进一步下降的趋势。     

晚期膀胱癌患者血清CA19-9测定的临床意义

目的：探讨晚期膀胱癌患者血清CA19-9检测的临床意义.方法：采用电化学发光法测定41例晚期膀胱癌患者外周血 CA19-9水平,并对其临床意义进行分析.结果：本组患者CA19-9测定值为（77.1±194.3）IU/ml,其中CA19-9阳性19例,阳性率为46.3% 对照组CA19-9测定值为（13.6±5.2）IU/ml,阳性率为0,两组相比差异有显著统计学意义（P＜0.01）.病理检查证实淋巴结转移的11例患者CA19-9阳性率为54.5%,阴性组为14.2%,两组相比差异有统计学意义（P＜0.05）.6例远处器官转移的患者中有5例CA19-9阳性,阳性率为83.3%,与无远处转移的患者相比,阳性率差异有统计学意义（P＜0.05）.41例患者随访3～46个月,CA19-9阳性组、阴性组3年生存率分别为52.1%和85.9%,差异有统计学意义（P=0.036）.结论：血清CA19-9水平与肿瘤的进展以及预后密切相关,可能是判断晚期膀胱癌生物学行为的一项有用的指标.     

Primary thymic adenocarcinoma with production of carbohydrate antigen 19-9 and carcinoembryonic antigen

A 59-year-old male, whose chest X-ray showed an abnormal shadow, visited us for further study. Laboratory examination showed the elevated level for both carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) in serum, and the chest X-ray and computed tomography showed an anterior mediastinal mass. Under a diagnosis of thymic malignancy, extended thymectomy with combined resection of the pleura and pericardium was performed. Histopathological findings showed a well-differentiated adenocarcinoma of the thymus, in which CA19-9 and CEA were positive immuno-histochemically. The level of serum CA19-9 and CEA returned to normal ranges postoperatively, however, the tumor recurred in local site with re-elevation of these tumor markers at the 20th month after surgery. He died at 4th month after the first recurrence despite the intensive chemotherapy. We report an extremely rare case of primary thymic adenocarcinoma with the production of CA19-9 and CEA.     

CA19-9在膀胱癌中的表达及临床意义

目的:探讨糖类抗原CA19-9在膀胱癌中的表达及临床意义.方法:免疫组织化学法检测40例膀胱癌标本(实验组)中及5例正常膀胱组织(对照组)中CA19-9的表达水平,并分析其表达结果与肿瘤的临床及病理参数的关系.结果:40例膀胱癌组中的阳性表达率明显高于正常膀胱组(P<0.05);且CA19-9在浅表性、高分化组膀胱癌组织中表达明显高于其在浸润性,低分化组膀胱癌中的表达.浅表性膀胱癌病例(Tis,T0,T1)中CA19-9表达率高达95%.5例正常膀胱组织标本中CA19-9表达均为阴性.结论:糖类抗原CA19-9可作为膀胱TCC的肿瘤标志物尤其是在低分级,浅表性的膀胱癌病例.     

The clinicopathologic features of serum CA 19-9-positive colorectal cancers

The preoperative serum levels of carbohydrate antigen 19-9 (CA 19-9) were determined in 206 patients with colorectal cancer, 52 (25.2%) of whom were found to be positive. All of these patients had advanced cancers and significantly higher incidences of tumor invasion through the muscularis propria (91.3%) and lymph node involvement (54.5%). The incidences of liver metastasis and Dukes' stage D in the CA 19-9-positive group were 38.5% and 42.9%, respectively, significantly higher than those in the CA 19-9-negative group of 6.5% and 14.8%, respectively. Moreover, the incidence of liver metastasis in the CA 19-9-positive group patients with Dukes' stage D cancer was 95.2% (20/21); CA 19-9 showing higher specificity (81.7%) and a more positive predictive value (38.5%) for liver metastasis than the carcinoembryonic antigen (CEA). When a cutoff value of 160 U/ml was used, the specificity and positive predictive value reached 97.7% and 81.0%, respectively. An analysis of response operating characteristic (ROC) curves for liver metastasis revealed that CA 19-9 was more useful than CEA. The long-term survival of the CA 19-9-positive group patients was significantly worse than that of the CA 19-9-negative group patients (P < 0.0001), with no 1.25-year survivors in the former group when the cutoff value of 160U/ml was used. These results suggest that serum CA 19-9 as a useful preoperative indicator of liver metastasis and prognosis in colorectal cancer.     

The clinical value of serum CA15-3 assay postoperatively in breast cancer patients

Serum carbohydrate antigen (CA15-3) values were examined in 300 normal subjects in order to determine the standard value of this antigen. The clinical relevance of repeatedly assaying this marker in patients with or without recurrent breast cancer postoperatively was compared with assaying the serum carcinoembryonic antigen (CEA) values. The upper limit of CA15-3 was calculated as being 25.3 U/ml in the normal subjects and the distributions of CA15-3 values were not markedly different among the normal subjects, even if they had been selected according to sex or age. Moreover, no differences were observed among normal women who had been randomly selected according to the age distribution of the breast cancer patients. Thirty samples taken from the breast cancer patients postoperatively revealed values of higher than 25 U/ml and 73 samples showed lower levels. The serum CEA values were positive in 16 samples and negative in 85 samples. Although the accuracy of the CEA assay was about 10 per cent higher than that of the CA15-3 assay, its low positive rate was unsatisfactory for effective use in the breast clinic. The results of this study suggest that serum CA15-3 is not detectable unless there is a relatively large number of tumor cells. The higher false positive rate of the CA15-3 assay should therefore be considered as suggesting recurrence.     

CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions

Background

Obstructive jaundice is frequently associated with false CA19-9 elevation in benign conditions. The diagnostic accuracy of this tumor marker was evaluated in the present longitudinal study.

Methods

In 128 patients admitted for obstructive jaundice (87 with pancreato-biliary malignancy and 41 benign disease) serum CA19-9 was measured. Statistical analysis of marker levels obtained before and after endoscopic biliary drainage was performed in 60 patients.

Results

Elevated CA19-9 levels (>37 U/mL) were found in 61% of benign cases and 86% of malignancies. After biliary drainage, decrease of serum CA19-9 was observed in 19 of 38 malignant cases and in almost all benign cases (Wilcoxon matched pairs test: P = .207 and P <.001, respectively). Receiver operating characteristic (ROC) analysis identified a cut-off value of 90 U/mL to be associated with improved diagnostic accuracy after biliary drainage (sensitivity 61%, specificity 95%).

Conclusions

In the presence of successfully drained obstructive jaundice, CA19-9 serum levels that remain unchanged or measure more than 90 U/mL are strongly indicative of a malignant cause of obstruction. However, the real clinical utility of this marker remains controversial.     

CA19-9联合多层螺旋CT在胰腺癌可切除性评估中的价值

目的:探讨CA19-9联合多层螺旋CT在胰腺癌可切除性评估中的价值。方法:将85例胰腺癌患者,根据治疗方式分为根治切除组、姑息手术治疗组与非手术治疗组,分析多层螺旋CT、CA19-9及二者联合在评估胰腺癌可切除性中的作用。结果:以CA19-9大于200作为评估不可切除的临界值,CA19-9评估胰腺癌可切除的准确率为65.6%,不可切除的准确率为56.6%。非手术治疗组CA19-9水平与根治切除组、姑息手术治疗组比较存在显著差异(P0.05)。多层螺旋CT对判断胰腺癌可切除的准确率为71.4%,不可切除的准确率为77.4%。二者联合对胰腺癌可切除性评估的准确率为78.6﹪,不可切除的准确率为95.7﹪。结论:CA19-9联合多层螺旋CT可以更好的评估胰腺癌的可切除性。     

老年人急性胆管炎CA19—9升高的临床意义

目的 探讨老年人急性胆管炎血清ＣＡ１９－９升高的临床意义。方法 放免法检测４５例老年人胆道生疾病病人血ＣＡ１９－９水平，将其分为三组；（１）慢 性胆囊炎且囊结石１８例；（２）急性胆管炎１４例。结果 １２例急性胆管炎病人ＣＡ１９－９有不同程度升高（８５．７％），正常值为低于３０Ｋｕ／Ｌ，最高值达５００Ｋｕ／Ｌ，而急性胆囊炎病人中仅１例升高（７．７％），慢性胆囊炎胆囊村石病人中无１例升高。结论 ＣＡ１     

The usefulness and limitations of CEA assay in the management of colorectal cancer

We investigated the usefulness and limitations of the measurement of CEA in the evaluation of tumor resection and the detection of recurrence in colorectal cancer patients. Preoperatively, 46 of 90 patients (51.1%) had CEA values of 5.0 ng/ml or higher. The percentage of patients with elevated CEA in whom the CEA values returned to normal one month postoperatively was significantly higher in those who had undergone a curative resection than in those who had undergone a non-curative resection (p<0.02). Among patients with normal CEA values, the changes were nil or only slight in CEA values, one month postoperatively Among 28 with recurrences, 24 (85.7%) had CEA values of 5.0 ng/ml or higher. All 11 with liver recurrences had values of 10.0 ng/ml or higher. In 4 with liver recurrences and in cases where CEA measurements were made, CEA values were found to be abnormal 3 to 10 months before the recurrences and a rapid elvation occurred for a short period. However, 4 out of 10 with local or lymphnode recurrences showed normal CEA values. CEA measurement was useful in detection of liver recurrences, but not so useful in detecting local or lymphnode recurrences.     

胰腺癌65例术后预后因素分析

目的探讨胰腺癌术后预后相关因素。方法收集2011年12月到2015年6月皖南医学院弋矶山医院65例胰腺癌临床资料并进行回顾性分析。结果 65例患者术后中位生存时间12.1个月,1、3、5年生存率分别为41.5%、8.2%、2.1%。单因素分析显示,淋巴结转移、CA19-9、肿瘤大小、分化程度、血管侵犯、神经侵犯为影响胰腺癌预后的因素(P0.05)。多因素分析显示,淋巴结转移、肿瘤大小、分化程度、血管侵犯、神经侵犯为影响胰腺癌预后的独立危险因素。结论胰腺癌预后受多种因素影响,其中淋巴结转移、肿瘤大小、分化程度、血管侵犯、神经侵犯可作为评估胰腺癌预后的重要指标。