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。     

术前白蛋白-胆红素评分以及其与CA19-9联合作为胰腺癌患者预后指标的临床价值

背景与目的:白蛋白-胆红素(ALBI)评分是用于评估肝细胞癌患者肝功能障碍严重程度的指标,但近来研究显示其与其他恶性肿瘤的预后也可能存在一定的关联。因此,本研究探讨术前ALBI评分以及ALBI评分与胰腺癌常用标志物糖类抗原19-9(CA19-9)联合应用作为胰腺癌患者预后指标的临床价值。方法:回顾性分析2010年1月—2014年11月期间辽宁省健康产业集团阜新矿总医院普通外科行胰腺癌切除术的97例患者临床资料。所有患者均术前当日测定血清白蛋白、总胆红素和CA19-9水平,分析患者血清白蛋白水平与胆红素浓度的相关性、ALBI评分与患者临床病理因素及CA19-9水平的关系、ALBI评分与CA19-9水平对患者预后的影响。结果:胰腺癌患者血清白蛋白水平与胆红素浓度呈明显相关性(r=0.45,P=0.018)。ALBI评分与患者术前是否因胆管梗阻行胆道引流术有关(P=0.008),而与患者CA19-9水平及其他临床病理因素均无明显关系(均P0.05)。高ALBI组患者5年生存率明显低于低ALBI组患者(22.2% vs.42.3%,P=0.036);高CA19-9组患者5年生存率明显低于低CA19-9组患者(24.1% vs.44.2%,P=0.035)。两者联合分析结果显示,高ALBI+高CA19-9(双高组)、高ALBI+低CA19-9(高ALBI组)、低ALBI和高CA19-9(高CA19-9组)、低ALBI+低CA19-9(双低组)患者的5年生存率分别为12.0%、35.0%、34.5%、52.2%;双高组患者5年生存率明显低于单高组(高ALBI组+高CA19-9组)和双低组(12.0% vs.34.7%,P=0.038;12.0% vs.52.2%,P=0.003),而后两组之间无统计学差异(P=0.159)。多因素分析显示,ALBI评分与CA19-9联合参数(P=0.009)及淋巴结转移(P=0.012)是胰腺癌患者预后的独立危险因素。结论:ALBI评分与胰腺癌患者的预后有一定的关联,ALBI评分与CA19-9水平的联合参数可作为独立预后因素用于胰腺癌患者的预后的评估,高ALBI评分同时CA19-9水平升高患者预后不良。     

Prognostic value of serum CA 19-9 levels in pancreatic adenocarcinoma.

Thirty-eight patients with histologically proven pancreatic adenocarcinoma were investigated to establish the utility of serum CA 19-9 as a prognostic indicator. CA 19-9 assays were performed serially during the course of the disease. In four patients with negative Lewis blood type, the CA 19-9 levels remained essentially normal throughout the disease course. In the remaining 34 patients, (1) CA 19-9 levels were significantly lower in patients with tumor size no larger than 5 cm in diameter, and in patients with resectable tumors than in those with tumor size larger than 5 cm or with unresectable tumors (p less than 0.01). 2) CA 19-9 levels dropped sharply after resection in all 11 resectable patients, whereas no significant change was found after laparotomy without resection. (3) The average survival time in seven patients whose CA 19-9 levels returned to normal after resection was significantly longer than in those four patients with postoperative CA 19-9 levels that decreased but did not return to normal (21.9 versus 8.7 months, p less than 0.05). (4) In 6 of 11 patients who underwent resection, recurrent elevation of CA 19-9 preceded changes detectable by computed tomography or clinical examination by 2 to 9 months. (5) In 23 patients who died of pancreatic carcinoma, 15 (65%) had an obvious rise in CA 19-9 level before death. There was a correlation between the doubling time of the CA 19-9 serum level and survival time (r = 0.5, p less than 0.05). Because it can be demonstrated that the reduction of tumor burden by resection lowers serum CA 19-9 levels, serum CA 19-9 levels may be a useful indicator of whether other forms of treatment such as radiation therapy or chemotherapy also reduce the tumor burden.     

外周血K-ras基因突变和CA19-9的联合检测在胰腺癌诊断中的作用

目的 研究K-ras基因突变和CA19-9联合检测在胰腺癌诊断中的作用。方法 选择同期的15例胰腺癌和33非胰腺癌病人,同时行外周血K-ras基因突变和CA19-9的检测,利用统计学方法进行数据分析。结果 外周血K-ras基因突变和CA19-9联合检测诊断胰腺癌的敏感性、特异性分别为66．67％和97％,研究组和对照组之间差异具有显著性意义(P=0．001)。结论 外周血K-ras基因突变和CA19-9的联合检测显著提高了胰腺癌诊断的特异性,弥补了单一K-ras基因突变和CA19-9检测的不足,可用于胰腺癌的辅助诊断。     

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.     

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.     

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).     

血浆K-ras突变联合CA19-9检测对胰腺癌的诊断价值

目的: 探讨血浆K-ras基因突变联合CA19-9检测对胰腺癌的诊断价值.方法: 对连续58例疑为胰腺肿瘤患者,入院时抽取外周静脉血,分离血浆并提取DNA.采用突变富集PCR-RFLP法分析K-ras基因密码子12突变,用放射免疫法测定血清CA19-9.所有病例的血标本分析均在术前完成,并将检测结果与手术探查、病理诊断进行比较.结果: 41例胰腺癌患者中,血浆K-ras基因突变者29例(占70.7%),血清CA19-9升高者30例(占73.2%).联合K-ras与CA19-9检测胰腺癌的敏感性为90.2%(37/41).在其他17例非胰腺癌患者中,有3例血浆K-ras突变,8例血清CA19-9有升高.结论: 血浆K-ras突变可能是诊断胰腺癌的一个有价值的指标,若同时测定血清CA19-9,可提高检测胰腺癌的敏感性.     

Resected lung cancer with production of CA19-9

We report 2 cases of resected CA19-9 producing adenocarcinoma of the lung. Immunohistochemical studies of the specimens in 2 cases showed positive staining for CA19-9 in most of tumor cells. The serum CA19-9 levels decreased after operations and effective chemotherapy in these cases. But the serum CA19-9 levels increased with regrowth of tumors or with no therapeutic gain by chemotherapy. The serum CA19-9 level was useful to evaluate the therapeutic effect of surgery and chemotherapy, and may be effective in detecting the recurrence of lung cancer.     

血清癌抗原19-9水平对胰腺癌可切除性判断的临床意义

目的 探讨血清癌抗原19-9 (CA19-9)水平在胰腺癌可切除性判断中的应用价值.方法 采用放射免疫法检测胰腺癌患者血清CA19-9的表达,通过接受者操作特征(ROC)曲线分析确定最佳分界点,通过ROC曲线下面积分析血清CA19-9水平对胰腺癌可切除性判断的临床应用价值.结果 可切除性胰腺癌患者CA19-9的水平为(313.6±515.5)kU/L,明显低于不可切除患者的(852.1±865.1)kU/L(P=0.00).根据接受者操作特性曲线,血清CA19-9对胰腺癌可切除性判断的最佳分界点为312.1 kU/L,其灵敏度为56.6％,特异度为73.3％,ROC曲线下面积0.67.结论 血清CA19-9水平可作为辅助性手段应用于胰腺癌可切除性的判断.     

A case of two patients with primary lung cancer secreting CA19-9

We experienced two primary lung cancer patients who showed high levels of CA19-9 (Carbohydrate Antigen 19-9). One case was small cell carcinoma and the other was adenocarcinoma. In contrast to malignancies of digestive organ origin, rare CA19-9 positive cases are reported in lung cancer. To get evidences that these lung cancer tissues were producing CA19-9, PAP stain (Peroxidase anti peroxidase method: Sternberger) was performed, and positive stains were obtained in tumors surgically removed from these two patients. Especially in a patient who showed very high level of CA19-9 (27,369 U/ml), almost every tumor cell was positively stained. From these findings, we suggest the importance of checking CA19-9 in patients with lung cancer.     

Serum CA 19-9 and CA 50 antigens in hemodialysis patients

Serum concentrations of monoclonal antibody-defined tumor markers CA 19-9 and CA 50 were measured in 64 uncomplicated hemodialysis patients (Group 1) and in 8 hemodialysis patients with cancer (Group 2) in comparison with corresponding CEA determinations. From our results in Group 1 patients it appears that both CA 19-9 and CA 50 maintained an excellent specificity in these patients. As to the sensitivity of these tests, our findings in Group 2 patients are comparable with those reported in patients with cancer and normal renal function. It is concluded that, unlike CEA, these new tumor markers maintain their clinical value in chronic renal failure.     

Serum CA19-9 measurement increases the effectiveness of staging laparoscopy in patients with suspected pancreatic malignancy

BACKGROUND/AIMS: Staging laparoscopy for suspected pancreatic neoplasia is not widely accepted due to its low yield. The aim of this study was to determine if serum carbohydrate antigen (CA19-9) levels could be used to improve the selection of patients for staging laparoscopy. METHODS: The data from a prospectively collected database (1997-2004) with 159 patients who had computed tomography-predicted resectable disease and who had undergone laparoscopic staging were analysed to determine if a low preoperative CA19-9 level (< or =150 kU/l, or < or =300 kU/l with a bilirubin >35 micromol/l) identified patients in whom laparoscopy was not useful. Results: The CA19-9 level was >150 kU/l in 96 patients of whom 75 (78%) were considered resectable following laparoscopic assessment. There were 63 patients with a CA19-9 < or =150 kU/l of whom 60 (95%) were considered resectable following laparoscopic assessment. The sensitivity, specificity, positive predictive value and negative predictive value for CA19-9 < or =150 kU/l in predicting that laparoscopic assessment would judge patients as resectable were 44, 88, 95 and 22%, respectively. A cut-off level of < or =300 kU/l in patients with a bilirubin >35 micromol/l produced values of 30, 94, 94 and 28%, respectively. By using CA19-9 < or =150 kU/l, laparoscopy could have been avoided in 40% of patients, increased to 55% of patients with adjustment for the presence of jaundice; concomitantly, the yield from laparoscopy would have been increased from 15 to 22 and 25%, respectively. Conclusion: Use of serum CA19-9 levels would increase the efficiency of laparoscopic staging in patients with suspected pancreatic malignancy.     

Diagnostic and prognostic values of CA 19-9 and CEA in periampullary cancers

BACKGROUND: The roles of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) in periampullary cancers have not been clearly established. Diagnostic and prognostic values of these two tumor markers were clarified in this study. STUDY DESIGN: Preoperative serum levels of CEA and CA 19-9, and clinicopathologic features were retrospectively reviewed in 143 surgical patients with periampullary cancer from 1989 to 1997. RESULTS: There were 86 resectable and 57 unresectable periampullary cancers. CA 19-9 demonstrated significantly higher sensitivity in detecting these cancers than CEA. The cancer with unresectable lesion, total bilirubin >7.3 mg/dL, or tumor size >2 cm tended to associate with higher CA 19-9 level. CEA level was significantly higher in the tumor >2 cm, not in the tumor < or =2 cm. CA 19-9 was a significant prognostic factor in both resectable and unresectable periampullary cancers, but CEA was significant only in the resectable group. Multivariate analysis revealed that independent prognostic factors included CA 19-9, resectability, primary tumor, and stage, and CA 19-9 was the most important one. CONCLUSION: CA 19-9 provided more important diagnostic and prognostic values than CEA in periampullary cancers and was the most important independent prognostic factor for periampullary cancers. This study recommends serum CA 19-9 as an adjunct in detecting periampullary cancers, in evaluating resectability, and in predicting prognosis.     

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.     

Clinical utility of CEA, CA 19-9, and CA 72-4 in the follow-up of patients with resectable gastric cancer

BACKGROUND: The aim of this longitudinal study was to evaluate the effectiveness of the serum tumor markers CEA, CA 19-9, and CA 72-4 in the early diagnosis of recurrence of gastric cancer. METHODS: One hundred and thirty-three patients who had undergone potentially curative surgery were considered. Serum samples were obtained preoperatively, 1 week after surgery, and at every follow-up examination. Mean follow-up time for the entire patient population was 41 +/- 33 months, and 71 +/- 27 months for patients classified as disease-free. RESULTS: Preoperative positivity was 16% for CEA, 35% for CA 19-9, and 20% for CA 72-4. Recurrence of disease was found in 75 patients (56%). Marker sensitivity in recurrent cases was 44% for CEA, 56% for CA 19-9, and 51% for CA 72-4; the combined use of the three markers increased sensitivity to 87%, which reached 100% in patients with positive preoperative levels. Marker specificity, evaluated in 58 disease-free patients, was 79% for CEA, 74% for CA 19-9, and 97% for CA 72-4. CONCLUSIONS: The combined assay of CEA, CA 19-9, and CA 72-4 may be useful for early diagnosis of recurrence of gastric cancer; however, only CA 72-4 positivity should be considered a specific predictor of tumor recurrence.     

Tumour antigens CA 195 and CA 19-9 in pancreatic juice and serum for the diagnosis of pancreatic carcinoma.

OBJECTIVE--To see if tumour associated antigens CA 195 and CA 19-9 were able to differentiate between patients with pancreatic carcinoma, and those with chronic pancreatitis or stones in the common bile duct. DESIGN--Prospective, open, clinical study. SETTING--47 patients with histologically confirmed pancreatic adenocarcinoma, 38 with chronic pancreatitis diagnosed by endoscopic retrograde cholangiopancreatography (ERCP), and 26 with stones in the common bile duct diagnosed and treated by ERCP. INTERVENTIONS--Samples of serum taken from all patients just before ERCP, and samples of pancreatic juice obtained from 18, 11, and 12 patients, respectively during ERCP. RESULTS--Assay of the two tumour markers in pancreatic juice failed to differentiate between patients with benign and malignant disease. When assayed in serum, however, CA 195 detected those with carcinoma with a sensitivity of 72% and a specificity of 92%, and CA 19-9 with a sensitivity of 81% and a specificity of 88%. The patients with unresectable tumours had significantly higher concentrations of both markers in serum than patients with resectable tumours (p less than 0.05). CONCLUSIONS--CA 195 and CA 19-9 concentrations in serum are equally successful in differentiating between benign and malignant pancreatic disease. Assay of markers in pancreatic juice does not provide useful diagnostic information.     

Significance of measurement of a carbohydrate antigenic determinant 19-9 (CA 19-9) for monitoring colorectal cancer patients

The significance of measurement of serum CA 19-9 levels and the correlation between the serum levels of CA 19-9 and CEA in 61 patients with colorectal cancer were investigated. CA 19-9 levels above 37 U/ml were found in 24.6 per cent, while CEA levels above 5 ng/ml were observed in 34.4 per cent. Elevation of one or both of two antigens was found in 44.3 per cent. In patients with elevated CA 19-9 levels, the CA 19-9 levels returned to normal after curative resections, whereas patients with normal levels of this antigen showed only slight or no differences after curative resections. Measurements of this antigen were useful for the evaluation of the effect of surgery, especially in patients with normal CEA levels and elevated CA 19-9 levels. Combination assays of these antigens may be more useful than CEA alone for monitoring colorectal cancer patients.