Assay of serum elastase 1 in adenocarcinoma of the pancreas: diagnostic value, compared and combined study with serum CEA and CA 19-9

Serum elastase 1, CEA and, CA 19-9 titers were determined by radioimmunoassay in 113 patients with benign non pancreatic digestive disease, 88 patients with non pancreatic carcinoma, 25 patients with chronic pancreatitis and 40 patients with pancreatic carcinoma (of whom 34 were classified according to Fortner's staging classification), respectively: a) to evaluate the diagnostic value of elastase in pancreatic carcinoma, b) to compare and to study the value of its association with CEA and CA 19-9 for earlier detection of this type of cancer. The specificity of serum elastase (greater than 500 ng/dl) was greater than that of CA 19-9 (greater than 37 U/ml), (93.3 p. 100 vs 64.6 p. 100, p less than 0.01), but its sensitivity was significantly lower than that of CA 19-9 (27.5 p. 100 vs 82.5 p. 100; p less than 0.001). The sensitivity of CA 19-9 (greater than 37 U/ml) and/or elastase (greater than 500 ng/dl) was 85.2 p. 100 (greater, but not significantly, than CA 19-9 alone) and 91.6 p. 100 in Fortner stage I or II tumors (greater, but not significantly, than Fortner stage III tumors which were at 83.6 p. 100). The specificity of the combined test was 62 p. 100, lower (but not significantly) than CA 19-9 alone. As serum CEA (greater than 5 ng/ml) alone and in association with CA 19-9 was disappointing, it might be replaced by the elastase assay. The combined CA 19-9-elastase assay coupled with morphologic investigations could represent an attractive approach for earlier detection of this cancer.     

Is jaundice a cause of error in the interpretation of CA 19-9 blood levels?

Serum CA 19-9 has been proposed as a tumour marker for pancreatic cancer (PC). However, false positive results are seen in sera of patients with benign jaundice. The CA 19-9 assay was performed by a solid state radioimmunoassay in 86 icteric patients (total bilirubin greater than 2 mg/dl). 24/86 had PC (12 men, 12 women, mean age 74 years) and 62/86 had benign jaundice (29 men, 33 women, mean age 56 years; cirrhosis: n = 20, angiocholitis: n = 21, hepatitis: n = 21). At a cut-off level of 60 U./ml, for detecting icteric PC, sensitivity was 83%, and specificity was 79%. At 120 U./ml, sensitivity was 79%, but specificity was increased to 92%. We conclude that 21% of patients with benign jaundice had a CA 19-9 level greater than 60 U./ml, and using a CA 19-9 level of 120 U./ml, the specificity of the test to detect icteric PC was increased, with little decrease in the sensitivity.     

The clinical utility of the CA 19-9 tumor-associated antigen

Since Koprowski and coworkers discovered the CA 19-9 antigen 10 yr ago, it has become the most useful blood test in the diagnosis and management of patients with cancer of the pancreas. With an upper limit of normal of 37 U/ml, the assay's overall sensitivity is approximately 80% and its specificity is 90%. If higher cutoffs are used, the specificity rises so that, at levels greater than 1000 U/ml, the marker's specificity approaches 100%. Acute cholangitis and cirrhosis are two benign conditions that might raise this assay significantly. This tumor-associated marker is also helpful in predicting unresectability of pancreatic adenocarcinoma, as 96% of tumors that result in blood levels greater than 1000 U/ml have been found to be unresectable. After potentially curative surgery, the CA 19-9 can help prognosticate survival. Patients who normalize their CA 19-9 postoperatively live longer than those who do not. Furthermore, the assay, when used serially, predicts recurrence of disease prior to radiographic or clinical findings. The CA 19-9 is currently the "gold" standard marker for pancreatic cancer, against which other assays in this field will be judged.     

Endoscopic ultrasound-guided fine needle aspiration in diagnosis of cystic pancreatic lesions

Background and study aimspancreatic cysts are commonly found lesions and proper diagnosis is very important for planning further management. The study aims to evaluate the role of cyst fluid amylase and tumour markers as cancer antigen (CA 19-9) and carcinoembryonic antigen (CEA) in addition to mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions.Patients and methodsThis prospective study was conducted on 184 patients diagnosed to have pancreatic cystic lesions from January 2013 to January 2018. Fluid analysis for CA 19-9, CEA, amylase, mucin stain and cytopathology were done. We compared these data with the final diagnosis based on histopathology after surgical resection, positive cytopathology and long period of follow up of the patients for at least 18 months.ResultsThe highest AUC was that of cystic CEA with cut-off value of 160 ng/ml; it had a sensitivity of 60.4% and a specificity of 85%. The best cut-off value for cystic CA 19-9 was 1318 U/ml with a sensitivity of 64.1% and a specificity of 68.1%. The cut-off value of cyst amylase level was 5500 U/L, with 84.2% sensitivity and 37.1% specificity. The sensitivity of mucin stain in detecting mucinous cystic neoplasm was 85.45%, specificity was 86.05% with accuracy 85.87%.ConclusionCyst fluid analysis by investigating amylase, mucin, CA 19-9, CEA and EUS examination improves the diagnosis of different pancreatic cysts.     

The utility of CA 19-9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis

OBJECTIVES: The diagnosis of cholangiocarcinoma is often difficult, making management approaches problematic. A reliable serum tumor marker for cholangiocarcinoma would be a useful additional diagnostic test. Previous studies have demonstrated that elevated serum concentrations of CA 19-9, a tumor-associated antigen, have good sensitivity and specificity for cholangiocarcinoma in patients with primary sclerosing cholangitis. However, the value of this tumor marker for cholangiocarcinoma unassociated with primary sclerosing cholangitis is unclear. Thus, the aims of this study were to determine the usefulness of a serum CA 19-9 determination in the diagnosis of de novo cholangiocarcinoma. METHODS: We prospectively measured serum CA 19-9 concentrations in patients with cholangiocarcinoma (n = 36), nonmalignant liver disease (n = 41), and benign bile duct strictures (n = 26). Serum CA 19-9 concentrations were measured by an immunoradiometric assay (CIS Bio International) without knowledge of the clinical diagnosis. RESULTS: The sensitivity of a CA 19-9 value >100 U/ml in diagnosing cholangiocarcinoma was 53%. When compared with the nonmalignant liver disease and the benign bile duct stricture groups, the true negative rates were 76% and 92%, respectively. Patients with unresectable cholangiocarcinoma had significantly greater mean CA 19-9 concentrations compared to patients with resectable cholangiocarcinoma. CONCLUSIONS: These data suggest that the serum CA 19-9 determination is a useful addition to the available tests for the differential diagnosis of cholangiocarcinoma.     

The diagnostic importance of CEA and CA 19-9 for the early diagnosis of pancreatic carcinoma

BACKGROUND/AIMS: CA 19-9 and CEA were evaluated for their specificity and sensitivity in the early diagnosis of pancreatic carcinoma. METHODOLOGY: This prospective study included 40 patients with pancreatic carcinoma. A control group of 60 patients were divided into two subgroups as upper gastrointestinal system malignancies and benign pancreatic disorders. CEA and CA 19-9 levels were measured in all the patients. RESULTS: When the reference value of CA 19-9 was accepted as 74 U/mL, the specificity was 100% when pancreatic carcinoma was compared with benign disorders of the pancreas, but it's specificity for upper gastrointestinal malignancies was 60-90%. When the reference value of CEA was increased, the sensitivity had been decreased but the specificity had been increased when compared with the control group. If the reference value of CEA was accepted as 5 ng/mL, the specificity was 100% when pancreatic carcinoma was compared with acute or chronic pancreatitis, but it is less specific for the differential diagnosis of pancreatic carcinoma from the upper gastrointestinal malignancies. CONCLUSIONS: With the progression of the pancreatic carcinoma, serum CEA level and the specificity of CEA were elevated similar to that of CA 19-9. However, the elevation of CEA specificity when compared with the control group was lower than the specificity of the CA 19-9 and the sensitivity of CA 19-9 was superior to that of CEA for pancreatic carcinoma. The level of CA 19-9 was increased with the development of early pancreatic cancer and this elevation steadily continued with the progression of the cancer.     

血清肿瘤标志物和肝功能指标联合检测在胰腺癌肝转移诊断中的价值

目的探讨肿瘤标志物和肝功能指标联合检测在胰腺癌肝转移早期诊断中的临床价值。方法选取125例胰腺癌患者,其中肝转移58例,无肝转移67例。检测患者血清肿瘤标志物和肝功能指标水平,并对结果进行分析。结果胰腺癌肝转移者血清中癌胚抗原（CEA）、糖类抗原19-9（CA19-9）、糖类抗原242（CA242）和乳酸脱氢酶（LDH）水平显著高于无肝转移者（P〈0.05）。ROC曲线分析显示CEA、CA19-9、CA242与LDH诊断肝转移的最佳上限为6.0μg/L、842 U/m l、64.48 U/L与220 U/L。CEA和LDH单独检测肝转移的敏感性为64.2%和51.9%,特异性为71.4%和74.2%。而CEA与LDH联合检测的敏感性和特异性为77.6%和93.5%。结论肿瘤标志物和肝功能指标联合检测特异性高,有助于胰腺癌肝转移的早期诊断。     

A new strategy for the application of CA19-9 in the differentiation of pancreaticobiliary cancer: analysis using a receiver operating characteristic curve

OBJECTIVE: Clinicians might be misled in interpreting an elevated CA19-9 when differentiating pancreaticobiliary cancer from benign clinical conditions such as acute cholangitis or cholestasis, because in these conditions, the concentration of CA19-9 may also be elevated. The aims of our study were to calculate new individual cutoff values for CA19-9 according to clinical situations using a receiver operating characteristic (ROC) curve and to define a new strategy for interpreting CA19-9 in pancreaticobiliary cancer. METHODS: One hundred sixty patients with pancreatic diseases (cancer 90, benign disease 70), 322 patients with biliary tract diseases (biliary cancer 152, benign disease 170), and 20,035 asymptomatic controls were enrolled in the present study. An ROC curve was described by plotting the sensitivity on the y-axis against 1-specificity on the x-axis for each of several cutoff values. RESULTS: The area under the ROC curve was significantly greater for pancreatic cancer than for biliary cancer (p < 0.05). For patients with pancreatic cancer, CA19-9 proved to be useful. At a cutoff value of 37 U/ml, sensitivity and specificity were 76.7% and 87.1%, respectively. For patients with biliary cancer, CA19-9 was not helpful. However, when patients with biliary disease were divided into two groups according to the presence of cholangitis or cholestasis, CA19-9 proved to be more useful for the group without cholangitis or cholestasis than for the group with cholangitis or cholestasis (p < 0.05). In the former group, the sensitivity and specificity of CA19-9 were 77.6% and 83%, respectively, at the cutoff value of 37 U/ml. For the latter group, the sensitivity and specificity of CA19-9 were 74% and 41.5% respectively, whereas the specificity reached 87% at 300 U/ml. CA19-9 in diagnosing pancreatic cancer was useful regardless of accompanying acute pancreatitis or cholestasis. The serum concentration of CA19-9 in asymptomatic individuals was 9.42 +/- 9.95 U/ml. Only 1 of 157 patients with a concentration of CA19-9 above 37 U/ml was found to have gallbladder cancer. The positive and negative predictive values were 0.65% and 0.78%, respectively. CONCLUSIONS: The use of CA19-9 for the differentiation of pancreaticobiliary cancer should be applied individually, depending on the clinical situation.     

联合CA19-9、CA125和CEA检测在AFP阴性的ICC鉴别诊断中的应用价值

目的探讨血清癌抗原19-9（CA19-9）、癌抗原125（CA125）和癌胚抗原（CEA）联合检测在甲胎蛋白（AFP）阴性的肝内胆管细胞癌（ICC）患者诊断中的价值。方法2014年6月~2016年6月我院收治的ICC患者60例,根据AFP检测结果,将其分为AFP阴性组和AFP阳性组,每组分别为30例。采用微阵列酶联免疫分析法（Array-ELISA）检测血清CA19-9、CA125和CEA,采用受试者工作特征曲线（ROC）下面积（AUC）分别对各标记物及联合检测诊断的灵敏度、特异度和正确率进行评估。结果30例AFP阴性组血清CA19-9、CA125和CEA水平分别为138.8（85.7~185.1）U/ml、109.6（48.4~201.8）U/ml、11.2（17.5~21.9）ng/ml,均显著高于AFP阳性组的【（38.0（16.9~75.5）U/ml、18.1（9.3~48.1）U/ml、5.5（3.1~8.5）ng/ml）,P<0.01】;两组血清肿瘤标志物诊断ICC的ROC曲线下面积均呈现出CA19-9>CA125>CEA的趋势,在AFP阴性组,各单项诊断的ROC曲线下面积分别为0.85、0.83和0.81,显著高于AFP阳性组的【（0.55、0.45和0.42）,P<0.05】;在单项诊断ICC时,血清CA19-9、CA125和CEA的最佳临床诊断截断点分别为124.89 U/ml、96.04 U/ml和11.97 ng/ml;血清CA19-9、CA125和CEA诊断ICC的灵敏度、特异度和正确率分别为（73.33%、76.67%和71.67%）、（66.67%、70.00%和68.33%）和（60.00%、70.00%和65.00%）,以CA19-9检测诊断的效能最高;两组联合检测诊断的ROC曲线下面积均高于单项指标检测的ROC曲线下面积,且都表现为（CA19-9/CA125/CEA）>（CA19-9/CA125）>（CA19-9/CEA）>（CA125/CEA）,在AFP阴性组,各联合检测诊断的ROC曲线下面积分别为0.94、0.88、0.86和0.85 ,显著高于在AFP阳性组的【（0.74、0.62、0.58和0.52）,P<0.05】;（CA19-9/CA125/CEA）、（CA19-9/CA125）、（CA19-9/CEA）和（CA125/CEA）四种联合检测诊断的灵敏度、特异度和正确率均提高,分别为（90.00%、90.00%和90.00%）、（83.33%、83.33%和81.67%）、（76.67%、83.33%和80.00%）和（70.00%、76.67%和73.33%）,以CA19-9/CA125/CEA联合检测诊断效能最高。结论我们认为,血清CA19-9、CA125和CEA联合检测可提高对AFP阴性ICC患者诊断的正确率,需要临床扩大验证。     

Comparison of CA 72-4 with CA 19-9 and carcinoembryonic antigen in the serodiagnostics of gastrointestinal malignancies

Serum levels of the new tumor-associated marker CA 72-4 were measured in healthy controls (n = 64) and patients with benign (n = 410) or malignant (n = 199) gastrointestinal diseases. A cut-off limit of 4 U/ml was established. Tumor-indicating sensitivity was compared with that of the conventional markers carcinoembryonic antigen (CEA) and CA 19-9. In serodiagnostic evaluations CA 72-4 was clearly inferior to CA 19-9 in pancreatic carcinomas (22% versus 82%; all stages) and to CEA in colorectal cancer (32% versus 58%; all stages), with no appreciable diagnostic gain from combined determination. However, in gastric carcinoma CA 72-4 identified 59% of all patients (CA 19-9, 52%; CEA, 25%), and a combination of CA 72-4 and CA 19-9 detected as many as 70%. Positive results correlated roughly with tumor size. Compared with the other two tumor markers, CA 72-4 had a very high specificity (98%) in benign diseases of the gastrointestinal tract, including inflammatory processes, so that elevated serum levels of CA 72-4 should always be taken seriously.     

CA 19-9 and CEA are unreliable markers for cholangiocarcinoma in patients with primary sclerosing cholangitis

AIMS/BACKGROUND: Diagnosis of early cholangiocarcinoma (CC) in patients with primary sclerosing cholangitis with available radiological methods is very difficult. This type of tumor is the second most common cause of mortality after liver failure in these patients. The recognition of CC is important for the selection of patients for, and the results of, liver transplantation (Ltx). In this study our aim was to investigate the value of measuring cancer markers (CA 19-9 and CEA) in patients with PSC for early diagnosis of CC. METHODS: 72 PSC patients who were followed at our institution for a long period were included in the study; 9 with CC and 63 without CC. Furthermore, nine patients with CC but without concomitant PSC were included, as well as 24 patients with various cholestatic liver diseases. Serum levels of CA 19-9 and CEA were measured, in 39 PSC patients without CC, on multiple occasions. Moreover, bile was collected during a diagnostic ERCP from 20 patients for measurements of CA 19-9 and CEA. RESULTS: In those PSC patients without CC during the follow-up and with more than one year of follow-up, 15 patients had increased values of CA 19-9 (>37 ng/ml) on some of the occasions. Four of them demonstrated large fluctuations (more than 100 ng/ml difference at different occasions) in serum levels of Ca 19-9. A significant correlation between high CA 19-9 values and serum alkaline phosphatase levels was observed in these patients. The sensitivity of CA 19-9 in detecting CC in PSC patients was only 63%. The sensitivity of CEA and the combination of CA 19-9 and CEA (marker product; King's College formula) were still lower (33%) although the specificity was relatively high (85%). Bile levels of the tumor markers did not demonstrate any clinically useful differences between the different patient groups. CONCLUSIONS: Tumor markers as a diagnostic tool in diagnosing CC in patients with PSC are unfortunately not as valuable as previously reported. The serum levels of CA 19-9 can rise temporarily in association with a "biochemical relapse" of PSC (increased values of serum alkaline phosphatase). The marker product of CA 19-9 and CEA has a low sensitivity but a relatively high specificity for the detection of CC in PSC patients.     

联合检测血清、腹水肿瘤标志物对良、恶性腹水的鉴别诊断价值

目的 探索肿瘤标志物对良、恶性腹水的鉴别诊断价值.方法 回顾性分析我院2008年12月～2013年2月收治的126例腹水患者的病历资料.根据病因将其分为恶性腹水组（58例）和良性腹水组（肝硬化腹水36例,结核性腹水32例）,比较血清和腹水中甲胎蛋白（AFP）、糖链抗原（CA） 19-9、CA125、CA72-4、癌胚抗原（CEA）在良恶性腹水患者的差异,并对有统计学意义的指标构建受试者工作特征曲线（ROC曲线）图,以期寻找最佳临界值.结果 恶性腹水患者血清及腹水中CA19-9、CA72-4、CEA含量均高于良性腹水患者,差异有统计学意义（P＜0.05）,良、恶性腹水患者腹水及血清中AFP、CA125含量差别均无统计学意义（P＞0.05）.血清CA72-4、腹水CA19-9、CA72-4和CEA的ROC曲线下面积分别为0.701、0.783、0.752和0.848,准确度最高时其临界值分别为4.03 U/ml、19.33 U/ml、1.895 U/ml和1.41 ng/ml,腹水和血清CA19-9、CA72-4、CEA 3项指标联合检测的敏感性均较单项检测指标高,差异有统计学意义（P＜0.05）,敏感性和特异性分别为48.28％、79.41％、71.43％和91.18％.结论 血清和腹水中CA19-9,CA72-4,CEA水平的检测有助于良恶性腹水的鉴别诊断,构建ROC曲线可为恶性腹水的诊断提供最佳生化指标的组合.     

Comparison of tumor marker CA 242 with CA 19-9 and carcinoembryonic antigen (CEA) in pancreatic cancer

BACKGROUND/AIMS: Although there are a variety of tumor markers used for diagnosis of pancreatic carcinoma, the sensitivity and specificity of those markers have not yet reached an ideal level. The aim of this study was to compare the diagnostic value of CA 242 with CA 19-9 and CEA in the patients with pancreatic cancer. METHODOLOGY: Serum CA 242, CA 19-9 and CEA levels were determined in 135 subjects in the following groups: Pancreatic cancer (n = 40), cholangiocellular carcinoma (n = 15), hepatocellular carcinoma (n = 10), cirrhosis (n = 7), chronic active hepatitis (n = 7), choledochal stone (n = 12), chronic pancreatitis (n = 9), acute pancreatitis (n = 6), and healthy controls (n = 29). RESULTS: An elevated serum CA 242 concentration (> 20 U/mL) was found in 30 out of 40 (70%) (mean; 2163 +/- 838 U/mL) patients with pancreas cancer, in 11 out of 15 patients with cholangiocellular carcinoma (93.3%) (mean 916 +/- 529 U/mL), in none of patients with hepatocellular carcinoma and healthy controls. Slightly elevated CA 242 concentration was found in 6 out of 41 patients with benign hepatobiliary and pancreatic disease (range 0.4-97.8 U/mL) (1 acute pancreatitis, 2 chronic pancreatitis, 1 cirrhosis, 2 choledochal stone). Mean serum CA 242, CA 19-9 and CEA levels of the pancreas cancer group were significantly higher than those of the other groups except the cholangiocellular carcinoma group. There was no significant difference between the stage of pancreas cancer regarding mean serum CA 242, CA 19-9 and CEA level. There was positive correlation between serum CA 242 and CA 19-9 level. In the pancreas cancer, the sensitivity of CA 242, CA 19-9 and CEA was 75%, 80%, 40%, respectively and the specificity of those markers was 85.5%, 67.5% and 73%, respectively. CONCLUSIONS: In conclusion, the advantage of CA 242 compared to CA 19-9 is that its specificity is higher than that of CA 19-9 in the diagnosis of pancreas cancer.     

胆汁肿瘤标志物检测对于胆管远端良恶性狭窄鉴别诊断的价值

目的 探讨ERCP中胆汁肿瘤标志物的检测对于胆管远端良恶性狭窄鉴别诊断的价值.方法 对经手术或病理学确诊的20例胆管远端恶性狭窄,30例胆管远端良性狭窄患者及13例非胆胰疾病志愿者在ERCP或PTC时提取胆汁,采用免疫放射分析法(IRMA)检测胆汁和血清的CA19-9,CEA,AFP含量,评价其诊断价值.结果 当界定值...     

肿瘤标志物、K-ras和p53突变对胰腺癌诊断的价值

目的评价血清肿瘤标志物CA19-9、CA242、CA50、癌胚抗原和粪便K-ras以及p53基因突变对胰腺癌诊断的价值。方法收集2002年2月至2004年3月在北京协和医院、中国医学科学院肿瘤医院和沈阳军区总医院确诊的新发胰腺癌患者136例,良性消化系统疾病患者240例,进行血清肿瘤标志物和粪便K-ras、p53基因突变的检测。根据结果绘制不同检测方法的受试者工作特征(ROC)曲线,计算ROC曲线下面积,并确定最佳阳性分界值。结果血清CA19-9和CA242的ROC曲线下面积分别为0·855±0·031(95%可信区间0·794~0·916)和0·859±0·031(95%可信区间0·799~0·920),最佳阳性分界值分别为68U/ml和25U/ml,其诊断胰腺癌的敏感性分别为84·4%(98/116)和88·4%(84/95),特异性分别为84·3%(145/172)和79·1%(144/182)。粪便K-ras和p53基因突变诊断胰腺癌的敏感性分别为77·8%和27·8%,特异性分别为82·2%和95·2%。将粪便K-ras和p53基因突变与血清CA19-9和CA242测定相结合计算胰腺癌诊断评分,绘制有序分类资料的ROC曲线,其曲线下面积为0·946±0·017(95%可信区间0·912~0·980),最佳阳性分界值为2分。结论血清CA19-9及CA242对胰腺癌诊断具有相似价值;联合粪便K-ras及p53突变的检测,通过胰腺癌可能性积分,可以显著提高胰腺癌的诊断效率。     

Multiparametric tumor marker (CA 19-9, CEA, AFP, POA) analyses of pancreatic juices and sera in pancreatic diseases

With respect to their diagnostic utility CA 19-9, CEA, AFP and POA were determined in pancreatic secretions and serum of patients suffering from pancreatic cancer (n = 76/55) or chronic pancreatitis (n = 79/45) and of controls (n = 81/42), respectively. While the determination of AFP and POA both in pancreatic secretions and serum does not permit a differential diagnosis, serum CEA (greater than 10 ng/ml) and CA 19-9 (greater than 50 U/ml) levels were indicative of pancreatic cancer in 30% and 83%, respectively, with a rate of false positive results of 5% and 8.5% confined to the chronic pancreatitis patients. A combination of tumor marker analyses, that is, serum CA 19-9 (greater than 50 U/ml) and pancreatic secretion CEA (greater than 70 ng/ml), proved to be positive in 92.9% of tumor patients with a maximum of 10.5% false positives. Likewise, values of serum CA 19-9 (greater than 50 U/ml) and serum CEA (greater than 10 ng/ml) were found in 85.8% of the pancreatic cancer patients with only 8.8% false positives, which were confined to the chronic pancreatitis patients. These results indicate the superiority of multiparametric tumor marker analyses for the diagnosis of pancreatic cancer, especially when including new monoclonal antibody defined tumor markers.     

端粒酶活性检测联合癌胚抗原、CA19-9对良恶性胸水的鉴别诊断价值

目的 探讨端粒酶活性联合癌胚抗原(CEA)、CA19-9在鉴别良、恶性胸水中的价值.方法 入选58例胸水患者,用改良的端粒重复序列扩增-酶联免疫吸附试验法检测胸水中脱落细胞端粒酶活性,并测定胸水CEA、CA19-9.结果 恶性胸水中端粒酶活性检出阳性率为85.7%.恶性胸水患者中端粒酶活性、CEA、CA19-9测定结果均明显高于良性胸水患者(P＜0.01).联合端粒酶、CEA、CA19-9共同检测,则敏感性为0.971,特异性为1.000.结论 端粒酶在诊断恶性胸水和鉴别良、恶性胸水中具有重要的价值,联合CEA、CA19-9对良、恶性胸水鉴别诊断意义更大.     

Determining the CA19-9 concentration that best predicts the presence of CT-occult unresectable features in patients with pancreatic cancer: A population-based analysis

BackgroundSerum CA19-9 concentration may be useful in triaging patients with pancreatic cancer for more intensive staging investigations. Our aim was to identify the CA19-9 cut-point with the greatest accuracy for detecting unresectable features not identified by CT scan, and to examine the performance of this and other cut-points in predicting the outcome of staging laparoscopy (SL).MethodsPatients with pancreatic cancer were drawn from two state-wide cancer registries between 2009 and 2011. We used classification and regression tree (CART) analysis to identify the CA19-9 cut-point which best predicted the presence of imaging-occult unresectable features, and compared its performance with that of a number of alternative cut-points. We then used logistic regression to test the association between CA19-9 concentration and detection of unresectable features in patients who underwent SL.ResultsFrom the CART analysis, the optimal CA19-9 cut-point was 440 U/mL. CA19-9 ≥ 150 U/mL had a similar Youden Index, but greater sensitivity (69% versus 47%). This remained true for those who had obstructive jaundice at the time of CA19-9 sampling. CA19-9 concentration greater than or equal to 110 U/mL, 150 U/mL and 200 U/mL was associated with significantly greater odds of unresectable features being detected during SL.ConclusionElevated serum CA19-9 concentration is a valid marker for CT-occult unresectable features; the most clinically appropriate cut-point appears to be ≥ 150 U/mL irrespective of the presence of jaundice. Clinical trials which evaluate the value of CA19-9 in the staging algorithm for pancreatic cancer are needed before it is routinely used in clinical practice.     

A comparative study of mucin-like carcinoma-associated antigen (MCA), CA 125, CA 19-9 and CEA in patients with ovarian cancer

A mucin-like carcinoma associated antigen (MCA), which is recognized by the monoclonal antibody b-12, was found to be elevated in sera of breast cancer patients. Since an immunohistochemical reaction of the monoclonal antibody b-12 was found in epithelial tumors of the ovary we investigated MCA serum levels in 50 patients with ovarian cancer (mean age 59 years, range 31-81 years). In addition, CA 125, CA 19-9 and CEA were determined to compare sensitivity, specificity and the predictive value of the positive test of each parameter used in this study. Blood samples were obtained in 20 patients with progressive disease and in 30 patients during disease free intervals. The MCA serum levels of patients with progressive ovarian cancer (mean +/- SD: 14.7 +/- 14.6 U/ml) did not differ significantly from those of patients in remission (mean +/- SD: 8.2 +/- 5.3 U/ml) or from values of a healthy control group (mean +/- SD: 7.7 +/- 3.8 U/ml, n = 70). Women with progressive disease displayed significantly higher CA 125 (p less than 0.0001) and CEA (p less than 0.0063) serum levels than patients in remission. No significant difference was found for CA 19-9 in patients with ovarian cancer, irrespective of the clinical status. Considering marker surge and tumor progression, the highest sensitivity was found for CA 125 (75%). Sensitivities of the other markers were significantly lower and reached only 25-35%. The predictive value of elevated marker levels as well as specificity of the marker substances were similar. Sensitivity could be extended to 90% if elevation of CA 125, CA 19-9, CEA and MCA were taken into consideration, however specificity was lowered by using this marker combination.     

Tumor markers in pleural effusion of patients with lung cancer and patients with tuberculous pleurisy]

Carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), NCC-ST-439, carbohydrate antigen 19-9 (CA 19-9), cytokeratin 19 fragment (CYFRA 21-1), sialyl Lewis X-i antigen (SLX), progastrin-releasing peptide (ProGRP), squamous cell carcinoma antigen (SCC) and neuron specific enolase (NSE) were evaluated in the pleural effusion of 39 patients with lung cancer (29 adenocarcinomas, seven small-cell carcinomas, three squamous cell carcinomas) and 43 patients with tuberculous pleurisy. The levels of the tumor markers other than SCC and NSE were significantly higher in lung cancer than in tuberculosis. High levels of CYFRA 21-1 and SCC were observed in squamous cell carcinoma and high levels of ProGRP and NSE were observed in small-cell carcinoma. According to the validity score, sensitivity (%) + specificity (%) - 100, the optimal cut-off levels of pleural effusion were 8.1 ng/ml for CEA, 660 U/ml for CA 125, 2.6 U/ml for NCC-ST-439, 10 U/ml for CA 19-9, 65 ng/ml for CYFRA 21-1, 140 U/ml for SLX, 23.2 pg/ml for ProGRP, 0.6 ng/ml for SCC and 5 ng/ml for NSE. By comparison of validity scores for each optimal cut-off level and of receiver operating characteristic (ROC) curves, we suggest that a CEA assay is the most useful for pleural effusion. The combined assay of CEA + ProGRP and CEA + ProGRP + CYFRA 21-1 were considered to be useful.