Carcinoembryonic antigen and immunoglobin in gastric juice in the diagnosis of gastric cancer

Levels of carcinoembryonic antigen (CEA) and immunoglobin (Ig) in gastric juice of 93 patients with benign and malignant gastric diseases were assayed. The CEA level in gastric cancer patients (55.73 +/- 38.26 ng/ml) was obviously higher than that in peptic ulcer (15.51 +/- 12.09 ng/ml) and superficial gastritis (26.96 +/- 20.17 ng/ml). But no significant difference was found between the CEA levels of gastric cancer and chronic atrophic gastritis (48.66 +/- 31.87 ng/ml). Also, elevated CEA was closely correlated to intestinal metaplasia. The positive rate of Ig was significantly higher in gastric cancer (IgG greater than or equal to 185 ug/ml, IgA greater than or equal to 100 ug/ml) than in benign gastric diseases. Although no correlation is present in the CEA and Ig in gastric juice, the combination of these two methods could improve the diagnostic accuracy. We believe that the two assays are worthy for screening gastric cancer from patients with high risk, and for identifying precancerous lesions.     

The prognostic significance of gastric juice CA 19-9 and CEA levels in gastric carcinoma patients

AIM: The usefulness of gastric juice CA 19-9 and carcinoembryonic antigen (CEA) levels in the diagnosis of gastric carcinoma is controversial. There is only one study related with their prognostic value. In this study the clinical significance of gastric juice CA 19-9 and CEA levels in patients with gastric carcinoma was investigated. METHODS: Preoperative serum and gastric juice CA 19-9 and CEA concentrations were measured in 139 patients with gastric carcinoma, 54 patients with benign gastroduodenal disease and as the 'healthy' control group 46 patients with inguinal hernia and with no other pathology. RESULTS: In all groups the mean gastric juice levels of CA 19-9 and CEA were significantly higher than the serum levels. The gastric juice CA 19-9 levels were not different between groups. Gastric juice CEA levels of the gastric carcinoma group were significantly higher than those of the benign gastroduodenal disease group (P=0.007) and had a tendency to increase when compared to those of the control group (P=0.064) whereas there was no significant difference between the benign gastroduodenal disease and the control group. The cut-off values of gastric juice CA 19-9 and CEA were 440U/ml and 320ng/ml and the positivity ratios of these markers in gastric carcinoma patients were 16.5 and 27.3%, respectively. There was no significant relationship between the histopathological features and the gastric juice CA 19-9 or CEA positivities. Neither univariate analysis nor the multivariate Cox proportional hazards model analysis showed prognostic value for gastric juice CA 19-9 and CEA positivities. CONCLUSIONS: The gastric juice CA 19-9 and CEA levels have no diagnostic and prognostic significance in gastric carcinoma patients.     

Increase in the circulating level of hepatocyte growth factor in gastric cancer patients.

We measured serum concentrations of hapatocyte growth factor (HGF) in patients with gastric cancer and compared these with the histological findings and conventional tumour markers, including CEA, CA19-9 and CA125, for evaluation of the significance of serum HGF levels as a tumour marker. The HGF levels were measured by an enzyme-linked immunosorbent assay (ELISA) system. The average levels of serum HGF in 89 healthy control subjects, 104 patients with primary gastric cancer and 15 patients with recurrent gastric cancer were 0.31 +/- 0.11 ng ml(1), 0.42 +/- 0.50 ng ml(-1) and 0.92 +/- 0.39 ng ml(-1) respectively. The average level in patients with recurrent disease was significantly higher than in healthy control subjects and in primary cancer patients (P< 0.001 and P< 0.003 respectively). Of 104 patients with primary gastric cancer, 35 (33.7%) showed an aberrant increase in the circulating level of HGF. The increased HGF levels were significantly associated with the degrees of histological tumour invasion and venous invasion. Of 15 patients with recurrent gastric cancer, 14 (93.3%) showed an aberrant increase. No correlation was found between serum HGF levels and CEA levels, CA19-9 levels and CA125 levels. However, the rate of the aberrant increase in HGF levels was significantly higher than that of any other tumour markers, including CEA, CA19-9 and CA125, in primary gastric cancer patients. In conclusion, the circulating levels of HGF were elevated in approximately one-third of patients with primary gastric cancer, particularly in those with high grades of histological tumour invasion and venous invasion, and frequently in patients with distant metastases, suggesting that HGF might play important roles in the tumour progression of gastric cancer. Furthermore, serum HGF levels may be of value as a tumour marker in patients with gastric cancer.     

Measurement of a monoclonal-antibody-defined antigen (CA19-9) in the sera of patients with malignant and nonmalignant diseases. Comparison with carcinoembryonic antigen

Immunoradiometric assay (IRMA) using monoclonal antibody for colon cancer cell surface antigen (CA19-9) was compared with carcinoembryonic antigen (CEA) with regard to sensitivity and specificity in 730 patients. In the 341 patients who had no evidence of malignant disease, CA19-9 levels ranged between less than 1.5 to 49 U/ml. Specificity of CA19-9 at a cutoff of 20 U/ml was similar to that of CEA at a cutoff of 5.0 ng/ml; CA19-9 was more sensitive than CEA in pancreatic cancer, whereas CEA was more sensitive than CA19-9 in breast, colon, and gastric cancer. Of 17 patients with pancreatic cancer, 13 had elevated levels of CA19-9 (sensitivity, 76%), whereas only 8 had elevated levels of CEA (sensitivity, 47%) and 15 had elevated levels of either CEA or CA19-9 (sensitivity, 88%). These findings suggest that, like CEA, CA19-9 is detectable in nonmalignant diseases and is not specific for gastrointestinal tumors, and has higher sensitivity than CEA only in pancreatic cancer. However, further prospective studies are required to verify its value in the diagnosis and management of pancreatic cancer.     

Carcinoembryonic antigen and carbohydrate antigen 19-9 levels of peripheral and draining venous blood in colorectal cancer patients. Correlation with histopathologic and immunohistochemical variables

Correlation between carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels of peripheral and draining venous blood, and 11 histopathologic and immunohistochemical variables was examined in 83 patients with colorectal cancer. CEA levels of draining blood (mean 34.5 ng/ml and positive rate greater than 5 ng/ml, 60.2%) were significantly higher than those (13.0 ng/ml and 28.9%) of peripheral blood. However, CA19-9 levels (mean 576.1 U/ml and positive rate greater than 37 U/ml, 29.5%) of draining blood were not different from those (568.0 U/ml and 29.5%) of peripheral blood. Immunohistochemically, CEA was observed in all of the 83 specimens and distributed in most of all cancer cells, whereas CA19-9 was found in 52 (62.5%) of the 83 specimens and sporadically distributed in some parts of cancer lesions in general. Elevation of CEA levels in draining and peripheral blood was most highly correlated with venous invasion, although the levels were related to four other histopathologic variables including liver metastasis, invasive layer of colorectal wall, lymphatic invasion, and Dukes' classification. Significant correlation between the CEA localized pattern of cancer cells was not found. Patients with CA19-9 nonlocalized cancer showed no elevation of the antigen levels in both peripheral and draining blood. The elevation of CA19-9 levels in peripheral blood of patients with CA19-9 localized cancer was most highly associated with lymphatic invasion, although the levels were correlated with five other variables consisting of liver metastasis, tumor differentiation, invasive layer of colorectal wall, venous invasion, and Dukes' classification out of 11 histopathologic and immunohistochemical variables. CEA levels of draining blood rose from 18.2 ng/ml and 40.3% to 30.1 ng/ml and 72.6%, respectively, after operative stimuli to cancer lesions, whereas the change of CA19-9 levels in draining blood of patients with CA19-9 localized cancer was not found during the time of operation. These results suggest that CEA may be drained mainly by the hematogenous portal system by the draining vein from the cancer cells in the invasive veins and that CA19-9 may be drained by the thoracic duct of the lymphatic system. It is also suggested that the CEA and CA19-9 elevation-relating variables may secondarily affect the CEA and CA19-9 elevation in the blood in association with the venous and lymphatic invasion of cancer lesions, respectively.     

CEA and CA 19-9 are Still Valuable Markers for the Prognosis of Colorectal and Gastric Cancer Patients

Background: The purpose of this study was to assess the predictive effect of preoperative CEA and CA 19-9levels on the prognosis of colorectal and gastric cancer patients. Materials and Methods: CEA and CA 19-9 wereevaluated preoperatively in patients undergoing surgery for colorectal cancer (n=116) and gastric cancer (n=49).Patients with CEA levels <5 ng/mL were classified as CEA Group 1, 5-30 ng/mL as CEA Group 2 and >30 ng/mL were classified as CEA Group 3. Similarly the patients with a CA 19-9 level <35 U/mL were classified as CA19-9 Group 1, with 35-100 U/mL as Group 2 and with >100 U/mL as Group and 3. TNM stages and histologicgrades were noted according to histopathological reports. Patients with a TNM grade 0 or 1 were classified asGroup A, TNM grade 2 patients constituted Group B and TNM grade 3 and 4 patients constituted Group C.Demographic characteristics, tumor locations and blood types of the patients were all recorded and these datawere compared with the preoperative CEA and CA19-9 values. Results: A significant correlation between CA19-9 levels (>100 U/mL) and TNM stage (in advanced stages) was determined. We also determined a significantcorrelation between TNM stages and positive vlaues for both CEA and CA 19-9 in colorectal and gastric cancerpatients. In comparison between CEA and CA 19-9 levels and age, gender, tumor location, ABO blood group,and tumor histologic grade, no significant correlation was found. Conclusions: Positive levels of both CEA andCA 19-9 can be considered to indicate an advanced stage in colorectal and gastric cancer patients.     

Evaluation of serum CEA and CA19-9 levels as prognostic factors in patients with gastric cancer

Background. This clinicopathological study evaluated the utility of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 as predictors of locoregional recurrence and long-term disease-free survival in patients with gastric cancer. Methods. During the period January 1989 to December 1994, 485 patients with primary gastric cancer were evaluated. Gastrectomies were performed in 434 patients. Prognostic factors were analyzed by the Kaplan-Meier method and multivariate analysis, using Cox regression. Results. Elevated serum CEA and CA19-9 levels were observed in 92 of the 485 patients (19.0%), and in 95 of the 435 patients (21.8%), respectively, and both markers were elevated in 29 of these 435 patients (6.7%). Elevated serum CEA and CA19-9 levels correlated well with lymph node metastasis, lymphatic invasion, vessel invasion, stage grouping, depth of invasion, and curability. Patients with elevated serum CEA levels were at significantly higher risk of having all recurrence factors than were those with normal serum CEA levels. Patients with elevated serum CA19-9 levels were at significantly higher risk of having peritoneal metastases and distant metastases than were those with normal serum CA19-9 levels. A significant difference in the cumulative survival curves of patients was demonstrated between those with elevated and those with normal serum CEA or CA19-9 levels, even for patients at the same disease stage (stage III). Patients with elevated levels of both markers had a significantly worse prognosis than patients in whom the levels of both markers were normal. In patients who underwent gastrectomy, elevated serum CEA levels either preoperatively or within 3 weeks after gastrectomy were associated with significantly worse prognosis than were normal levels. When the cutoff level of serum CEA was increased to 10 ng/ml, serum CEA, age, lymph node metastasis, and surgical stage grouping were selected as independent prognostic factors by multivariate analysis of 14 prognostic factors, using Cox regression. Conclusion. Serum CEA and CA19-9 levels provide additional prognostic information in patients with primary gastric cancer. In particular, an elevated serum CEA level provides additional prognostic information and is a useful indicator of curability in patients who undergo gastrectomy. Serum CEA level is an independent prognostic factor in patients with primary gastric cancer. Received: June 20, 2000 / Accepted: November 14, 2000     

Gastrointestinal cancer

Although their sensitivity is not high, SCC, TPA and IAP are useful for esophageal cancer. The sensitivity of CEA, CA 19-9, is relatively high, especially in well-differentiated adenocarcinoma of gastric cancer with lymph node metastasis. AFP is specific to liver metastasis from gastric cancer, and CA 125 is also specific to peritoneal dissemination. CA 72-4 and NCC-ST-439 are useful markers for advanced staging. CEA, CA 19-9, is useful for colon cancer, especially for predicting preoperative staging. Half-life and doubling time of tumor markers is useful in some cases for the evaluation of operation and chemotherapy. We showed our data concerning postoperative CEA and/or CA 19-9 monitoring after operation for gastric cancer in 120 recurrent patients. Positivities of CEA and CA 19-9 for recurrence were 65.8% and 85.0%, respectively, both of which were significantly higher than the preoperative sensitivities (28.3% and 45.0%, respectively). In most patients with high levels of preoperative CEA and/or CA 19-9, these tumor markers increased again at recurrence. Recurrent diseases were detected between 5 months after detection by diagnostic imagings and 12 months before detection by diagnostic imagings (mean of 3.1+/-3.6 months before detection by diagnostic imagings) and between 10 months after detection by diagnostic imagings and 13 months before detection by diagnostic imagings (mean 2.2+/-3.9 months before detection by diagnostic imagings) by CEA and CA 19-9 monitorings, respectively. These results suggest that CEA and/or CA 19-9 monitoring after operation was useful to predict the recurrence of gastric cancer, especially in almost all the patients with high preoperative levels of these markers.     

胃癌患者血清CA72-4、CEA及CA19-9水平及其与临床病理特征的相关性

目的:探讨血清CA72-4、CEA及CA19-9水平与胃癌患者病理特征的相关性。方法:选择2011年6月-2013年3月收治的86例胃癌患者,56例胃良性肿瘤患者,60例普通胃病患者,比较三组患者CA72-4、CA19-9和CEA水平;CA72-4、CA19-9和CEA单项检测及联合检测胃癌患者的阳性率;CA72-4、CA19-9和CEA水平与胃癌病理特征的关系。结果:胃癌组患者血清CA72-4、CA19-9和CEA水平均高于胃良性肿瘤组患者（P＜0.05),胃癌良性组患者均高于对照组（P＜0.05);三种胃癌肿瘤标志物中CA72-4诊断胃癌的阳性率最高,肿瘤3项标志物的阳性检测率要显著高于单项CA72-4、CA19-9、CEA的阳性检出率（P＜0.05）;肿瘤越大、TNM分期越高,CA72-4、CA19-9和CEA水平越高。结论:采用CA72-4、CA19-9和CEA联合检测是诊断胃癌比较理想的组合。CA72-4、CA19-9和CEA水平的变化可以反应胃癌患者的病理特征。     

Prognostic significance of tumor markers in peritoneal lavage in advanced gastric cancer

OBJECTIVE: Predicting peritoneal dissemination of cancer is very difficult whatever method of examination is used. Recently, a cytological examination of peritoneal lavage has been shown to be a feasible measure to predict an early state of peritoneal seeding. The predictive value of the levels of tumor markers in peritoneal lavage for peritoneal metastasis from gastric carcinoma was thus studied. METHODS: In 229 patients gastric cancer tumor markers, CEA, CA 125, and CA 19-9, in peritoneal lavage were intraoperatively evaluated using a chemiluminescent enzyme immunoassay. RESULTS: CEA in peritoneal lavage at a cutoff level of 0.5 ng/ml showed overall a higher sensitivity of 75.8% at a specificity of 90.8% for a diagnosis of peritoneal dissemination including cytologically positive peritoneal lavage [CY(+)] than CA 125 or CA 19-9 in peritoneal lavage. The CEA level in peritoneal lavage as well as both serosal invasion and the CA 125 level in peritoneal lavage were significant factors for the prediction of peritoneal dissemination including CY(+) with a relative risk of 6.6, 14.1 and 9.4. In patients undergoing curative operations, the recurrence rate for peritoneal dissemination and liver metastasis in cases with CEA levels in peritoneal lavage of > or = 0.5 ng/ml was significantly higher than that in cases with CEA levels of < 0.5 ng/ml (p < 0.0001, p < 0.002). CONCLUSIONS: These finding suggest that the CEA level in peritoneal lavage is thus considered to be a predictor of peritoneal dissemination including CY(+).     

糖抗原CA19—9测定对消化系统恶性肿瘤的诊断意义

Serum carbohydrate antigen CA 19-9 level was measured by radioimmunoassay in 55 patients with malignant digestive disease (14 esophageal cancers, 11 gastric cancers, 5 colorectal cancers, 14 primary liver cancers and 11 pancreatic cancers). The mean value of serum CA 19-9 levels was 22.11 +/- 24.79 u/ml in esophageal cancer, 99.91 +/- 100.12 u/ml in gastric cancer, 64.5 +/- 53.43 u/ml in colorectal carcinoma, 47.81 +/- 68.62 u/ml in primary hepatic cancer and 459.55 +/- 696.76 u/ml in pancreatic cancer (CA 19-9 greater than 37 mu/ml as positive). There were significant differences (P less than 0.05) between the mean serum CA 19-9 levels of pancreatic cancer and esophageal cancer, primary hepatic cancer. An increased CA 19-9 synthesis and excretion by tumor cells or increased pressure on pancreatic duct by the tumor may cause the elevation of serum CA 19-9 level in cancer patients. The authors conclude that CA19-9 is a valuable tumor marker in the diagnosis of pancreatic cancer and, probably, other gastrointestinal tumors.     

癌胚抗原糖链抗原CA199和CA724联合检测在胃癌诊断中的价值

目的分析血清癌胚抗原(CEA)、糖链抗原CA199和CA724联合检测在胃癌诊断中的价值。方法选取2011年2月到2013年2月间收治的、经临床检查确诊为胃癌的84例患者,胃良性病变者80例,另选取80例健康人作为对照组。采用电化学发光法检测患者血清中CEA、CA199和CA724含量,分析CEA+CA199、CEA+CA724、CA199+CA724及CEA+CA199+CA724等不同组合联合方式的胃癌诊断价值。结果胃癌组患者血清中CEA、CA199和CA724含量分别为(48.1±21.2)ng/ml、(98.4±12.2)U/ml和(39.8±19.6)U/ml,均明显高于胃良性病变组和对照组,差异有统计学意义(P<0.05)。3项指标联合检测诊断胃癌的准确率为86.2%,特异度为88.9%,敏感度为84.1%,准确率和敏感度明显高于两种肿瘤标志物联合检测,差异有统计学意义(P<0.05)。3项指标不同组合方式联合检测的特异度无明显差异(P>0.05)。结论 CEA、CA199和CA724联合检测对胃癌诊断具有优越性,而对胃良性病变仅有一定的指导意义。     

Assay of serum carbohydrate antigen (CA) 19-9 in the diagnosis of gastric cancer

The levels of the serum carbohydrate antigen (CA) 19-9 were assayed in 284 cases including 77 patients with gastric cancer. The CA 19-9 levels were positive in 38% of gastric cancer cases, and they were significantly higher than those of benign gastric diseases. Extremely increased levels were found in advanced gastric cancer, but not in early gastric cancer. There was no significant correlation between CA 19-9 and CEA, and CA 19-9 seemed to be superior to CEA in specificity for gastric cancer, but inferior in sensitivity. Thus, the assay of CA 19-9 in combination with CEA could be helpful in the differentiation between benign and malignant gastric diseases.     

甲胎蛋白、癌胚抗原和糖链抗原19-9联合检测诊断消化系统恶性肿瘤的价值分析

目的 探讨甲胎蛋白(AFP)、癌胚抗原(CEA)和糖链抗原19-9(CA19-9)联合检测对消化系统恶性肿瘤的诊断价值.方法 回顾性分析300例消化系统恶性肿瘤患者和108例消化系统良性病变患者的临床资料,记录患者的血清AFP、CEA和CA19-9水平,评价其诊断效能.结果 肝癌患者的血清AFP、CEA和CA19-9水平均高于肝硬化患者,胃癌、胰腺癌和结直肠癌患者的血清CEA和CA19-9水平分别高于胃溃疡、胰腺炎和溃疡性结肠炎患者,差异均有统计学意义(P<0.05).单项检测中,AFP对肝癌的诊断敏感度(78.5%)高于CEA和CA19-9(P<0.05);CA19-9对胰腺癌的诊断敏感度(78.2%)高于AFP和CEA(P<0.05).对于肝癌、胃癌、胰腺癌和结直肠癌,3项联合检测的敏感度均高于单项检测(P<0.05).结论 血清AFP、CEA和CA19-9联合检测对消化系统恶性肿瘤的早期诊断具有重要意义,可提高诊断的敏感度,且不会降低特异度.     

Diagnostic accuracy of a new tumor serologic marker, CA 19-9: comparison with CEA

Two hundred and twenty-one hospitalized patients underwent serum determination of CA 19-9, a recently developed tumor marker assay, and CEA. Among these, 53 had a gastrointestinal (GI) cancer, 59 a GI benign disease, 52 a non-GI cancer, and 57 a non-GI benign disease. CA 19-9 assay was more accurate than CEA to detect malignancy, especially of GI source (69.8% sensitivity vs. 24.5% in GI patients); when a cutoff level of 41 ng/ml for CA 19-9 was considered, only 6 false-positive cases were found and both markers showed excellent specificity (94.9% for CEA and 89.9% for CA 19-9 in gastric, hepatobiliary and pancreatic cancer). We conclude that CA 19-9 is a useful GI tumor marker and it seems to be better than CEA in some pathologic situations.     

血清脂联素、CEA、CA19-9、CA72-4联合检测在胃癌早期筛查中的临床价值分析

目的:探讨血清脂联素、CEA、CA19-9、CA72-4联合检测在胃癌早期筛查中的临床价值。方法:选取首次确诊的早期胃癌患者60例,胃癌患者再根据幽门螺杆菌是否感染分为感染组32例与未感染组28例;胃良性疾病组患者100例;健康对照组110例。采用化学发光法检测CEA、CA19-9、CA72-4水平,ELISA检测血清脂联素水平,幽门螺杆菌检测采用C14呼气试验,比较不同分组间各指标的差异。结果:胃癌组血清CEA、CA19-9、CA72-4水平均高于胃良性疾病组和健康对照组(P<0.01),血清脂联素水平显著低于胃良性疾病组和健康对照组(P<0.01);胃癌患者幽门螺杆菌感染时,血清CEA、CA19-9、CA72-4水平明显高于未感染组(P<0.01),感染组患者血清脂联素水平与未感染组比较,无显著性差异(P>0.05);四项联合检测胃癌灵敏度最高,达96.67,特异度为98.10%,阳性预测值为93.55%,阴性预测值为99.04%,阳性似然比为50.75、阴性似然比为0.03,约登指数达0.95,ROC曲线下面积为0.955。结论:胃癌早期患者血清脂联素水平不受幽门螺杆菌感染的影响,四项联合检测可明显提高检测的灵敏度和特异度,对胃癌患者早期筛查具有较高的临床应用价值。     

An autopsy case of a gastric cancer associated with elevated AFP, CEA and CA19-9

A 48-year-old male developed gastric cancer (Borrmann III) with lung and liver metastases. Laboratory examination revealed a markedly elevated AFP (24, 241 ng/ml), CEA (9739.8 ng/ml), and CA-19-9 (726U/ml). Nevertheless, he underwent a subtotal gastrectomy for the hemostasis of a bleeding malignant lesion. Histological examination showed a moderately differentiated adenocarcinoma. A PAP for an AFP and a CEA disclosed positive staining. In addition, An autopsy revealed metastases to the liver and lungs with a positive result of PAP for AFP and CEA. Further, CA19-9 also was confirmed weakly in these same tissues, histochemically. Therefore this gastric cancer was considered an AFP, CEA, and CA19-9-producing tumor. Gastric cancer with 3 elevated tumor markers in the same patient is rare and its mechanism may elucidate the origin of gastric cancer and the resulting differentiation in the foregut.     

Carcinoembryonic antigen in gastric cancer patients

Carcinoembryonic antigen (CEA) levels were determined in 252 gastric cancer patients. In patients with resectable cancer, the preoperative CEA values and CEA positivity rates were 2.4 +/- 1.5 ng/ml and 7.7% for stage I, 24.9 +/- 72.0 ng/ml and 10.0% for stage II, 21.6 +/- 84.1 ng/ml and 17.9% for stage III, and 6.3 +/- 8.4 ng/ml and 27.1% for stage IV cancers, respectively. In patients with nonresectable cancers, the CEA value was 83.0 +/- 235.5 ng/ml, the CEA positivity rate was 47.8%. Overall, of 252 patients with primary gastric cancer, 47(18.7%) were positive for CEA. In patients with cancer recurrence, the CEA value averaged 41.8 +/- 101.8 ng/ml, the positivity rate was 63%. This rate increased as the cancer stage increased; it was highest in gastric cancer patients with liver metastasis. In 4 of 13 patients with recurrence, an elevation in CEA was observed about 4.8 months before the clinical detection of cancer recurrence. Our results suggest that in gastric cancer patients, the preoperative and periodic postoperative assay of CEA levels has predictive value in determining cancer stage, progression and recurrence.     

Evaluation of Ca 12-5 as a tumor marker for gastric and colo-rectal cancer in comparison to CEA and Ca 19-9

We performed simultaneous measurements of CA 12-5, CEA and Ca 19-9 in the preoperative sera of 87 patients with gastric cancer, 177 patients with colo-rectal cancer and 55 patients with benign diseases. 5.6% of the control patients, 13.8% of the gastric cancer patients and 9.6% of the colo-rectal cancer patients showed Ca 12-5 values of 27.0 U/ml and more. In contrast, the sensitivity of the tumor markers CEA (greater than or equal to 5.0 ng/ml in 17.1% of the gastric cancer and 36.2% of the colo-rectal cancer patients examined) and Ca 19-9 (greater than or equal to 25.0 U/ml in 16.1% of the gastric cancer and 19.8% of the colo-rectal cancer patients) was distinctly higher. The simultaneous determination of three markers on the one hand increased the rate of 'marker-positive' patients (up to 34.5% in gastric cancer and 45.2% in colo-rectal cancer) but on the other hand diminished the specificity (from 96.4% to 89.1%) of the examination.     

Type IV collagen levels are elevated in the serum of patients with peritoneal dissemination of gastric cancer

Type III procollagen (amino-terminal propeptide of procollagen type III) and type IV collagen are considered to be reliable serum markers for monitoring the progression of liver fibrosis. The peritoneal dissemination of gastric cancer is also characterised by abundant collagen deposition in the peritoneum. The present study was performed to investigate the potential of serum type III procollagen and IV collagen as biomarkers for peritoneal dissemination in gastric cancer. The study population consisted of 117 patients with gastric cancer: 32 patients had peritoneal dissemination which was pathologically diagnosed by laparotomy or laparoscopic examination, while 85 patients (45/40, early/advanced gastric cancer) had no peritoneal dissemination. We measured the serum levels of type III procollagen and type IV collagen in comparison to the commonly accepted tumor markers carcinoembryonic (CEA), carbohydrate antigen (CA)19-9 and CA125. The median type III procollagen levels showed no significant differences between the two groups, whereas the median type IV collagen levels were significantly (201 ng/ml) higher in patients with than in those without peritoneal dissemination (early/advanced gastric cancer, 124/136 ng/ml) (P<0.05). In receiver operating characteristic (ROC) curve analysis, type IV collagen had the largest area under the curve (0.83), followed by CA125 (0.72), CA19-9 (0.64), CEA (0.59) and type III procollagen (0.48). Type IV collagen was an independent marker (P<0.0001, odds ratio 15.7) for predicting peritoneal dissemination along with CA125 (P=0.0086, odds ratio 9.4) based on multivariate logistic regression. In conclusion, serum type IV collagen levels may be significant in the early detection and management of patients with peritoneal dissemination of gastric cancer.