Carbohydrate antigen 242 highly consists with carbohydrate antigen 19-9 in diagnosis and prognosis of colorectal cancer: study on 185 cases

The objective of the study was to compare the clinical value of preoperative serum carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 242 (CA242) in diagnosis and prognosis for 5-year recurrence-free survival (RFS) in patients with colorectal cancer (CRC). Preoperative serum CA19-9 and CA242 concentrations were detected by C12 protein chip diagnostic system in 185 patients with CRC, and informative data were collected during 5-year follow-up periods. The value of CA19-9 and CA242 in diagnosis and prognosis for 5-year RFS as well as their consistencies and correlations were comparatively analyzed. The sensitivities of CA19-9 and CA242 were only 19.5 and 20%, respectively; the efficiencies of two TMs were 53.9 and 54.2%, respectively; and two TMs increased significantly with advancing clinical stages (P < 0.0001). Preoperative CA19-9 and CA242 levels correlated with stage (r, 0.411 and 0.408) and CEA concentration (r, 0.553 and 0.630). The concentrations of two TMs closely correlated with each other (r = 0.829), and two TMs had a very strong consistency in diagnosis (κ = 0.931). Among 88 of 185 cases with complete follow-up information on RFS, patients with positive preoperative serum CA19-9 or CA242 had higher 5-year recurrent rates (72.2% vs. 44.3%, P = 0.034; 76.5% vs. 43.7%, P = 0.015) and reduced median RFS (14 vs. 36 months, 12 vs. 36 months) compared with those with negative TMs. The consistency of predicting prognosis for RFS of two TMs was extremely strong (κ = 0.964). ROC curves analysis showed that CA242 test performed better than CA19-9 test (AUC, 0.648 vs. 0.605). Univariate analysis showed that preoperative serum status of both TMs was correlated with 5-year RFS (P < 0.05), whereas multivariate Cox regression model analysis revealed that none of them were independent prognostic factors for RFS. Both CA19-9 and CA242 had strong consistencies in diagnosis and prognosis for predicting 5-year RFS. CA242 demonstrated superior value to CA19-9 in CRC.     

Preoperative Serum Carcinoembryonic Antigen,Carbohydrate Antigen19-9 and Carbohydrate Antigen 125 as Prognostic Factors for Recurrence-free Survival in Colorectal Cancer

Objective: Colorectal cancer (CRC) is among the most common malignancies worldwide. Understanding CRCprognosis at the initial diagnosis is very important for therapeutic strategy selection. This study was conductedto evaluate the prognostic value of preoperative serum carbohydrate antigen 19-9 (CA19-9), carcinoembryonicantigen (CEA) and carbohydrate antigen 125 (CA125) for predicting 5-year recurrence-free survival (RFS) inCRC patients. Methods: Preoperative serum CA19-9, CEA and CA125 levels were detected by C12 proteinchip diagnostic system in 103 patients with CRC, and their correlations with the 5-year RFS were analyzed.Results: Patients with positive preoperative serum CA19-9, CEA and CA125 had higher 5-year recurrent rates(75.0% vs 41.0%, 65.6% vs 39.4%, and 87.5% vs 44.2% respectively, all p<0.05), and reduced median RFS (14vs 35 months, 20 vs 36 months, and 4 vs 35 months respectively, all p<0.05) compared with patients negative forcorresponding tumor marker (TM). The median RFS was 59 months (95% CI 28.9-89.1 months) with negativeTMs, 14 months (95% CI 4.5-23.5) for 1~2 positive TMs, and 4 months (95% CI 2.4-5.6) for all 3 positive TMs.Patients with simultaneously positive serum CA19-9, CEA and CA125 had the highest recurrence rate (100%)and the shortest RFS (median 4 months). Univariate analysis showed that stage and the preoperative singleTM or combined TMs correlated with RFS, whereas multivariate Cox regression model analysis revealed onlystage and preoperative serum status of CEA+CA19-9+CA125 to be independent prognostic factors. Conclusion:Preoperative serum CA19-9+CEA+CA125 can be used an independent prognostic factor for CRC 5-year RFS.     

EGFR is a potential therapeutic target for highly glycosylated and aggressive pancreatic neuroendocrine neoplasms

pNENs are relative indolent tumors with heterogeneous clinical presentation at diagnosis. It is important to establish aggressive subgroups of pNENs and identify potential therapeutic targets. Patients with pNEN (322 cases) were included to examine the association between glycosylation biomarkers and clinical/pathological traits. The molecular and metabolic features stratified by glycosylation status were assessed by RNA-seq/whole exome sequencing and immunohistochemistry. A considerable proportion of patients had elevated glycosylation biomarkers (carbohydrate antigen [CA] 19-9, 11.9%; CA125, 7.5%; carcinoembryonic antigen [CEA], 12.8%). CA19-9 (hazard ratio [HR] = 2.26, P = .019), CA125 (HR = 3.79, P = .004) and CEA (HR = 3.16, P = .002) were each independent prognostic variables for overall survival. High glycosylation group, defined as pNENs with elevated level of circulating CA19-9, CA125 or CEA, accounted for 23.4% of all pNENs. High glycosylation (HR = 3.14, P = .001) was an independent prognostic variable for overall survival and correlated with G3 grade (P < .001), poor differentiation (P = .001), perineural invasion (P = .004) and distant metastasis (P < .001). Epidermal growth factor receptor (EGFR) was enriched in high glycosylation pNENs using RNA-seq. EGFR was expressed in 21.2% of pNENs using immunohistochemistry and associated with poor overall survival (P = .020). A clinical trial focusing on EGFR expressed pNENs was initiated (NCT05316480). Thus, pNEN with aberrant glycosylation correlates with a dismal outcome and suggests potential therapeutic target of EGFR.     

High preoperative serum CA19-9 level is predictive of poor prognosis for patients with colorectal liver oligometastases undergoing hepatic resection

Oligometastasis is defined as a transitional state between localized and widespread systemic metastatic cancers. In colorectal cancer, the prognostic factors and prognostic value of preoperative serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) for patients with colorectal liver oligometastases (CLOM) undergoing hepatic resection have not been well explored. Therefore, the present study included 141 patients with CLOM (≤5 liver metastases) who underwent R0 resection from 2005 to 2012. The association of clinicopathological factors including preoperative CA19-9 and CEA levels with overall survival (OS) was analyzed with univariate and multivariate analyses. Kaplan–Meier analysis showed that patients with high CA19-9 levels tended to have poorer OS than those with low levels (median OS 21.5 vs. 64.0 months, P = 0.002). Preoperative CEA levels were not significantly associated with OS (P > 0.05). Univariate and multivariate analyses demonstrated that larger tumor size of liver metastases (HR 1.911; 95 % CI 1.172–3.114; P = 0.009), bilobar distribution (HR 1.776; 95 % CI 1.097–2.873; P = 0.019), and higher preoperative CA19-9 levels (HR 1.954; 95 % CI 1.177–3.242; P = 0.010) were independent predictors of poor OS for patients with CLOM. Our study identified tumor size, distribution, and preoperative CA19-9 levels as independent prognostic factors for OS of patients with CLOM. In particular, measurement of preoperative CA19-9 levels offers an easy tool that could help identify high-risk patients and aid in improving the management of patients with CLOM.     

结直肠癌血清纤维蛋白原和炎性介质、肿瘤标志物的术前诊断价值

目的探讨纤维蛋白原FIB、炎性介质（CRP、SAA）和肿瘤标志物（CEA、CA19-9、CA72-4）在术前评估结直肠癌分期的价值。方法178例经病理诊断为结直肠癌的患者,均于术前3天测定FIB、CRP、SAA、CEA、CA19-9和CA72-4的水平,并与术后病理分期相比较。结果FIB与CRP、SAA、CEA和CA19-9的相关性有统计学意义,相关系数分别为0.600（ P =0.000）、0.547（ P=0.000）、0.168（ P =0.025）、0.231（ P =0.002）。FIB（ P =0.000）、CRP( P =0.004)、SAA( P =0.046)、CEA( P =0.001)、CA19-9（ P =0.000）和CA724( P =0.040)的值在不同的TNM分期之间差异有统计学意义。 建立诊断转移性结直肠癌的ROC曲线,FIB的ROC曲线下面积A_Z=0.728（ P =0.000）,CRP的A_Z=0.646（ P =0.001）,SAA的A_Z=0.658（ P =0.042）,CA19-9的A_Z=0.665（ P =0.000）,CA72-4的A_Z=0.586（ P =0.049）有统计学意义;当取FIB=3.715g/L为分界点时,FIB诊断转移性结直肠癌的敏感度为65.8%,特异性为66.6%,准确性为66.3%。结论FIB、炎性介质和肿瘤标志物有相关性,运用FIB术前评估有淋巴结转移的结直肠癌患者有潜在应用价值。     

Combination of Neutrophil-to-Lymphocyte Ratio and Red Cell Distribution Width With Serum Tumor Markers for the Differential Diagnosis of Breast Cancer and its Association With Pathological Features and Molecular Types

ObjectiveTo explore the neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW) and serum tumor markers as differential diagnostic markers of breast cancer (BC) and breast fibroadenoma (FA) and their associations with histopathological indicators and molecular typing in BC patients.MethodsWe collected pathological and routine clinical test data [NLR, RDW, serum tumor markers (CEA, CA15-3, CA125, CA19-9)] of 653 patients with BC and 100 patients with FA. After identifying indicators with significant inter-group differences, we used ROC curves to determine clinically significant cutoff values. Binary logistic regression analyses and ROC curves were used to analyze combined models for the differential diagnosis of BC and FA. Ordinal multinomial logistic regression analysis was used to explore correlations between routine clinical test indicators and pathological BC features.ResultsThe BC and FA groups had significantly different CEA, NLR, and CA19-9 levels (P < .05), with respective areas under the curve (AUC) of 0.799, 0.747, and 0.711 for differentiating BC from FA and respective optimal cutoff values of 1.35 ng/mL, 1.58, and 8.55 U/mL. Binary logistic regression and ROC curve analysis showed that CEA was superior to the other 2 factors for the differential diagnosis of BC and FA. whereas the combined use of all three indicators was diagnostically most effective (AUC = 0.886; 95% confidence interval: 0.838–0.933, P = .000; sensitivity and/or specificity: 76.5%/88.9%). Ordered multinomial logistic regression analysis showed that NLR, CEA, and CA15-3 correlated positively with BC TNM staging; RDW was negatively correlated with BC histological grade; RDW, CA15-3 and CA125 were obviously associated with BC molecular typing.ConclusionThe combination of CEA, NLR, and CA19-9 may be used to screen and diagnose BC. NLR, CEA and CA15-3 are related to the TNM staging of BC. RDW is related to BC histological grading. RDW, CA15-3 and CA125 are related to BC molecular typing.     

Beneficiaries of radical surgery among clinical complete responders to neoadjuvant chemoradiotherapy in rectal cancer

This study aimed to identify patients who benefit from radical surgery among those with rectal cancer who achieved clinical complete response (cCR). Patients with locally advanced rectal cancer (LARC; stage II/III) who achieved cCR after neoadjuvant chemoradiotherapy (nCRT) were included (n = 212). Univariate/multivariate Cox analysis was performed to validate predictors for distant metastasis-free survival (DMFS). A decision tree was generated using recursive partitioning analysis (RPA) to categorize patients into different risk stratifications. Total mesorectal excision (TME) was compared with the watch-and-wait (W&W) strategy in each risk group. Two molecular predicators of CEA and CA19-9 were selected to establish the RPA-based risk stratification, categorizing LARC patients into low-risk (n = 139; CA19-9 < 35 U/mL and CEA < 5 ng/mL) and high-risk (n = 73; CA19-9 ≥ 35 U/mL or CEA ≥5 ng/mL) groups. Superior 5-y DMFS was observed in the low-risk group vs. the high-risk group (92.9% vs. 76.2%, P = .002). Low-risk LARC patients who underwent TME had significantly improved 5-y DMFS compared with their counterparts receiving the W&W strategy (95.9% vs. 84.3%; P = .028). No significant survival difference was observed in high-risk patients receiving the 2 treatment modalities (77.9% vs. 94.1%; P = .143). LARC patients with cCR who had both baseline CA19-9 < 35 U/mL and CEA < 5 ng/mL may benefit from radical surgery.     

CA 19-9 As a Marker in Addition to CEA to Monitor Colorectal Cancer

BackgroundCarcinoembryonic antigen is the commonly used tumor marker in patients with colorectal cancer, and CA 19-9 might be an additional marker. The aim of this retrospective study was to investigate whether CA 19-9 levels can be used to monitor the disease process in patients with colorectal cancer who had no elevated CEA levels. The secondary aim was to determine if preoperative increased levels of CEA and CA 19-9 were associated with mortality.Materials and MethodsTwo sets of data from patients with histologically confirmed colorectal cancer, were included in a single-center study. First, patients with a minimum of 3 serial measurements of CA 19-9 and CEA tumor markers were related to the clinical course of their disease. Second, patients with preoperative levels of CEA and CA 19-9 were related to survival.ResultsIn patients with colorectal cancer and 3 serial measurements of tumor markers, 7.3% had only increased CA 19-9 levels without increased CEA levels, and 55.4% of the patients had an increase of CA 19-9 and CEA levels. In the patients with available preoperative markers, patients with only an increase of CA 19-9 had a significantly decreased 5-year survival compared with patients with an increase of only CEA (P = .013).ConclusionCA 19-9 can be used as additional marker to follow the disease process in patients with colorectal cancer without an increase in CEA level. Patients with preoperative increased CA 19-9 level had a poorer 5-year survival than patients with preoperative increased CEA levels.     

Clinical Application of Serum Tumor Abnormal Protein (TAP) in Colorectal Cancer Patients

Objective: To explore the association of serum tumor abnormal protein (TAP) with other serologicalbiomarkers e.g. carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), carbohydrate antigen19-9 (CA19-9) and its clinical application in colorectal cancer (CRC) patients. Methods: Patients (N=98) wereenrolled into this study with histologically or cytologically confirmed CRC. Using a test kit, the level of TAPwas determined, while chemiluminescence was used to measure the levels of some other common serologicalbiomarkers e.g. CEA, CA125 and CA19-9. Results: The area of TAP condensed particulate matter decreased afterchemotherapy compared with before chemotherapy when CT or MRI scans showed disease control. In contrast,it increased with disease progression (P<0.05). Furthermore, a statistically significant difference was confirmed inmonitoring of TAP and common serological biomarkers e.g. CEA and CA19-9 (p<0.05). Conclusions: DetectingTAP in CRC patients has high sensitivity and specificity and can be used as a new independent indicator forclinically monitoring CRC patients in the course of chemotherapy.     

血清肿瘤标志物及免疫组化指标在不同临床病理特征胃腺癌患者中的表达水平

目的 研究血清肿瘤标志物及免疫组化指标在不同临床病理特征胃腺癌患者中的表达水平.方法回顾性分析106例胃腺癌患者的临床资料,比较分析血清肿瘤标志物和免疫组化指标在不同临床病理特征胃腺癌患者中的表达水平.结果不同临床分期胃腺癌患者的癌胚抗原(CEA)和糖链抗原125(CA125)表达水平比较,差异有统计学意义(P﹤0.05);不同肿瘤直径胃腺癌患者的糖链抗原72-4(CA72-4)、糖链抗原19-9(CA19-9)和CEA表达水平比较,差异有统计学意义(P﹤0.05);不同淋巴结转移情况胃腺癌患者的CA72-4、CEA和CA125表达水平比较,差异有统计学意义(P﹤0.05);不同胃壁浸润深度胃腺癌患者的CA72-4和CA19-9表达水平比较,差异有统计学意义(P﹤0.05).不同肿瘤直径和临床分期胃腺癌患者的人类表皮生长因子受体2(HER2)表达水平比较,差异有统计学意义(P﹤0.05);不同病变类型、淋巴结转移情况和胃壁浸润深度胃腺癌患者的HER2表达水平比较,差异无统计学意义(P﹥0.05).结论肿瘤标志物CA72-4、CEA、CA19-9及CA125的表达水平与胃腺癌患者的胃壁浸润深度、淋巴结转移情况和肿瘤直径有关;免疫组化指标HER2的表达水平与胃腺癌患者的肿瘤直径、临床分期有关.     

Serum Cyr61 as a potential biomarker for diagnosis of colorectal cancer

Purpose

To determine the sensitivity and specificity of serum Cyr61 as a potential biomarker for the diagnosis of colorectal cancer (CRC) and to assess the association between serum Cyr61 level and CRC clinicopathological status.

Methods

We used an enzyme-linked immunosorbent assay to measure serum Cyr61 in patients with CRC, patients with colorectal adenomas, and healthy controls. We also analyzed the relationship between serum Cyr61 and clinicopathological features of CRC patients. The levels of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were quantified using the Roche Cobas 6000 Analyzer. The sensitivity and specificity of Cyr61, CEA, CA19-9 and CEA + CA19-9 were evaluated by receiver operating characteristic (ROC) analysis.

Results

The serum level of Cyr61 was significantly increased in CRC patients compared with colorectal adenoma patients and healthy controls (p < 0.001). Furthermore, the area under the ROC curve for Cyr61 was 0.935 (95 % confidence interval 0.902–0.968), higher than that for CEA + CA19-9 (0.827, 95 % confidence interval: 0.783–0.871). Use of a Cyr61 cutoff value of 92.0 pg/mL allowed distinguishing CRC patients and healthy controls with a sensitivity of 83 % and a specificity of 97 %. Among CRC patients, an elevated level of serum Cyr61 was significantly associated with more advanced TNM stage (p < 0.0042), lymph node metastasis (p < 0.0088), and vascular invasion (p = 0.0027).

Conclusion

Cyr61 has potential as a serum biomarker for the diagnosis of CRC and for assessment of the clinicopathological status of CRC.

     

大肠癌术后腹腔引流液中CEA、CA125和CA19-9的水平及其临床意义

目的 探讨大肠癌术后腹腔引流液中癌胚抗原（CEA）、糖类抗原125（CA125）和糖类抗原19-9（CA19-9）的水平及其与临床分期和腹腔微转移的关系。方法 收集经手术治疗的86例大肠癌患者（大肠癌组）和30例肠道良性疾病患者（对照组）术后第1天的腹腔引流液,检测腹腔引流液中CEA、CA125和CA19-9的水平,并分析其与大肠癌临床病理特征的关系。结果 大肠癌组腹腔引流液的CEA水平高于对照组（P＜0.05）,CA125和CA19-9水平两组差异均无统计学意义（P＞0.05）;腹腔引流液中CA125和CA19 9水平与大肠癌临床病理特征无关（P＞0.05）,而CEA水平与淋巴结转移、浸润深度和临床分期有关。结论 大肠癌术后腹腔引流液CEA检测可用于预测临床分期、腹腔微转移并判断预后。     

Tumor Markers in Serum and Ascites in the Diagnosis of Benign and Malignant Ascites

Objective: To evaluate the values of 4 tumor markers in serum and ascites and their ascites/serum ratios inthe identification and diagnosis of benign and malignant ascites. Materials and Methods: A total of 76 patientswere selected as subjects and divided into malignant ascites group (45 cases) and benign ascites group (31cases). Samples of ascites and serum of all hospitalized patients were collected before treatment. The levels ofcarcinoembryonic antigen (CEA), alpha fetoprotein (AFP), cancer antigen 125 (CA125) and carbohydrate antigen19-9 (CA19-9) were detected by chemiluminescence (CLIA) . Results: CEA, AFP and CA19-9 in both serumand ascites as well as CA125 in ascites were evidently higher in the malignant ascites group than in the benignascites group (P<0.01). Malignant ascites was associated with elevated ascites/serum ratios for AFP and CA125(P<0.01). The areas under receiver operating characteristic (AUROCs) of CEA and CA125 in ascites and theratios of ascites/serum of AFP, CEA, CA125 and CA19-9 were all >0.7, suggesting certain values, while those ofascites CA19-9 and serum CEA were 0.697 and 0.629 respectively, indicating low accuracy in the identificationand diagnosis of benign and malignant ascites. However, the AUROCs of the remaining indexes were <0.5, with novalue for identification and diagnosis. Compared with single index, the sensitivity of combined detection increasedsignificantly (P<0.05), in which the combined detection of CEA, CA19-9 and CA125 in ascites as well as the ratioof ascites/serum of CEA, CA19-9, CA125 and AFP had the highest sensitivity (98.4%) but with relevantly lowspecificity. Both sensitivity and specificity of combined detection should be comprehensively considered so asto choose the most appropriate index. Conclusions: Compared with single index, combined detection of tumormarkers in serum and ascites can significantly improve the diagnostic sensitivity and specificity.     

炎性介质ＣＲＰ和ＳＡＡ与肿瘤标记物ＣＥＡ、ＣＡ１９-９和ＣＡ７２-４术前联合评估结直肠癌

目的：探讨运用炎性介质Ｃ反应蛋白（ＣＲＰ）、血清淀粉样蛋白Ａ（ＳＡＡ）与肿瘤标记物ＣＥＡ、ＣＡ１９-９、ＣＡ７２-４术前联合评估结直肠肿瘤分期的价值。方法：纳入１３０例结直肠癌患者,于术前３天测定血清ＣＥＡ、ＣＡ１９-９、ＣＡ７２-４、ＣＲＰ和ＳＡＡ的水平,并与术后病理分期进行比较。结果：术前ＳＡＡ与ＣＲＰ、ＣＥＡ有相关性,相关系数分别为ｒ＝０.６４７（Ｐ＝０.０００）和ｒ＝０.２９５（Ｐ＝０.００１）;ＣＲＰ（Ｐ＝０.０２１）、ＳＡＡ（Ｐ＝０.０３６）、ＣＡ１９-９（Ｐ＝０.０１７）在不同的ＴＮＭ分期之间差异有统计学意义;建立ＣＲＰ、ＳＡＡ和ＣＡ１９. ９诊断Ⅱ ～Ⅳ期结直肠癌的ＲＯＣ曲线,ＳＡＡ的曲线下面积（ＡＵＣ）为０.６７４（Ｐ＝０００５）,ＣＡ１９.９的ＡＵＣ为０.６６４（Ｐ＝０００８）,ＣＲＰ的ＡＵＣ没有统计学意义;以血清ＳＡＡ值≥２.６６５ｍｇ／Ｌ为阳性,或ＣＡ１９-９值≥８.７０５Ｕ／ｍｌ为阳性联合诊断Ⅱ ～Ⅳ期结直肠癌的准确度为７５.６％,敏感度为８８.３％,特异度为３４.５％。结论：炎性介质和肿瘤标记物具有相关性,联合检测ＳＡＡ和ＣＡ１９-９筛选Ⅱ ～Ⅳ期结直肠癌患者具有较高价值。     

Gastric Cancer: Tumor Markers as Predictive Factors for Preoperative Staging

Introduction

CEA, CA 19-9, and CA 72-4 are tumor markers commonly used for gastric neoplasms. The clinical importance of the preoperative serum levels of these tumor markers in gastric cancer (GC) is not well known. Even less is known about the predictive value of the preoperative serum levels of the ??-subunit of human chorionic gonadotropin (hCG??).

Aims and Methods

We designed a prospective study to evaluate the significance of the preoperative values of these tumor markers in GC. The serum levels that we considered as positive are as follows: CA 72-4, >4 U/ml; CEA, >5?ng/ml; CA 19-9, >37 U/ml; hCG??-free subunit, <5 mUI/ml. These levels were correlated by pathological stage, lymph node status, and histology.

Results

We studied 66 (42 male and 24 female) patients prospectively. Twenty-seven patients had stage I and stage II GCs, while 39 patients had stage III and stage IV GCs. Two patients tested positive for hCG??. The preoperative positivity rates of CA 72-4 in patients at the early stages (stages I and II) and in patients with advanced disease (stages III and IV) were 0 and 28 patients, respectively. The preoperative positivity rates of CEA/CA 19.9 were 0/5 and 7/12 patients in early stages and advanced disease, respectively. The serum levels of these markers were not correlated with the histological type or tumoral grade of GC.

Conclusion

The preoperative serum level of CA 72-4 has the best predictive value in indicating advanced disease in patients diagnosed with GC. A combination of these four markers is better in predicting this situation.     

Are high initial CEA and CA 19–9 levels associated with the presence of K-ras mutation in patients with metastatic colorectal cancer?

In certain cell culture studies, significant CEA expression was observed in K-ras mutant cells. However, the relationship between high CEA levels and K-ras status has not been sufficiently investigated. In the present study, we aimed to determine the prognostic role of initial CEA and CA 19–9 values in metastatic colorectal cancer patients according to the status of K-ras. Between 2000 and 2010, a total of 215 patients with metastatic colorectal cancer who were treated and followed up in our oncology center were analyzed. Smokers were excluded from the study. The clinicopathological findings and initial CEA and CA19-9 values were determined. K-ras mutation analysis was performed using quantitative PCR evaluation of the DNA from the tumor tissues. Eighty-two patients (38.1 %) were female and 133 (61.9 %) were male, with a median age of 59 years (range 27–83). Based on tumor localization, 127 patients (59 %) were classified as colon cancer patients and 88 patients (41 %) were classified as rectal cancer patients. The majority of patients (83.3 %) had pure adenocarcinoma histology, while 36 cases (16.7 %) had mucinous adenocarcinoma. The initial CEA levels were detected to be high (>5 ng/mL) in 108 of the patients (50.2 %), while high levels of initial CA 19–9 (>37 ng/mL) were found in 90 patients (41.8 %). K-ras mutations were detected in 99 of the patients (46 %). K-ras was found to be wild type in 116 patients (54 %). Significant differences were detected between the K-ras wild-type and mutant groups with respect to age and the initial serum CEA levels. Patients with K-ras mutations were younger (p?=?0.04) and had higher initial CEA levels (p?=?0.02) compared to patients with K-ras wild type. The median overall survival (OS) time and 3-year OS rate for patients with a high initial CEA level (>5 ng/mL) were significantly shorter than those of patients with a low initial CEA level (<5 ng/mL) (50.5 months and 61.8 % vs. 78.6 months and 79.1 %, p?=?0.014). Furthermore, the patients with low initial CA 19–9 levels (<37 ng/mL) had a significant better median OS interval and 3-year OS rate (76.1 months and 80.1 %) compared to patients with high initial CA 19–9 levels (>37 ng/mL) (37.6 months and 55.7 %, p?=?0.04). Multivariate analysis indicated that stage at the time of diagnosis (p?<?0.001) and low initial serum CEA level (p?=?0.037) were independent prognostic factors of OS. For K-ras mutant patients, the stage at diagnosis (p?=?0.017), low initial serum CEA level (p?=?0.001), and low initial serum CA 19–9 level were found to be independent prognostic indicators of OS. Our findings demonstrate for the first time that the presence of a K-ras mutation correlated with high initial CEA and CA 19–9 levels in patients with metastatic colorectal cancer. Patients with high initial CEA and CA 19–9 levels may potentially predict the presence of a K-ras mutation, and this prediction may guide targeted therapies in these patients.     

肿瘤标志物在结直肠癌诊断和监测中的价值和改进策略:130例患者的临床资料分析

背景与目的:肿瘤标志物检测是肿瘤血清学诊断的主要方法之一,但肿瘤标志物的阳性诊断率较低.本研究旨在分析肿瘤蛋白芯片C12在结直肠癌(colorectal cancer,CRC)诊断中的价值.方法:分析总结130例CRC初治患者12种肿瘤标志物的检测结果,找出与CRC相关性最强的肿瘤标志物,计算各标志物组检测对提高诊断率的作用.结果:C12对本组CRC患者的总体诊断率是42.3%,对Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的诊断率分别是13.6%、39.5%、38.2%和68.8%;对Ⅳ期患者的诊断率显著高于Ⅰ期患者(P＜0.001);癌胚抗原(carcioembryonicantigen,CEA)的阳性率最高,达35.4%,与之相比,阳性率最高的5种标志物的任何组合方式(2、3、4、5种标志物的组合)均不能提高诊断率,但四项指标联合检测CEA 前列腺特异性抗原(free prostate specific antigen,f-PSA) 肿瘤抗原cancer antigen,CA)125 CA242或CEA CAl9-9 CAl25 f-PSA足以替代12项指标联合检测.结论:C12对诊断中晚期CRC有一定价值,但对早期CRC的灵敏度不高.     

Preoperative Serum CEA and CA19-9 in Gastric Cancer - a Single Tertiary Hospital Study of 1,075 Cases

To evaluate the clinical impact of preoperative serum CEA and CA19-9 on resectable gastric cancer (GC),a total of 1,075 consecutive cases with gastric adenocarcinoma were obtained retrospectively from January2012 and December 2013 in a single tertiary hospital, and the relationships between serum CEA, CA19-9 andclinicopathologic features were investigated. Positive preoperative serum rates of CEA and CA19-9 were 22.4%and 12.3% respectively, levels significantly correlating with each other and depth of invasion, lymph nodeinvolvement, pTNM and stage. The CEA level also presented a remarkable association with lymphovascularinvasion. Both CEA and CA19-9 positivity significantly and positively correlated with depth of invasion, nodalinvolvement, pTNM stage, lymphovascular invasion, tumor size and tumor location. Stratified analyses accordingto gender or tumor location showed preoperative CEA or CA19-9 had different associations with clinicopathologicfeatures in different gender subgroups or location subgroups. Preoperative serum CA19-9 positivity may bemore meaningful for tumor size rather than CEA. In conclusion, preoperative serum CEA and CA19-9 correlatewith disease progression of GC, and may have applications in aiding more accurate estimation of tumor stage,decision of treatment choice and prognosis evaluation.     

Normalization of CA19-9 Following Resection for Pancreatic Ductal Adenocarcinoma is not Tantamount to being Cured?

Background: Postoperative carbohydrate antigen 19-9 (CA19-9) is an independent predictor of survival forpancreatic ductal adenocarcinoma (PDAC), and more powerful than preoperative CA19-9. However, makingdecisions just dependent on postoperative CA19-9 may result in necessary treatments not being performed.Materials and Methods: A total of 178 patients with resected PDAC were eligible for this retrospective study,classified into two corresponding subgroups according to postoperative CA19-9. Prognostic significance of allclinicopathologic factors was evaluated by univariate and multivariate analyses. Results: Postoperative CA19-9,preoperative CA125 and lymph node status were independent predictors. Better predictive performances foroverall survival (OS) and recurrence-free survival (RFS) were achieved by postoperative CA19-9 comparedto preoperative CA125 and lymph node status. Particularly, preoperative CA125 was associated with poor OS(p<0.001 for the normalized CA19-9 patients, p=0.012 for the elevated) and RFS (p=0.005 for the normalized,p=0.004 for the elevated). Moreover, preoperative CA125 levels related with survival in double- negative patients.Conclusions: Normalization of CA19-9 is not tantamount to be cured. Preoperative CA125 is a critical predictorfor PDAC patients, especially in double-negative patients.     

Prognostic significance of CEA, CA 19-9 and CA 72-4 preoperative serum levels in gastric carcinoma.

The prognostic value of preoperative serum levels of CEA, CA 19-9 and CA 72-4 tumor markers was investigated in 153 patients resected for gastric cancer. The positivity rates for CEA, CA 19-9 and CA 72-4 were 20.9, 34.6 and 28.1%, respectively. Multiple logistic regression analysis for positive levels of tumor markers indicates that CEA positivity is significantly related to the depth of invasion (p < 0.005) and the presence of distant metastasis (p < 0. 05), CA 19-9 positivity is related to nodal involvement (p < 0.05) and the depth of invasion (p < 0.05), whereas CA 72-4 positivity is influenced by tumor size (p < 0.005) and noncurative surgery (p < 0. 05). Positive levels of each tumor marker were associated with a worse prognosis if compared with negative cases using univariate analysis. Multivariate analysis of curatively resected cases identified depth in gastric wall (p < 0.0001), nodal status (p < 0. 0005), and tumor location in the upper third (p < 0.05) as significant prognostic variables; CEA, CA 19-9 and CA 72-4 serum positivity did not reach statistical significance. However, when the positivity of the three markers was associated, a p value < 0.05 was observed. The analysis of survival curves stratified by tumor stage revealed that marker positivity significantly affects survival in stages I, II and IV (p < 0.05). The combined assay of CEA, CA 19-9 and CA 72-4 preoperative serum levels provides additional prognostic information in patients resected for gastric cancer; patients with preoperative positivity for one of these tumor markers should be considered at high risk of recurrence even in early stages of gastric carcinoma.