An elevated CA 19-9 is associated with invasive cancer and worse survival in IPMN

BackgroundCurrent guidelines for IPMN include an elevated serum carbohydrate antigen (CA) 19-9 among the worrisome features. However, the correlation of CA 19-9 with histological malignant features and survival is unclear. Serum CEA is also currently used for preoperative management of IPMN, although its measurement is not evidence-based. Accordingly, we aimed to assess the role of these tumor markers as predictors of malignancy in IPMN.MethodsIPMN resected between 1998 and 2018 at Massachusetts General Hospital were analyzed. Clinical, pathological and survival data were collected and compared to preoperative levels of CA 19-9 and CEA. Receiver operating characteristic (ROC) and Cox regression analyses were performed considering cut-offs of 37 U/ml (CA 19-9) and 5 μg/l (CEA).ResultsAnalysis of 594 patients showed that preoperative CA 19-9 levels > 37 U/ml (n = 128) were associated with an increased likelihood of invasive carcinoma when compared to normal levels (45.3% vs. 18.0%, P < 0.001), while there was no difference with respect to high-grade dysplasia (32.9% vs 31.9%, P = 0.88). The proportion of concurrent pancreatic cancer was higher in patients with CA 19-9 > 37 U/ml (17.2% vs 4.9%, P < 0.001). An elevated CA 19-9 was also associated with worse overall and disease-free survival (HR = 1.943, P = 0.007 and HR = 2.484, P < 0.001 respectively). CEA levels did not correlate with malignancy.ConclusionIn patients with IPMN, serum CA19-9 > 37 U/ml is associated with invasive IPMN and concurrent pancreatic cancer as well as worse survival, but not with high-grade dysplasia. Serum CEA appears to have minimal utility in the management of these patients.     

Classification and pathology of gastroenteropancreatic neuroendocrine neoplasms

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are composed of cells with a neuroendocrine phenotype. The old and the new WHO classifications distinguish between well-differentiated and poorly differentiated neoplasms. All well-differentiated neoplasms, regardless of whether they behave benignly or develop metastases, will be called neuroendocrine tumours (NETs), and graded G1 (Ki67 <2%) or G2 (Ki67 2-20%). All poorly differentiated neoplasms will be termed neuroendocrine carcinomas (NECs) and graded G3 (Ki67 >20%). To stratify the GEP-NETs and GEP-NECs regarding their prognosis, they are now further classified according to TNM-stage systems that were recently proposed by the European Neuroendocrine Tumour Society (ENETS) and the AJCC/UICC. In the light of these criteria the pathology and biology of the various NETs and NECs of the gastrointestinal tract (including the oesophagus) and the pancreas are reviewed.     

Immunotherapies for well-differentiated grade 3 gastroenteropancreatic neuroendocrine tumors: A new category in the World Health Organization classification

According to the 2019 World Health Organization (WHO) classification, well-differentiated grade 3 (G3) gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) are a new category of cancer of the digestive system. G3 GEP-NET research and treatment are not as robust as those of lower grade (G1/2) NETs and poorly differentiated neuroendocrine carcinomas (NECs). Previously, the management of high-grade NETs was mainly based on NEC therapies, as high-grade NETs were classified as NECs under the previous WHO classification. Despite this, G3 GEP-NETs are significantly less responsive to platinum-based chemotherapy regimens than NECs, due to their distinct molecular pathogenesis and course of pathological grade transition. Patients with advanced G3 GEP-NETs, who have progressed or are intolerant to chemotherapy regimens such as capecitabine plus temozolomide, have limited treatment choices. Immunotherapy has helped patients with a variety of cancers attain long-term survival through the use of immune checkpoint inhibitors. Immunotherapies, either alone or in combination with other therapies, do not have a clear function in the treatment of G3 GEP-NETs. Currently, the majority of immunotherapy studies, both prospective and retrospective, do not reliably differentiate G3 GEP-NETs from NECs. By contrast, a significant number of studies include non-GEP neuroendocrine neoplasms (NENs). Therefore, there is an urgent need to summarize and evaluate these data to provide more effective therapeutic approaches for patients with this rare tumor. The purpose of this mini-review was to screen and summarize information on G3 GEP-NETs from all studies on NENs immunotherapy.     

食管癌新辅助放化疗患者血清肿瘤标记物水平动态变化及意义

目的：探讨血清肿瘤标记物水平动态变化判断食管癌新辅助放化疗患者疗效及预后的价值。方法对30例行新辅助放化疗食管癌切除术患者的血清细胞角化素蛋白片段19（ CYFRA21-1）、癌胚抗原（ CEA ）及糖链抗原19-9（CA19-9）水平行动态观察,分析其变化与临床疗效及预后的关系。结果治疗前CEA阳性者中位生存期明显短于CEA阴性者,P＜0．05;CA19-9阳性者中位生存期短于CA19-9阴性者（但因阳性例数过少,无法行统计学处理）;CYFRA21-1阳性与阴性者中位生存期无统计学差异。治疗过程中标志物呈下降趋势者中位生存期长于、有效率高于呈上升趋势者,P均＜0．05。结论对食管癌新辅助放化疗患者血清CYFRA21-1、CEA及CA19-9联合动态及变化趋势检测,可评价治疗效果及判断预后。     

Prognostic factors of patients with gastroenteropancreatic neuroendocrine neoplasms

There is an increasing trend in the incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) worldwide. The aim of the present study was to identify the prognostic factors of patients with GEP-NENs. A cross-sectional, retrospective chart review study was conducted among patients with pathologically proven GEP-NENs between January 2003 and December 2016 at Kaohsiung Chung-Gung Memorial Hospital. A total of 97 patients who met the inclusion criteria were included (male/female = 56/41, age: 57.7 ± 15.4 years). The presentation, clinical characteristics, and disease outcomes were reviewed and analyzed. The most common primary site of the GEP-NENs was the rectum (49.5%), followed by the pancreas (17.5%), duodenum (11.3%), stomach (10.3%), colon (6.2%), and appendix (5.2%), and most GEP-NENs were hormonally nonfunctional (94.8%). There were 56 tumors classified as G1 neuroendocrine tumors (NETs), 9 as G2 NETs, and 14 as G3 neuroendocrine carcinoma (NEC). Metastasis was found in 15 patients (15%). Curative treatments, such as surgery or endoscopic resection, were performed in 83.5% of patients (n = 81). The mean overall survival duration was 107.2 ± 7.8 months. The estimated 3- and 5-year overall survival rates for all patients were 84% and 82%, respectively. Logistic regression analysis showed that large tumor size, non-rectal NENs, high histopathological grading, lymphatic metastases and distant metastases were associated with poor survival. This study suggested that the presence of lymphatic or distant metastases at diagnosis is an independent risk factor for poor prognosis in patients with GEP-NENs.     

The use of tumor markers as predictors of prognosis in gastric cancer

BACKGROUND/AIMS: The aim of this study was to evaluate the prognostic significance of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) levels in patients with gastric cancer. METHODOLOGY: During the period January 2000 and January 2003, 36 patients operated for primary gastric cancer, at Sisli Etfal Training and Research Hospital, Department of General Surgery, were analyzed. Serum CEA and CA19-9 levels were determined preoperatively and the correlation between the elevated levels of tumor markers and several clinicopathological features, and survival were evaluated. RESULTS: Elevated serum CEA and CA19-9 levels were determined in 10 of 35 patients (28.6%), and 9 of 31 patients (29%), respectively, and both markers were elevated in 3 of 31 patients (9.6%). Elevated levels of CEA correlated with depth of invasion (p=0.018) and pathological stage (p=0.029); elevated levels of CA19-9 correlated with lymph node metastasis (p=0.026); and elevated levels of both markers correlated well with lymph node metastasis (p=0.031). The survival of patients with normal CEA levels was significantly better than those with elevated levels (p=0.0072). CONCLUSIONS: Preoperative serum CEA and CA19-9 levels may add useful information in patients with gastric carcinoma, and CEA level is a predictor of prognosis.     

Significance of multiple tumor markers measurements in conversion surgery for unresectable locally advanced pancreatic cancer

BackgroundThis study aimed to evaluate the significance of multiple tumor markers (TMs) measurements in determining the indications for conversion surgery (CS) in the management of unresectable locally advanced pancreatic cancer (UR-LAPC).MethodsA total of 103 patients with UR-LAPC, treated between 2008 and June 2021, were enrolled in this study. Three TMs, including carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), and Duke pancreatic monoclonal antigen type 2 (DUPAN-2), were measured.ResultsTwenty-five patients (24%) underwent CS. The median preoperative treatment period was 9.5 months. The median survival time (MST) from the initial treatment for patients with CS was significantly longer than that for patients without surgery (34.6 vs. 18.9 months, P < 0.001). The number of elevated TMs before CS was one in five patients and two in five patients, while 15 patients had normal levels of all three TMs. Notably, the MST from the initial treatment for patients with all three preoperative normal TMs levels was favorable for 70.5 months. In contrast, patients with one or two preoperatively elevated TMs levels had a significantly worse prognosis (25.4 and 21.0 months, respectively, P < 0.001). Furthermore, the relapse-free survival of patients with three preoperative normal TMs levels was significantly longer than those with one or two elevated TMs levels (21.9 vs. 11.3 or 3.0 months, respectively, P < 0.001). Non-normal values of all TMs before CS were identified as independent poor prognostic factors.ConclusionsSimultaneous measurement and assessment of the three TMs levels may help determine the surgical indications for UR-LAPC after systemic anticancer treatment.     

结直肠癌患者根治术前血清CEA和CA19-9表达水平对预后的预测价值

目的探讨结直肠癌患者根治术前CEA、CA19-9水平对预后的预测价值。 方法回顾性分析复旦大学附属肿瘤医院2003年12月至2007年1月间491例接受根治性切除的Ⅱ、Ⅲ期结直肠癌患者临床资料,包括患者术前血清CEA和CA19-9水平、临床病理资料及预后情况。利用单变量和多变量分析患者年龄、性别、肿瘤部位、肿瘤分化、TNM分期、肿瘤侵犯深度及淋巴结转移个数与预后的关系。 结果患者术前血清CEA和CA19-9水平、TNM分期、淋巴结转移数、肿瘤侵犯深度、肿瘤的分化都与预后相关。在多变量分析中,CEA和CA19-9水平、TNM分期、肿瘤分化是总生存的独立预测因素,CA19-9水平、TNM分期、肿瘤分化是无病生存的独立预测因素。 结论术前血清CA19-9与CEA水平均对结直肠癌患者的预后有预测价值。CA19-9水平应该作为常规的术前检查指标,对CEA检测结果有补充作用。     

Serum tumor markers not useful in screening patients with pancreatic mucinous cystic lesions associated with malignant changes

BACKGROUND: Serum cancer antigen 19-9 (CA19-9) pro-vides additional information about mucinous cystic pancre-atic neoplasm (MPN). This study was undertaken to assess both CA19-9 and carcinoembryonic antigen (CEA) serum concentrations in consecutive patients affected by MPNs and other chronic benign and malignant pancreatic diseases. We also evaluated whether serum CA19-9 and CEA determina-tions provide additional information such as the presence of invasive carcinoma in MPN patients.
METHODS: Serum CA19-9 and CEA from 91 patients with pancreatic diseases were tested by commercially available kits at the time of diagnosis. The upper reference limit of serum CA19-9 was 37 U/mL and that of serum CEA was 3 ng/mL.
RESULTS: Thirty-ifve patients was diagnosed with chronic pancreatitis (CP), 32 with MPN, and 24 with pancreatic ductal adenocarcinoma (PDAC) conifrmed histologically. Surgery was carried out in 5 CP patients, in 10 MPN patients (7 of them had severe dysplasia), and 9 PDAC patients. Serum CA19-9 activity was high in 12 (34.3%) CP patients, in 7 (21.9%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.089). High se-rum CEA concentrations were noted in 6 (17.1%) CP patients, in 6 (18.8%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.010). In the 7 MPN patients associated with histological-ly conifrmed severe dysplasia, 3 (42.9%) patients had elevated serum activity of serum CA19-9, and 2 (28.6%) patients had high levels of CEA.
CONCLUSION: Serum determination of oncological markers is not useful in selecting MPN patients with malignant changes.     

Serological studies on CEA, CA 19-9, STn and SLX in colorectal cancer.

BACKGROUND/AIMS: Sialyl Le(x) (NeuAca2-3Galb1-4(Fuca1-3)GlcNAc1-R) (SLX) was introduced as cancer-associated. In this study, serological expression of SLX was examined with that of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and sialyl Tn antigen (STn) concerning the prognosis and clinicopathological findings of patients with colorectal carcinoma. METHODOLOGY: One hundred and seventeen patients were operated on for colorectal cancer and were enrolled in this study. Serum CEA, CA 19-9, STn and SLX levels were measured pre-operatively by radioimmunoassays and the cut-off values were 5ng/ml, 37U/ml, 45U/ml, and 38U/ml, respectively. RESULTS: Serologically, the positive rates of CEA, CA 19-9, STn and SLX antigens were 33.3, 26.5, 23.1, and 17.1%, respectively. The CEA, CA 19-9 and SLX are stage specific in clinical stage. In the CEA, CA 19-9, STn, SLX-positive patients, 5-year survival rates were 41.0, 29.7, 50.1, and 29.1%, respectively. In the tumor marker-positive patients, prognosis was significantly poorer than in the negative patients. In the patients with Curability A or B, the difference in survival between the SLX-positive and negative patients was significant. Multivariate analysis revealed that significant prognostic indicators were accompanying liver metastasis, histological type, depth of invasion, CEA and SLX. CONCLUSIONS: The combination assay of serum CEA, CA 19-9, STn and SLX will be beneficial for diagnosis and follow-up of colorectal cancer.     

Value of serum carbohydrate antigen 19-9 for predicting extrahepatic metastasis in patients with liver metastasis from colorectal carcinoma

BACKGROUND/AIMS: Serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are frequently elevated in patients with colorectal carcinoma. However, the predictive utility of these two markers has not been fully investigated in patients with liver metastasis. METHODOLOGY: We retrospectively analyzed data obtained from 90 hepatectomy or non-hepatectomy patients with liver metastases from colorectal carcinoma. We examined correlation between serum levels of CEA and CA19-9 and other clinicopathologic factors and performed univariate and multivariate analyses to determine the impact of these tumor markers on extrahepatic metastasis after admission to our hospital. RESULTS: CEA elevation correlated to advanced age (> or = 60 years), and CA19-9 elevation correlated with the site (colon) of primary tumor. Univariate analysis showed that treatment without hepatectomy, > or = 4 hepatic tumors, and CA19-9 elevation had been an adverse effect on extrahepatic disease-free survival time after admission. Multivariate analysis showed that CA19-9 elevation (risk ratio, 1.84) and treatment without hepatectomy (risk ratio, 1.62) had a significant effect on extrahepatic disease-free time. CONCLUSIONS: In patients with colorectal liver metastasis, elevation of serum CA19-9 is a risk factor for extrahepatic metastasis, and CEA appears to be useless for predicting extrahepatic metastasis in these patients.     

Prognostic impact of the ratio of preoperative CA19-9 to liver enzyme levels in pancreatic cancer patients with jaundice (predictability of combined CA19-9/AST and CA19-9/γ-GGT for jaundiced PDAC patients)

BackgroundCarbohydrate antigen 19–9 (CA19-9) has been reported as the most significant survival predictor of patients with pancreatic ductal adenocarcinoma (PDAC). However, the elevation of CA19-9 could interfere with obstructive jaundice and the predictive value of CA19-9 in PDAC patients with jaundice remains to be analyzed and elucidated to find possible adjustments.ObjectiveTo evaluate the predictability of preoperative CA19-9 and its adjustments for the overall survival (OS) of PDAC patients by analyzing the relationship between preoperative serum CA19-9 and total bilirubin (TBIL).MethodsA total of 563 consecutive patients who underwent surgery for primary pancreatic adenocarcinoma in our center between January 2015 and September 2018 were retrospectively reviewed. Clinicopathologic information was collected and preoperative parameters such as CA19-9, CEA, TBIL, γ-GGT, AST, ALT, and ALP were recorded as well as overall survival rates, which began from the date of operation to that of death or the last follow-up. Kaplan-Meier survival curves with log-rank test and Cox regression models were applied using SPSS and the survival and survminer packages in R software.ResultsUsing 39/390/1000 as the cut-off values for preoperative serum CA19-9, significant capability of OS stratification was found in the total cohort (p < 0.001, MST = 29.7/19.1/15.2/12.1 months) and patients with TBIL <102.6 μmol/L (p < 0.001, MST = 32.2/19.6/15.0/11.2 months). However, in the subgroup of TBIL≥102.6 μmol/L, this classification method was replaced by the combined scoring of CA19-9/AST and CA19-9/γ-GGT.ConclusionsAs an independent predictor of overall survival of PDAC patients, preoperative serum CA19-9 is defective in survival stratification when TBIL≥102.6 μmol/L but a positive survival prognosis could be achieved with the application of combined preoperative CA19-9/AST and CA19-9/γ-GGT.     

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。     

Clinical importance of preoperative carcinoembryonic antigen and carbohydrate antigen 19-9 levels in gastric cancer

Although serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are commonly measured before surgery for gastric carcinoma, this clinical significance is not fully understood. We evaluated a total of 549 patients with gastric cancer who underwent gastrectomy. Levels of CEA and CA19-9 were measured preoperatively in all patients. We retrospectively analyzed correlations between CEA or CA19-9 and clinicopathologic features, and estimated the prognostic utility of the tumor markers by analyzing clinicopathologic characteristics of the carcinoma as a function of seropositivity or negativity of the antigens in combination or by raising the levels. The positivity rates of CEA (> or =5 ng/mL) and CA19-9 (> or =37 U/mL) were 19.5% and 18%, respectively. Serum CEA and CA19-9 positivity significantly correlated with depth of invasion, hepatic metastasis, and curativity. Forty-nine patients positive for both CEA and CA19-9 had significantly higher frequencies of lymph node metastasis, deeper invasion by the tumor, lower rates of curative resection (p < 0.01), and higher rates of hepatic metastasis (p < 0.05) than 377 patients with normal levels of CEA and CA19-9. Surgical outcomes of patients who were CEA- and CA19-9-positive were poorer than those of patients with normal CEA and CA19-9 levels (p < 0.01). Significant correlation was found between serum CEA and CA19-9 level (p < 0.001, r = 0.24). Doubling the threshold level of serum positivity to 10 ng/mL (CEA) and 74 U/mL (CA19-9) improved the prognostic value of these factors. However, multivariate analysis using Cox's hazards model revealed that only CEA positivity using the doubled threshold value (10 ng/mL) (p = 0.04, hazard ratio = 1.7), nodal involvement (p = 0.01, hazard ratio = 1.9), and depth of invasion (p = 0.02 hazard ratio = 1.5) significantly predicted prognosis. Carcinoembryonic antigen positivity using the doubled threshold level (10 ng/mL) was an important prognostic factor in patients with gastric cancer.     

Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for the evaluation of curability and resectability in patients with pancreatic adenocarcinoma

Background Purpose

Although carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most studied serum tumor markers that have been evaluated for diagnosis and prognosis in patients with pancreatic cancer, little is known of the value of these markers for the prediction of curability and resectability.

Methods

We retrospectively reviewed preoperative serum levels of CEA and CA 19-9 in 244 consecutive patients with pancreatic operations.

Results

Although 159 pancreatic operations seemed “resectable”, 93 of them were judged curative (R0) and the other 66 turned out to be noncurative (R1/2). The remaining 85 failed resection because of unexpected metastasis or locally advanced disease (LD), which was unresectable compared with levels in those patients without liver metastasis or LD. CEA levels were significantly higher in patients with liver metastasis and LD, while CA 19-9 levels were correlated with liver and peritoneal metastases. When both markers were negative, curative (R0) and respectable (R0 + R1/2) operation were performed in 70% and 85% of patients, respectively. Logistic regression analysis indicated that under conditions where both CEA and CA 19-9 were negative, the odds ratios for curative and respectable operations were 4.43 and 3.58, respectively.

Conclusions

Our data suggest that combined preoperative CEA and CA 19-9 levels are suitable for assessing expected curability and resectability in patients with pancreatic cancer.

     

Mucinous biliary cystadenoma with mesenchymal stroma: Expressions of CA 19-9 and carcinoembryonic antigen in serum and cystic fluid

a case of mucinous biliary cystadenoma with mesenchymal stroma (CMS tumor) in a 64-year-old woman is reported. The patient presented with acute abdominal pain and a palpable mass in the upper abdomen. Computed tomography and abdominal sonography showed characteristic multilocular cysts in the left lobe of the liver. Serum CA 19-9 was elevated to 108 U/ml with normal carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) levels. The levels of CA 19-9 and CEA in the cystic fluid were high at 7430 U/ml and 576ng/ml, respectively. The serum CA 19-9 returned to 35 U/ml 4 weeks after tumor resection. These corresponding findings of both tumor markers in the serum and cystic fluid imply that (1) CA 19-9 and CEA both exist in the epithelial component of CMS tumors as evidenced by immunohistochemical stain, (2) serum CA 19-9 is a valuable marker in the diagnosis and monitoring of CMS, and (3) in cystic fluid, there are more significantly high levels of CA 19-9 in CMS compared with levels in simple cyst and polycystic liver disease. Therefore, measurement of CA 19-9 in cystic fluid and serum may be helpful in the differential diagnosis of hepatic cystic lesions.     

Colorectal carcinoma liver metastases: clinical significance of preoperative measurement of serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels

The clinical significance of preoperative levels of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) was evaluated in patients with colorectal carcinoma liver metastases. Preoperative serum CEA and CA 19-9 levels, the number and size of liver metastases, and survival data were analyzed retrospectively in 73 patients. Using the cutoff level of 5 ng/ml for CEA and 37 U/ml for CA 19-9, the positivity of these for detecting metastatic deposits were 81% and 56%, respectively. CEA level was correlated with the number (P = 0.0081) and size (P = 0.013) of liver metastases among patients with positive CEA level, while CA 19-9 level was correlated only with the number of liver metastases (P = 0.0072) among those with positive CA 19-9 level. In the overall series, preoperative CEA and CA 19-9 levels were correlated significantly with survival only at higher cutoff levels. In 46 patients undergoing curative hepatectomy, however, these levels were not correlated with survival, even at higher cutoff levels. In conclusion, the CEA level is closely associated with the extent of liver metastases, while the CA 19-9 level may reflect multiplicity of hepatic deposits. Preoperative measurement of serum CEA and CA 19-9 levels appears to be of some prognostic value.     

Validation of serum tumor biomarkers in predicting advanced cystic mucinous neoplasm of the pancreas

BACKGROUND Early detection of advanced cystic mucinous neoplasms[(A-cMNs),defined as high-grade dysplasia or malignancy]of the pancreas is of great significance.As a simple and feasible detection method,serum tumor markers(STMs)may be used to predict advanced intraductal papillary mucinous neoplasms(IPMNs)and mucinous cystic neoplasms(MCNs).However,there are few studies on the usefulness of STMs other than carbohydrate antigen(CA)19-9 for early detection of A-cMNs.AIM To study the ability of five STMs-CA19-9,carcinoembryonic antigen(CEA),CA125,CA724,and CA242 to predict A-cMNs and distinguish IPMNs and MCNs.METHODS We mainly measured the levels of each STM in patients pathologically diagnosed with cMNs.The mean levels of STMs and the number of A-cMN subjects with a higher STM level than the cutoff were compared respectively to identify the ability of STMs to predict A-cMNs and distinguish MCNs from IPMNs.A receiver operating characteristic curve with the area under curve(AUC)was also created to identify the performance of the five STMs.RESULTS A total of 187 patients with cMNs were identified and 72 of them showed AcMNs.We found that CA19-9 exhibited the highest sensitivity(SE)(54.2%)and accuracy(76.5%)and a moderate ability(AUC=0.766)to predict A-cMNs.In predicting high-grade dysplasia IPMNs,the SE of CA19-9 decreased to 38.5%.The ability of CEA,CA125,and CA724 to predict A-cMNs was low(AUC=0.651,0.583,and 0.618,respectively).The predictive ability of CA242 was not identified.The combination of STMs improved the SE to 62.5%.CA125 may be specific to the diagnosis of advanced MCNs.CONCLUSION CA19-9 has a moderate ability,and CEA,CA125,and CA724 have a low ability to predict A-cMNs.The combination of STM testing could improve SE in predicting A-cMNs.     

Diagnosis of malignant versus tuberculous ascites using tumor markers and globulin ratios in serum and ascites: A Fisher discriminant model

Background and study aimsThis study was conducted to investigate the significance of tumor and biochemical markers in serum and ascitic fluid in the differential diagnosis of tuberculous and malignant ascites.Patients and methodsBased on findings from natural orifice transluminal endoscopic surgery and postoperative pathology or cytology of 63 patients, they were divided into the malignant group (31 patients) and the tuberculous group (32 patients). Levels of tumor markers, albumin, globulin, and lactate dehydrogenase were measured simultaneously. Data were statistically analyzed, and a Fisher discriminant model was established. The receiver operating characteristic curve was constructed to confirm the discriminant value.ResultsThe levels of carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 19-9 (CA 19-9), and globulin in serum and ascitic fluid were different between the tuberculous and malignant ascites groups (P < .05). The ratios of ascites-to-serum levels of CEA, CA125, and CA 19-9, as well as the ratio of serum-to-ascites of globulin levels, were different between the two groups (P < .05). The Fisher discriminant model was established based on the ascites-to-serum ratios of CEA, CA125, and CA 19-9 levels and the serum-to-ascites ratio of globulin levels. The area under the curve was 0.908, the sensitivity was 0.838 (26/31), and the specificity was 0.875 (28/32).ConclusionA Fisher discriminant model can be established using serum and ascites tumor markers and globulin ratios, which is valuable in the differential diagnosis of tuberculous versus malignant ascites.     

High serum concentrations of sialyl Tn antigen in carcinomas of the biliary tract and pancreas

Sialyl-Tn (STn) antigen is a cancer-associated carbohydrate antigen expressed in cancers of the digestive tract. In the present study, we compared the serum level of STn antigen in 14 patients with benign diseases of the biliary tract and pancreas, 15 patients with bile duct cancers, and 9 patients with cancer of the pancreas. High levels of serum STn (>45 U/ml) were frequently detected in patients with carcinoma of the biliary tract (53.3%) or pancreas (55.6%), compared with the detection of high levels in those with benign diseases (14.3%;P < 0.05). Serum levels of STn did not correlate with the presence of jaundice, cholangitis, or pancreatitis, or with the level of carcinoembryonic antigen (CEA) or carbohydrate antigen (CA) 19–9. In cancer tissues, the expression of STn antigen detected by immunostaining correlated significantly with serum STn (P < 0.05). Our results indicate that measurement of serum STn level may be potentially useful for the diagnosis of carcinomas of the biliary tract and pancreas, particularly when combined with other tumor markers such as CEA or CA19-9.