Individual Cutoff Levels of Carcinoembryonic Antigen and CA 242 Indicate Recurrence of Colorectal Cancer With High Sensitivity

PURPOSE: This study was designed to identify the sensitivity and specificity associated with recurrent colorectal cancer, principally hepatic metastases, with individual cutoff levels of carcinoembryonic antigen; identify the corresponding data for CA 50 and CA 242; compare these findings with standard cutoff levels, clinical examinations, and patients personal health assessments; and identify the time between increasing serum levels and detection of actual relapses, particularly hepatic metastases. METHODS: A prospective study was performed that included 132 patients with colorectal cancer who underwent surgery with curative intent and who were followed up for a minimum of 5 years. Serum samples were obtained the first two years after surgery. Marker serum levels were analyzed with the commercial Delfia® test kit. RESULTS: During the sampling period, carcinoembryonic antigen levels were very high or above the individual cutoff level in 21 of 24 cases with recurrent disease. All eight hepatic metastases detected during the sampling period were indicated by carcinoembryonic antigen 0 to 19 months earlier. In the 3rd postoperative year, nine patients with recurrence were identified, and in eight of them, carcinoembryonic antigen rose above the individual cutoff level 23 months before diagnosis. The overall sensitivity and specificity associated with recurrent disease with individual cutoff levels were 79 and 64 percent for carcinoembryonic antigen, 46 and 77 percent for CA 50, and 63 and 76 percent for CA 242, respectively, which was higher than for any other method compared. CONCLUSIONS: With individual cutoff levels, both carcinoembryonic antigen and CA 242 had high sensitivity and acceptable specificity for indicating recurrent colorectal cancer. Because most (29/33) patients with recurrent disease identified within 3 years after surgery and all 8 with hepatic metastases identified during the sampling period were indicated by carcinoembryonic antigen with the individual cutoff, that method was established as the best for postoperative surveillance.     

肿瘤标志物CA242与CA19-9对胰腺癌的诊断价值

目的:比较血清肿瘤标志物CA242与CA19-9对胰腺癌的诊断价值。方法:1996年4月至1997年6月,北京医院对门诊及住院197例患者进行了血清CA19-9的检测,148例进行了CA242的检测,其中25例为临床明确诊断为胰腺癌,12例为急性胰腺炎,18例为良性阻塞性黄疸。结果显示:胰腺癌患者血清CA19-9和CA242较对照明显增高,其中25例胰腺癌患者有21例CA19-9阳性,检测的灵敏度为84％,特异性为74.4％,有17例CA242阳性,检测的灵敏度为68％,特异性为87.8％。CA242与CA19-9比较,灵敏度无显著差异(0.10相似文献   

Utility of 2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography in Managing Patients of Colorectal Cancer With Unexplained Carcinoembryonic Antigen Elevation at Different Levels

PURPOSE Serum carcinoembryonic antigen elevation without detectable relapse during colorectal cancer follow-up presents a challenge. This study was designed to evaluate the utility of fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography in colorectal cancer patients with unexplained carcinoembryonic antigen elevation at different levels. METHODS Thirty-seven colorectal cancer patients referred for positron emission tomography after primary surgery who had serum carcinoembryonic antigen levels >5 ng/ml and negative or equivocal conventional imaging studies were analyzed. Patient status was determined by histopathology and/or clinical follow-up. Grouping as disease-free, potentially resectable, or advanced disease was performed. The management impact was defined as the percentage of patients with a true-positive positron emission tomography result. RESULTS The sensitivity, specificity, and accuracy of positron emission tomography for relapse detection were 89, 89, and 89 percent, respectively. The management impact was 68 percent. In 24 patients with carcinoembryonic antigen levels <25 ng/ml, positron emission tomography helped correct patient grouping in 20 patients (83 percent), including 8 in the disease-free group, 5 in the potentially resectable group, and 7 in the advanced-disease group. In 13 patients with carcinoembryonic antigen levels >25 ng/ml, positron emission tomography identified 8 patients in the advanced-disease group and 1 patient in the potentially resectable group but missed 2 patients with relapse and undergrouped 2 patients in the advanced-disease group as potentially resectable. CONCLUSIONS 2-fluoro-2-deoxy-D-glucose positron emission tomography can help triage patients for appropriate management with unexplained carcinoembryonic antigen elevation <25 ng/ml. For patients with unexplained elevation of carcinoembryonic antigen >25 ng/ml, the utility of positron emission tomography is mainly to confirm the presence of advanced disease and occasionally to identify potentially resectable lesions. Supported by grants from the National Science Council - Taiwan (NSC 93-2314-B-182A-008).     

The Influence of Cholestasis on CA 50 and CA 242 in Pancreatic Cancer and Benign Biliopancreatic Diseases

The tumour markers CA 50 and CA 242 were determined in serum from 70 cholestatic patients–35 with pancreatic cancer and 35 with benign biliopancreatic diseases. Both markers correlated (r = 0.37) with serum bilirubin in all patients. When the patients were subdivided into groups, the only correlation apparent was between CA 50 and bilirubin in patients with benign diseases (r = 0.40). The serum concentrations of both markers were much higher in patients with pancreatic cancer. Serial sampling before and after decompression of the cholestasis showed reduction of CA 50 and CA 242 concurrently with bilirubin and alkaline phosphatases in nine patients with benign disease but unchanged levels in six cancer patients. When the two markers were compared, sensitivity was superior for CA 50 (94% versus 73%), whereas specificity was better for CA242 (65% versus 34%), as was positive prediction (76% versus 59%), whereas negative prediction was higher for CA 50 (86% versus 61%). Higher cut-off levels yielded better specificity for CA 50 but not for CA 242. Both markers indicate pancreatic cancer irrespective of cholestasis, but moderate elevations occur in some patients with benign disorders.     

结直肠癌患者血癌胚抗原mRNA检测的临床意义

背景:结直肠癌预后不佳,进一步研究结直肠癌患者肿瘤标记物的表达及其与肿瘤临床病理特征的关系对指导临床治疗具有重要意义.目的:检测结直肠癌患者的外周血癌胚抗原(CEA)、CEA mRNA以及肿瘤回流静脉血CEAmRNA,探讨血CEA mRNA检测在结直肠癌诊治中的临床意义.方法:以酶联免疫吸附测定(ELISA)检测71例结直肠癌患者的外周血清CEA,同时以巢式逆转录聚合酶链反应(RT-PCR)检测其外周血(71例)和肠系膜上静脉血(35例)CEA mRNA.分析血CEA和CEA mRNA的表达与结直肠癌临床病理特征的关系.结果:结直肠癌患者的外周血CEA mRNA阳性率为69.0%,显著低于肠系膜上静脉血的82.9%(P<0.05),外周血CEA阳性率(45.1%)显著低于CEA mRNA阳性率(P<0.01).Dukes C期和D期结直肠癌患者的外周血CEA和CEA mRNA阳性率显著高于A期和B期患者(P<0.05).Dukes D期肝转移患者肠系膜上静脉血CEA mRNA阳性率为85.7%(6/7).结论:检测外周血CEA mRNA有助于结直肠癌患者的预后判断,肿瘤回流静脉血CEA mRNA的检测对结直肠癌肝转移的诊断具有重要意义.     

Combined Measurement of Hepatocyte Growth Factor and Carcinoembryonic Antigen as a Prognostic Marker for Patients with Dukes A and B Colorectal Cancer: Results of a Five-Year Study

Purpose There is no marker capable of differentiating patients with Dukes A and B colorectal cancer with aggressive diseases from those with indolent diseases. We evaluated the results of five years of actuarial survival data to determine whether serial monitoring of serum hepatocyte growth factor could provide prognostic information on these patients. Methods Blood samples of 147 colorectal cancer patients were obtained and the serum concentration of hepatocyte growth factor was measured. Results Elevated serum hepatocyte growth factor levels were associated with stage progression. Although the overall positive rate of hepatocyte growth factor in the patients was the same as that of the carcinoembryonic antigen, the positive rate of hepatocyte growth factor in the Dukes A patients was two times higher than that of the carcinoembryonic antigen, and nearly 40 percent of the carcinoembryonic antigen-negative patients had a positive serum hepatocyte growth factor in the Dukes A and B classification. In this subgroup, patients with positive serum hepatocyte growth factor or carcinoembryonic antigen levels had a poorer prognosis, whereas positive serum hepatocyte growth factor level after surgery could predict disease recurrence. Conclusions A combination of serum hepatocyte growth factor and carcinoembryonic antigen tests might be useful for selecting patients with aggressive diseases in Dukes A and B classification.     

胰腺癌患者血清CA242定量测定及其意义

目的 探讨定量测定胰腺癌患者血清CA242的临床意义。方法 链亲和素-生物素双抗体夹心ELISA法定量测定83例健康人、28例胰腺癌、16例胰腺炎及68例其它肿瘤患者的血清CA242,并比较其在不同疾病间的差异。结果 血清CA242含量（U/ml）在83例正常人为7.34±5.09;28例胰腺癌为112.85±56.54;16例胰腺炎为8.91±4.58;68例其它肿瘤为23.10±39.89。该法测定胰腺癌患者血清CA242的灵敏度为85.7％,特异性为92.2％,阳性预示值为64.9％,阴性预示值为97.5％。结论血清CA242的定量测定是诊断胰腺癌的敏感而又特异的指标。     

Serum Carcinoembryonic Antigen in Relation to Survival,DNA Ploidy Pattern,and Recurrent Disease in 406 Colorectal Carcinoma Patients

Serum carcinoembryonic antigen (CEA) levels in relation to survival, flow cytometric DNA ploidy pattern, Dukes stage, and recurrent disease was prospectively evaluated in 406 patients with colorectal carcinoma. In 246 patients (61%) the carcinomas were DNA aneuploid. Increased preoperative CEA levels (>5 μg/l) were found in 151 of 363 evaluable patients (42%). Dukes stage-B patients with preoperative CEA elevation showed significantly poorer prognosis than those with normal CEA values (p = 0.001). A weak but significant correlation was found between preoperative CEA level and Dukes stage (Kendall's α = 0.25, p < 0.01). Of 50 evaluable patients with clinical recurrence and postoperative normal or normalized CEA levels, 28 (56%) had a rise in CEA before or at the time of clinical recurrence. The sensitivity of the CEA test for primary and for recurrent disease was not significantly different in the DNA aneuploid and the DNA near-diploid groups.     

Plasma Levels of Matrix Metalloproteinase-2 and Tissue Inhibitor of Metalloproteinase-1 Correlate With Disease Stage and Survival in Colorectal Cancer Patients

PURPOSE The matrix metalloproteinases and their inhibitors are known to be involved in the process of tumor invasion and progression. Our objective was to investigate the potential diagnostic and prognostic value of plasma matrix metalloproteinase-2 and -9 and tissue inhibitor of metalloproteinase-1 in colorectal cancer.METHODS Gelatinase bioactivity and immunoreactivity of pro-matrix metalloproteinase-2 and -9, tissue inhibitor of metalloproteinase-1, and carcinoembryonic antigen were determined simultaneously in preoperative plasma and serum of colorectal cancer patients (n = 94) and in healthy controls (n = 51).RESULTS Plasma pro-matrix metalloproteinase-2 levels were lower in colorectal cancer patients (P < 0.0001) than in controls, and its gelatinolytic activity revealed an inverse correlation with adverse clinicopathologic parameters, such as lymph node involvement (P = 0.017), stage (0, I, II vs. III, IV; P = 0.012), and the carcinoembryonic antigen level (P = 0.016). Pro-matrix metalloproteinase-9 levels did not differ between patients and controls. Pro-matrix metalloproteinase-2 gelatinolytic activity showed potential value in colorectal cancer diagnosis, identifying patients with 70 percent sensitivity at 95 percent specificity. Pro-matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and carcinoembryonic antigen all showed lower sensitivities. Combining pro-matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-1 measurements increased the sensitivity significantly to 84 percent. With respect to prognosis, tissue inhibitor of metalloproteinase-1 showed value in predicting disease outcome in our patient group, whereas pro-matrix metalloproteinase-2 and -9 did not. The combination of tissue inhibitor of metalloproteinase-1 and carcinoembryonic antigen was better in predicting three-year survival than tissue inhibitor of metalloproteinase-1 alone, but it remains to be determined if the combination would be a better marker for survival than carcinoembryonic antigen alone.CONCLUSIONS Low pro-matrix metalloproteinase-2 levels and high tissue inhibitor of metalloproteinase-1 levels correlate with parameters of colorectal cancer disease. These correlations may be used in the search for new markers in colorectal cancer diagnosis and prognosis.This work was supported by the Dutch Cancer Society (grant KUN 97-1380).     

Negative Serum Carcinoembryonic Antigen has Insufficient Accuracy for Excluding Recurrence from Patients with Dukes C Colorectal Cancer: Analysis with Likelihood Ratio and Posttest Probability in a Follow-Up Study

PURPOSE  This study was designed to determine the efficacy of carcinoembryonic antigen (CEA) monitoring for screening patients with colorectal cancer by using posttest probability of recurrence. METHODS  For this study, 348 (preoperative serum CEA level elevated: CEA+, n = 119; or normal: CEA−, n = 229) patients who had undergone potentially curative surgery for colorectal cancer were enrolled. After five-year follow-up with measurements of serum CEA levels and imaging workup, posttest probabilities of recurrence were calculated. RESULTS  Recurrence was observed in 39 percent of CEA+ patients and 30 percent in CEA− patients, and CEA levels were elevated in 33.3 percent of CEA+ patients and 17.5 percent of CEA− patients. With obtained sensitivity (68.4 percent, CEA+; 41 percent, CEA−), specificity (83 percent, CEA+; 91 percent, CEA−) and likelihood ratio (test positive: 4.0, CEA+; 4.4, CEA−; and test negative: 0.38, CEA+; 0.66, CEA−), posttest probability given the presence of CEA elevation in the CEA+ and CEA− was 72.2 and 65.5 percent, respectively, and that given the absence of CEA elevation was 20 and 22.2 percent, respectively. CONCLUSIONS  Whereas postoperative CEA elevation indicates recurrence with high probability, a normal postoperative CEA is not useful for excluding the probability of recurrence.     

肺癌患者外周血癌胚抗原、细胞角蛋白19mRNA水平与肿瘤分期、近期疗效及预后的关系

目的探讨肺癌患者治疗前后外周血癌胚抗原（CEA）、细胞角蛋向19（CKl9）mRNA的表达水平．及其与肿瘤分期、近期疗效、监测预后的关系。方法应用Taq Man定量逆转录-聚合酶链反应（RT-PCR）检测78例肺癌患者（鳞癌28例、腺癌40例、小细胞肺癌9例、大细胞肺癌1例）治疗前后、30例肺部良性疾病患者及30例健康对照者外周血癌胚抗原（CEA）、细胞角蛋白19（CK19）mRNA的水平；同时采用酶联免疫吸附测定法检测肺癌患者治疗前血清CEA和细胞角蛋白19片段（CYFRA21—1）水平。患者随访2年。结果肺癌患者外周血CEA、CK19mRNA阳性率分别为69．2％（54／78）、62．8％（49／78）．显著高于肺部良性疾病患者及健康对照者，3者差异有统计学意义（χ^2值分别为37．65、41．54；27．41、30．84，p〈0．01）。鳞癌组CK19mRNA阳性率最高，腺癌组CEAmRNA阳性率晟高。不同分期患者问CEA、CK19mRNA阳性率差异无统计学意义（χ^2值分别为3．63、3．81）。肺癌患者外周血CEA、CK19mRNA的阳性率显著高于血清CEA、CYFRA21—1水平；手术后CEA、CK19mRNA阳性率显著下降；化疗后阳性率下降不明显。化疗前CEAmRNA阳性患者的中位生存期明湿低于阴性患者（分别为8．5月、11．7月）、化疗前CK19mRNA阳性患者的中位生存期明显低于阴性患者（分别为8,9月、12．3月）：术前CEAmR—NA阳性患者肿瘤复发或转移率（29．4％）高于术前阴性患者（7．7％），术前CK19mRNA阳性患者肿瘤复发或转移率（18．8％）高于术前阴性患者（7．1％）。结论CEA、CK19mRNA对于检测肺癌患者肿瘤细胞微转移有一定的临床意义．有助于评估手术疗效及预测预后；CEA、CK19mRNA表达水平与肿瘤分期无关；CEA、CK19基因的检测敏感性优于蛋白水平的检测．可有助于肺癌的辅助诊断。     

胰腺癌患者血清中巨噬细胞因子-1、糖链抗原19-9、糖链抗原242及癌胚抗原的检测分析

目的 探讨血清巨噬细胞因子-1（MIC-1）、糖链抗原（CA）19-9 、CA242及癌胚抗原（CEA）在胰腺癌中的应用价值.方法 分析129例胰腺癌患者和120例健康体检者4项肿瘤标志物的检测结果,计算各肿瘤标志物组合方式对提高胰腺癌诊断的作用.结果 胰腺癌患者血清中各项肿瘤标志物的水平与对照组比较差异有统计学意义（P〈0.05）.MIC-1＋CA19-9组合的敏感性与单项检测敏感性最高的MIC-1比较,差异有统计学意义（P〈0.05）;MIC-1＋CA19-9组合的特异性与单项检测特异性最高的CA19-9比较,差异无统计学意义（P〉0.05）.Ⅲ~Ⅳ期胰腺癌患者血清CA19-9、CA242水平与Ⅰ~Ⅱ期比较,差异有统计学意义（P〈0.05）.结论 4项肿瘤标志物的检测对胰腺癌的诊断均有一定的价值,MIC-1＋CA19-9联合检测可提高诊断的敏感性,同时未降低其特异性.CA19-9、CA242对判断胰腺癌的预后有一定价值.     

Comparison of Characteristics and Survival of Colorectal Cancer Between Japanese-Americans in Hawaii and Native Japanese in Japan

Purpose This study was designed to investigate whether characteristics, prognostic risk factors, and survival of colorectal cancer of Japanese-Americans in Hawaii are different from those of native Japanese in Japan. Methods Aretrospective review of patients with colorectal cancer surgically resected in single institutions in Hawaii and Japan from 1996 to 2002. Results A total of 410 Japanese-American patients (218 males; median age, 73 years) and621 native Japanese patients (382 males; median age, 65 years) were included. There were significant differences in age (P < 0.001), age distribution (P < 0.001), gender (P= 0.008), preoperative carcinoembryonic antigen (P < 0.001), and anatomic site distribution (P < 0.001). The tumor characteristics of Japanese-American patients wereclose to the general American population compared with the Surveillance, Epidemiology, and End Results data. There were no differences in tumor size, histologic grade, each of T, N, M status and TNM stage between the two groups. The overall five-year survival rates (Japanese-Americans, 75.5 percent; native Japanese, 76.2 percent; P = 0.55) and survival rates in each of four stratified stages were similar. Risk factors associated with survival were not different, except for carcinoembryonic antigen (P = 0.036). Conclusions In patients with colorectal cancer in Japanese-Americans in Hawaii, some of tumor characteristics have changed from those of native Japanese inJapan. However, there are no remarkable differences in prognostic factors and survival between the two groups. The present study suggests that certain changes of colorectal cancer characteristics that were seen in Japanese-American may occur in native Japanese in Japan in the near future, although the survivaloutcome of colorectal cancer may remain the same. Read at the Clinical Congress of the American Collage of Surgeons, San Francisco, California, October 16 to 20, 2005.     

Survival Stratification Panel of Colorectal Carcinoma with Combined Expression of Carcinoembryonic Antigen,Matrix Metalloproteinases-2, and p27<Superscript>kip1</Superscript>

Purpose The prognosis varies greatly in colorectal carcinoma patients, even in the same stage. We examined the association between the expression of matrix metalloproteinases-2, carcinoembryonic antigen, p27^kip1, and clinicopathologic features in patients with colorectal carcinoma to identify a possible panel of tumor markers in predicting prognosis of colorectal carcinoma. Methods The expressions of three individual markers in 127 colorectal carcinoma cases were analyzed by immunohistochemistry method. Univariate and multivariate analysis were performed to analyze the expression with the disease-free survival time in colorectal carcinoma. Results High expression of matrix metalloproteinases-2, carcinoembryonic antigen, and low expression of p27^kip1 were related to poor prognosis in univariate analysis (P = 0.0002; P < 0.0001; P = 0.0008). The expression of matrix metalloproteinases-2, carcinoembryonic antigen, p27^kip1, and tumor differentiation were independent prognostic factors for disease-free survival by Cox regression analysis. The coexpression panel of matrix metalloproteinases-2, carcinoembryonic antigen, and p27^kip had significant prognostic value in all patients (P_AB = 0.0103; P_BC = 0.0068; P_CD = 0.0117). Multivariate analysis with Cox regression reveals that coexpression of matrix metalloproteinases-2, carcinoembryonic antigen, and p27^kip1 were independent prognostic factors as tumor differentiation in colorectal carcinoma. In different stages, coexpression tumor markers functioned in Stages II and III but not in the 19 cases of Stage I. The reason might be the number of patients was too small. Conclusions The results of this study provided further evidence that the combination of tumor markers of matrix metalloproteinases-2, carcinoembryonic antigen, and p27^kip1 was more informative than any single tumor marker alone for the disease-free survival stratification of colorectal carcinoma. Coexpression of matrix metalloproteinases-2, carcinoembryonic antigen, and p27^kip1 might be a useful survival stratification panel for clinical management. Supported by the Research fund of the Beijing Municipal Science & Technology Commission (Grant H020920030390); Beijing New Star Project on Science & Technology (Grant 2006B55). Poster presentation at Digestive Disease Week, Los Angeles, California, May 20 to 25, 2006.     

Synchronous Colorectal Neoplasms in Patients With Colorectal Cancer: Predisposing Individual and Familial Factors

PURPOSE: Patients with colorectal cancer have an increased risk for developing synchronous and metachronous neoplasms. However, besides those cases with inherited disorders predisposing to tumor multicentricity, it is unknown which patients are prone to this condition. This study was designed to identify individual and familial characteristics associated with the development of synchronous colorectal neoplasms in patients with colorectal cancer.METHODS: During a one-year period, all patients with colorectal cancer attended in 25 Spanish hospitals were included. Exclusion criteria were colorectal cancer developed in the context of familial adenomatous polyposis or inflammatory bowel disease, refusal to participate in the study, incomplete family history, and inadequate examination of the colon and rectum. In addition to demographic, clinical, pathology, molecular (microsatellite instability status), and familial characteristics, presence of synchronous colorectal neoplasms (adenoma or carcinoma) were analyzed.RESULTS: A total of 1,522 patients were included in the study. Synchronous colorectal neoplasms were documented in 505 patients (33.2 percent): adenoma (n = 411), carcinoma (n = 27), or both (n = 67). Development of these lesions was associated with male gender (odds ratio, 1.94; 95 percent confidence interval, 1.43–2.65), personal history of colorectal adenoma (odds ratio, 3.39; 95 percent confidence interval, 1.58–7.31), proximal location of primary tumor (odds ratio, 1.40; 95 percent confidence interval, 1.02–1.94), tumor TNM Stage II (odds ratio, 1.31; 95 percent confidence interval, 1.15–4.66), mucinous carcinoma (odds ratio, 1.89; 95 percent confidence interval, 1.19–2.99), and family history of gastric cancer (odds ratio, 2.03; 95 percent confidence interval, 1.17–3.52).CONCLUSIONS: Based on individual and familial characteristics associated with synchronous colorectal neoplasms, it has been possible to identify a subgroup of patients with colorectal cancer prone to tumor multicentricity with potential implications on the delineation of preventive strategies.Supported by grants from the Fondo de Investigación Sanitaria (FIS 01/0104-01, 01/0104-02, and 01/0104-03), from the Instituto de Salud Carlos III (RC03/02 and RC03/10), and from Merck, Sharp and Dhome, Spain. Virgínia Piñol, M.D. received a research grant from the Institut dInvestigacions Biomèdiques August Pi i Sunyer (IDIBAPS).Presented at the meeting of the American Gastroenterological Association, Orlando, Florida, May 17 to 22, 2003.     

Multivariate analysis of a tissue CEA,TPA, and CA 19.9 quantitative study in colorectal cancer patients

Tissue CEA, TPA, and CA 19.9 concentrations from samples of surgical specimens were measured in 47 evaluable colorectal cancer patients (median follow-up, 20 months, 13 recurrences) and correlated with individual patient follow-up status. The quantitative method appeared to be sensitive, easily reproducible, and standardizable. The tissue marker concentration was analyzed by means of the multivariate discriminant analysis, to evaluate the risk of relapse in each patient; the tumor CEA (CEAT) showed the best discriminant capacity (P=.005). The relative Fisher function provided a reliable prognostic patient index, independently of other recognized prognostic factors (Dukes' stage and cellular differentiation grade). The Cox model showed a statistical significance analyzing the tumor (T) and healthy mucosa (M) CEA values (P=.001 andP=.006, respectively). The combination of these two variables allowed for identification of three classes of patients according to CEA T and M threshold values of 216 and 85 ng/mg of protein, respectively, and different disease-free curves were obtained for each group. The two-year disease-free rate was 81 percent for patients with low values of both CEA T and M, and 21.4 percent for the group with both values above these thresholds (P=.0008). In the third class (CEA T or M higher than the reported cut-off levels), the two-year disease-free rate was 65.9 percent. Read at the 32nd World Congress of Surgery, Sydney, Australia, September 20 to 26, 1987. Partially supported by C.N.R. Progetto Finalizzato Oncologia, grant no. 84.00849.44.     

胰腺癌患者血清CEMIP、CA19-9和CA242水平变化及其临床意义*

目的 研究胰腺癌患者血清CEMIP、CA19-9和CA242水平变化及其临床意义。方法 2013年4月～2016年8月我院诊治的92例胰腺癌患者、105例胰腺良性疾病患者和选择的83例健康人，采用ELISA法检测血清细胞迁移诱导透明质酸结合蛋白（CEMIP）水平，采用放射免疫法检测血清CA19-9和CA242水平。应用受试者工作特征曲线（ROC）下面积（AUC）评价各指标的诊断效能。采用Kaplan-Meier和Cox风险比例模型行生存分析。采用Logistic回归分析影响术后生存的因素。结果 胰腺癌患者血清CEMIP、CA19-9和CA242水平分别为0.7（0.4，1.0） ng/mL、180.1（89.1，230.3） U/mL和61.7（20.7，93.5）U/mL，均显著高于胰腺良性疾病患者和健康人，差异有统计学意义（P均<0.05）；应用血清CEMIP、CA19-9和CA242联合诊断胰腺癌的AUC为0.966，其诊断效能显著高于任一指标单独诊断；应用血清CEMIP、CA19-9和CA242水平预测胰腺癌患者根治术后1年生存的效能均较高；经Kaplan-Meier和Cox多因素分析，结果表明肿瘤分化程度、血管侵犯、术后化疗、血清CEMIP≥0.7 ng/mL、CA19-9≥90.3 U/mL和CA242≥32.8 U/mL均是影响胰腺癌患者根治术后生存的独立危险因素。结论 检测胰腺癌患者血清CEMIP、CA19-9和CA242水平可有助于对疾病的诊断和预后评估。     

The correlation of CA15.3 and TPS with tumor course in patients with metastatic breast cancer

Purpose: This study was performed to deter mine the correlation of CA15.3 and TPS with disease course in patients with metastatic breast cancer.Methods: Levels of CA15.3 and tissue polypeptide antigen using the M₃ monoclonal antibody (TPS) were determined in the serum of 60 patients with metastatic breast cancer. CA15.3 and TPS were measured at two assay times.Results: A change of more than 25% in the serum level of CA15.3 or TPS was highly correlated with tumor response. The association between response and change in marker levels was stronger for CA15.3 (P=0.0001) than for TPS (P=0.0005). Distinct mismatches between marker changes and the tumor response were observed for both CA15.3 and TPS.Conclusion: CA15.3 and TPS are useful in the determination of response to treatment. Because of observed disagreement, marker changes can only be regarded as indicative of disease course.Abbreviations TPA tissue polypeptide antigen - TPS marker using mAb against epitope M₃ of TPA