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.     

The prognostic significance of preoperative serum CA 19-9 in patients with resectable gastric carcinoma: comparison with CEA

BACKGROUND AND OBJECTIVES: In this study, the prognostic value of pre-operative serum levels of tumor markers CA 19-9 and carcinoembryonic antigen (CEA) in gastric carcinoma which has been a controversial matter was investigated. METHODS: Preoperative serum CA 19-9 (cut-off value 37 U/ml) and CEA (cut-off value 5 ng/ml) levels were measured in 168 patients with resectable gastric carcinoma. The correlation between tumor marker levels and clinicopathological features and overall survival was studied. RESULTS: CA 19-9 and CEA positivity rates were 31.5 and 17.8% respectively. In CA 19-9 positive patients, the ratio of males, tumors exceeding subserosa and advanced stage tumors (stages III and IV) was significantly higher (P = 0.052, P = 0.0005 and P= 0.029, respectively). A weak correlation was found with CA 19-9 positivity and tumor location; however, no correlation existed between CA 19-9 positivity and age, tumor size, histologic type, lymph node, hepatic and peritoneal metastasis. The proportion of tumors extending beyond subserosa and with lymph node metastasis was significantly higher in CEA positive patients (P = 0.011 and P = 0.045, respectively). No correlation was found between CEA positivity and gender, age, tumor location, tumor size, and hepatic and peritoneal metastasis; however, a weak correlation existed between CEA positivity and histologic type and tumor stage. Overall survival was significantly poorer in CA 19-9 and CEA positive patients (log-rank test, P = 0.014, P = 0.003, respectively). However, the Cox proportional hazards regression analysis did not show independent prognostic value for both tumor markers. CONCLUSIONS: In resectable gastric carcinoma, preoperative serum CA 19-9 and CEA levels may indicate stage of the disease, but neither has an independent prognostic value.     

Comparison of a new tumour marker CA 242 with CA 19-9, CA 50 and carcinoembryonic antigen (CEA) in digestive tract diseases

The levels of CA 242, a new tumour marker of carbohydrate nature, were measured in sera of 185 patients with malignancies of the digestive tract and of 123 patients with benign digestive tract diseases. High percentages of elevated CA 242 levels (greater than 20 U ml-1) were recorded in patients with pancreatic and biliary cancers (68%). The sensitivity was somewhat lower than that of CA 19-9 (76%) and CA 50 (73%). On the other hand, in benign pancreatic and biliary tract diseases the CA 242 level was less frequently elevated than the CA 19-9 and CA 50 levels. The serum CA 242 concentration was increased in 55% of patients with colorectal cancer. CA 242 detected more Dukes A-B carcinomas (47%) than CEA (32%), whereas CEA was more often elevated (71% vs 59%) in Dukes C-D carcinomas. CA 242 was slightly elevated (ad 41 U ml-1) in 10% of patients with benign colorectal diseases. CA 50 and CA 19-9 had lower sensitivities than CA 242 using the recommended cut-off values. When cut-off levels based on relevant benign colorectal diseases were used, the sensitivities of these markers were similar and somewhat higher than that of CEA. Less than half of patients with gastric cancer (44%) had an elevated CA 242 serum level. CA 242 is a promising new tumour marker, that may be of additional value in the diagnosis of pancreatic and biliary, as well as colorectal cancer, and may be useful in monitoring cancer patients after radical surgery.     

Comparison of CA 19-9 and carcinoembryonic antigen (CEA) levels in the serum of patients with colorectal diseases

The serum levels of CA 19-9 and carcinoembryonic antigen (CEA) were determined in 37 patients with benign colorectal diseases and in 111 patients with newly discovered colorectal carcinomas or clinically verified relapses. In cancer patients, the CA 19-9 level ranged from normal (0-37 U ml-1) to 77,500 U ml-1 whereas all samples but one from patients with benign colorectal diseases had a normal value. CA 19-9 was increased in 46% and 45% of patients with an advanced (Dukes C or D) carcinoma or a verified recidive, respectively. Only one out of 26 patients (4%) with a localized (Dukes A or B) carcinoma displayed an elevated CA 19-9 level (greater than 37 U ml-1). No clear correlation was found between the CA 19-9 and CEA levels. The sensitivity of the CA 19-9 test (36%) was poorer than that of the CEA assay (69%), but the new test was markedly more specific (97% vs 70%) than the CEA assay.     

血清糖类抗原及癌胚抗原联合检测在恶性肿瘤诊断中的价值

目的探讨血清糖类抗原及癌胚抗原(CEA)联合检测在恶性肿瘤诊断中的价值,以期为恶性肿瘤的早期诊断提供更可靠的依据。方法选取毕节市中医院2010年3月至2014年3月间收治的恶性肿瘤患者90例,其中直肠癌患者30例,肝癌30例,胰腺癌30例,并选择同期健康体检者40例作为对照,分析癌胚抗原(CEA)以及血清糖类抗原(CA125、CA19-9)在各人群、各类型肿瘤中表达情况。结果在恶性肿瘤患者中,CEA、CA125、CA19-9表达升高的比例显著高于健康体检者,差异有统计学意义(P<0.05);各类型肿瘤中,直肠癌中CEA升高明显高于胰腺癌和肝癌,差异有统计学意义(P<0.05);胰腺癌中CA125、CA19-9升高率明显高于肝癌和直肠癌,差异有统计学意义(P<0.05);CEA、CA125、CA19-9联合检测率直肠癌为96.7%、肝癌为90.0%、胰腺癌为93.3%,明显高于各组的单项检测率,三项联合检测率与单个检查率相比,差异具有统计学意义(P<0.05)。结论联合检测肿瘤标志物CEA、CA125、CA19-9可显著提高胰腺癌、肝癌、直肠癌等恶性肿瘤诊断的敏感性,为临床治疗提供依据。     

Combined Detection of CEA,CA 19-9, CA 242 and CA 50 in the Diagnosis and Prognosis of Resectable Gastric Cancer

Our aim was to investigate the value of combined detection of serum  carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, CA 242 and CA 50 in diagnosis and assessment of prognosis in consecutive gastric cancer patients. Clinical data including preoperative serum CEA, CA 19-9, CA 242, and CA 50 values and information on clinical pathological factors were collected and analyzed retrospectively. Univariate and multivariate survival analyses were used to explore the relationship between tumor markers and survival. Positive rates of tumor markers CEA, CA 19-9, CA 242 and CA 50 in the diagnosis of gastric cancer were 17.7, 17.1, 20.4 and 13.8%, respectively, and the positive rate for all four markers combined was 36.6%. Patients with elevated preoperative serum concentrations of CEA, CA 19-9, CA 242 and CA 50, had late clinical tumor stageand significantly poorer overall survival. Five-year survival rates in patients with elevated CEA, CA 19-9, CA 242 and CA 50 were 28.1, 25.8, 27.0 and 24.1%, respectively, compared with 55.0, 55.4, 56.4 and 54.5% in patients with these markers at normal levels (p<0.01). In multivariate Cox proportional hazards analyses, an elevated CA 242 level was determined to be an independent prognostic marker in gastric cancer patients. Combined detection of four tumor markers increased the positive rate for gastric cancer diagnosis. CA 242 showed higher diagnostic value and CA 50 showed lower diagnostic value. In resectable gastric carcinoma, preoperative CA 242 level was associated with disease stage, and was found to be a significant independent prognostic marker in gastric cancer patients.     

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.     

Comparison of Serum Assays for TAG-72, CA19-9 and CEA in Gastrointestinal Carcinoma Patients

Tumor-associated glycoprotein (TAG-72) has been shown to beexpressed in a wide variety of epithelial malignant tissues.We have investigated serum levles of TAG-72 antigen in patientswith gastrointestinal cancer with a solid phase radioimmunometricassay (RIA), CA72-4, utiliz ing murine monoclonal antibodiesCC49 and B72.3 which recognize the TAG-72 antigen. Elevatedlevels of serum TAG-72 antigen were found in 48% of 56 gastriccarcinoma patients and 67% of 45 colorectal carcinoma patients.The serum concentrations of TAG-72 were compared to those ofCA19-9 and CEA. The positive rates of CA19-9 in gastric carcinomaand colorectal carcinoma patients were 29% and 54%, and thoseof CEA were 52% and 60%, respectively. Elevated serum levelsof TAG-72, CA19-9 and CEA were observed in 7%, 14% and 24%,respectively, of patients with benign disease, thus indicatinga preferential expression of TAG-72, compared to CA19-9 andCEA, in gastrointestinal carcinoma patients versus in patientswith benign disorder. A cocktail of CA72-4, CA19-9 and CEA RIAsincreased positive rates to 68% in sera of gastric cancer patientsand 84% in sera of colorectal cancer patients. Combination assays using CA72-4, CEA and CA19-9 RIM for patients with benigngastrointestinal disorder, however, also increased the positiverate to 31%. These results indicate that CA72-4, CA19-9 andCEA RIA may be complementary in detecting circulating tumor-associatedantigens. It must be emphasized, however, that interpretationof the data provided by the combination serum as says requirescareful consideration.     

CA 19-9 and carcinoembryonic antigen in pancreatic cancer diagnosis

CA 19-9 (Centocor, Malvern, PA) and carcinoembryonic antigen (CEA), two recently developed immunoradiometric assays utilizing monoclonal antibodies, were evaluated in the sera of 139 subjects in order to assay their individual and combined value in pancreatic cancer diagnosis and to assess the influence of jaundice. Sensitivity, specificity, and accuracy in detecting pancreatic cancer were 69%, 85%, and 54% for CA 19-9; and 28%, 78%, and 6% for CEA, respectively. Combined evaluation gave the highest specificity (95%) when both, and the highest sensitivity (79%) when at least one, gave pathologic results. The receiver-operating characteristic curves demonstrated that CA 19-9 is more discriminating than CEA, for any serum value. A correlation between serum bilirubin and CA 19-9 was demonstrated in pancreatic and extrapancreatic disease. CEA determination, performed using monoclonal antibodies, seems to be unsatisfactory as compared to CA 19-9 in pancreatic cancer diagnosis, and combined assessment does not improve the results of CA 19-9 alone. Jaundice may influence serum CA 19-9 in pancreatic and extrapancreatic diseases.     

联合检测术前与术后CEA CA19-9 CA72-4对不同分期胃癌根治术后复发的预测价值

  目的   探讨联合检测术前、术后CEA、CA19-9、CA72-4等肿瘤标志物对不同分期胃癌根治术后复发的预测价值。   方法   回顾性分析北京大学肿瘤医院2002年1月至2007年3月收治的564例胃癌患者的临床资料及血清肿瘤标志物情况。所有患者均未行新辅助治疗,术前、术后均联合检测CEA、CA19-9、CA72-4等肿瘤标志物。分析CEA、CA19-9、CA72-4等肿瘤标志物与胃癌复发的关系。   结果   在Ⅰ、Ⅱ期胃癌患者中,CEA、CA19-9、CA72-4术前阳性的患者术后复发率分别为50.0%、24.1%、22.6%,而术后阳性的患者复发率分别为42.9%、21.7%、14.3%。在Ⅲ期胃癌患者中,CEA、CA19-9、CA72-4术前阳性的患者术后复发率分别为50.0%、55.2%、47.6%,而术后阳性的患者术后复发率分别为75.0%、66.7%、66.7%。多因素分析表明术前CEA增高是Ⅰ、Ⅱ期胃癌复发的独立影响因素,术后CA72-4增高是Ⅲ期胃癌复发的独立影响因素。   结论   对于Ⅰ、Ⅱ期胃癌,术前CEA水平是预测复发较好的因子;对于Ⅲ期胃癌,术后CA72-4水平的预测性较好。      

多肿瘤标志物蛋白芯片中CA19-9表达水平升高对恶性肿瘤的诊断价值

目的探讨多肿瘤标志物蛋白芯片中糖链抗原CA19-9水平升高的临床诊断意义。方法收集可供分析的25 076例多肿瘤蛋白芯片检测结果,分析CA19-9水平在各人群、各肿瘤组织中升高情况。结果恶性肿瘤患者CA19-9水平升高发生率明显高于良性病变患者及正常体检者,且胰腺癌发生率最高(62.04%),其次为肝癌(44.25%)、胃癌(26.40%)、结直肠癌(26.32%);CA19-9伴随升高的指标以CA242最为常见,其次为CEA、CA125;CA19-9/CA242、CA19-9/CEA伴随升高最常见于结直肠癌(90.00%,86.45%);CA19-9/CA125伴随升高最常见于肺癌(71.66%)。CA19-9+CA242+CA125联合升高最常见于胰腺癌(54.91%);CA19-9+CA242+CEA联合升高最常见于结直肠癌(81.61%);CA19-9+AFP+CA125联合升高最常见于肝癌(32.14%);CA19-9+CEA+CA125联合升高最常见于肺癌(55.56%)。结论 CA19-9在恶性肿瘤中广泛表达,但并非恶性肿瘤的特异性指标。CA19-9单项指标升高对消化系统肿瘤具有较高的诊断价值,尤其对胰腺癌,而CA19-9伴随CA125、CA19-9、CA242水平升高,有助于提高各肿瘤诊断阳性率,降低误诊率。     

Initial clinical evaluation of an immunoradiometric assay for CA 19-9 using the NCI serum bank

More than 1,600 coded sera obtained from blood donors and the NCI/Mayo Clinic Serum Bank were analyzed with an improved immunoradiometric assay for the carbohydrate antigenic determinant, CA 19-9. Results indicated that CA 19-9 is elevated in a large fraction of sera (67%) from patients with advanced adenocarcinomas of the upper gastrointestinal (GI) tract, including those with pancreatic, hepatobiliary and gastric carcinomas. Several of these sera had CA 19-9 exceeding 300,000 U/ml. A smaller fraction (18%) of patients with carcinomas of the large bowel had elevated serum CA 19-9 levels, the majority among patients with metastatic disease. In contrast, none of the healthy donors from the serum bank and only 4 of 1,023 of the blood donor specimens (0.4%) had CA 19-9 levels greater than or equal to 40 U/ml. Three of 235 sera (1.3%) from benign disease patients had levels of CA 19-9 in excess of 40 U/ml. These data suggest that the improved CA 19-9 immunoradiometric assay may have clinical utility as a diagnostic adjunct for adenocarcinoma of the upper GI tract and that the assay also may have some value in monitoring patients with advancing colorectal carcinoma, particularly in combination with CEA determinations. Rigorous prospective clinical trials will be necessary to verify these hypotheses.     

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。     

Carcinoembryonic antigen and carbohydrate 19-9 antigen as markers for colorectal carcinoma in children and adolescents.

Colorectal cancer is rare in patients younger than 20 years of age (incidence, 1 in 10 million). Although carcinoembryonic antigen (CEA) and carbohydrate 19-9 antigen (CA 19-9) have been used widely as markers for the efficacy of therapy or detection of recurrent colorectal carcinomas in adults, no studies evaluating their efficacy in children and adolescents have been performed. Between 1986 and 1989, serial measurements of serum CEA and CA 19-9 levels were obtained from 11 patients (aged 8 to 18 years) treated at the institution of the authors. In contrast to the experience in adults, most (9 of 11) of the tumors were localized in the right or transverse colon. Histologically, 10 of 11 carcinomas were mucinous. Most patients had either Dukes' C (5 of 11) or D (5 of 11) lesions. After surgery, all patients were treated with a combination of 5-fluorouracil with Leucovorin (Lederle Laboratories, Pearl River, NY). With the use of the adult normal standards (CEA less than 3.0 ng/ml and CA 19-9 less than 37 ng/ml)6 for the patients, the specificity and sensitivity of CEA were 77% and 64%, respectively, whereas the specificity of CA 19-9 was 79% and the sensitivity was significantly low (10%). The combined specificity of the two markers was 71%, and the combined sensitivity was 60%. On the basis of these results, the authors believe that CEA and CA 19-9 are not effective markers for detection of recurrent or progressive colorectal carcinomas in children and adolescents.     

CA 19-9 and pancreatic adenocarcinoma

The diagnostic place value of CA 19-9, a tumor-associated antigen, was tested in 611 patients. This group of patients included 273 patients who suffered from a malignant disease (48 patients with pancreatic carcinomas and 225 patients with extrapancreatic malignant growths) and 338 patients with benign diseases (66 patients with chronic pancreatitis, 36 patients with acute pancreatitis, and 236 patients with general surgical diseases). In 93% of the patients with pancreatic carcinoma (media value, 528 U/ml), in 37% and 19% of the patients with carcinoma of the stomach and colorectal carcinomas (median value 8 U/ml), respectively, the CA 19-9 value was estimated as being above the normal limits of 6 to 37 U/ml. A sensitivity of 93% and a specificity of 85%, as well as a total accuracy of 82%, were established in pancreatic carcinoma during preoperative observation. The preoperatively raised CA 19-9 concentration in patients with pancreatic carcinomas dropped after curative resection of the carcinoma to within normal limits. However, a serum concentration of less than 37 U/ml was not recorded in any CA 19-9 estimation after a palliative surgical intervention, or in any case of inoperable carcinomas.     

血清CEA、CA19-9、CA724检测对老年胃癌病理、临床分期的意义

目的:探讨血清CEA、CA19-9、CA724对老年胃癌的临床应用价值.方法:采用ELISA方法对87例老年胃癌患者进行回顾性分析.结果:老年胃癌患者CEA、CA19-9、CA724阳性率分别为25%、21%、21%,联合检测阳性率为41%,其中TNM Ⅳ期患者CA19-9、CA724、联合检测阳性率明显高于TNM Ⅰ+Ⅱ期患者.TNM Ⅲ+Ⅳ期患者CA19-9、CA724检测值明显高于Ⅰ+Ⅱ期患者.CEA、CA19-9、CA724阳性率、其值大小与胃癌病理类型、分化无关.结论:CEA、CA19-9、CA724可用于老年胃癌的诊断、病情判断,联合检测可提高诊断效率,但早期诊断价值有限.     

血清CA125、CA19-9、CEA的检测在大肠癌诊断及治疗中的意义

目的探讨血清CA125、CA199、CEA的检测在大肠癌诊断及治疗中的价值。方法82例大肠癌病人均于2004年6月～2005年6月收治并手术,同时选取41例正常人做为对照组。以蛋白芯片法测定两组血清中CA125、CA199、CEA含量。结果三项指标定量检测大肠癌组明显高于对照组。其阳性率与部位、大体类型、组织类型无明显相关。三项指标阳性率Duke'sC+D期明显高于Duke'sA+B期。CA125、CA199、CEA三项指标敏感度分别为34.1%、34.1%、30.5%,特异度均为97.6%,三项联检敏感度为58.5%,特异度为92.7%,而在Duke'sC+D期,三项联检敏感度为86.8%,特异度为92.7%。结论血清CA125、CA199、CEA的检测对于大肠癌的诊断价值较低,但三项联检在Duke'sC、D期大肠癌病人诊断价值较高,有助于判断大肠癌病理分期并指导手术范围。     

Significance of serum and tissue carcinoembryonic antigen for the prognosis of gastric carcinoma patients

BACKGROUND AND OBJECTIVES: Carcinoembryonic antigen (CEA) has been widely accepted as a tumor marker useful in the diagnosis and management of colorectal carcinoma. When CEA levels are positive in patients with gastric carcinoma, they could be useful prognostic indicators. The value of CEA as a tumor marker for gastric carcinoma, however, remains a matter of controversy. The purpose of this study was to determine whether preoperative serum CEA value and tissue CEA staining are useful prognostic indicators for gastric carcinoma. METHODS: We measured preoperative serum CEA levels by radioimmunoassay and stained tissue CEA production by tumor cells from gastric carcinomas using immunohistochemical staining in patients with gastric carcinoma. RESULTS: The patients with preoperative serum CEA levels >10.0 ng/mL had a more prominent serosal invasion, much more lymph node involvement, more advanced stage and more poorly differentiated than did the patients with preoperative serum CEA levels <5.0 ng/mL. The survival rate of patients with serum CEA levels >10.0 ng/mL was poorer than those of patients with serum CEA levels between 5.0 and 10.0 ng/mL, and those of patients with serum CEA levels <5.0 ng/mL (P < 0.05). The preoperative serum CEA levels and tumor CEA-positivity were correlated (P < 0.05). In patients with lymph node metastases, the CEA-positivity (78.0%) was higher than in patients without lymph node metastasis (63.2%) (P < 0.05). A correlation was also found between the depth of tumor invasion and tissue CEA-positivity (P < 0.001). The postoperative survival rate was significantly better in the CEA-negative staining group (78.0%) than in the CEA-positive staining group (60.0%). CONCLUSIONS: These data suggest that preoperative serum CEA levels and staining for CEA in gastric carcinoma tissue sections may have a predictive value in determining prognostic information for patients with resectable gastric carcinoma.     

CA 72-4 measurement of tumor-associated glycoprotein 72 (TAG-72) as a serum marker in the management of gastric carcinoma.

The presence of three distinct serum markers of carcinoma, tumor-associated glycoprotein 72 (TAG-72; as measured by the CA 72-4 assay), CA 19-9, and carcinoembryonic antigen (CEA), was evaluated in 194 patients diagnosed with either malignant (n = 94) or benign (n = 100) gastric disease. Of the 94 patients diagnosed with gastric carcinoma, the percentage of patients whose serum samples were positive for TAG-72, CA 19-9, or CEA was 42.6, 31.9, and 20.2%, respectively. Furthermore, fewer false positive samples were observed for TAG-72 than either CA 19-9 or CEA. The analysis of serum TAG-72, CA 19-9, and CEA levels in patients diagnosed with early (stage I and II) versus advanced (stage III and IV) disease revealed a significantly higher level of TAG-72 and CA 19-9 in the serum of patients with advanced stage gastric carcinoma. The serum samples were also analyzed to determine whether any advantage might be gained by simultaneously measuring two or more of the tumor markers. The data clearly indicate that the measurement of TAG-72 with CA 19-9 significantly increased the percentage of gastric carcinoma patients with positive serum levels of either antigen. This advantage was achieved with no significant increase in the number of false positives. Twenty-one patients were followed postsurgically for up to 3 years to determine whether the appearance or reappearance of TAG-72, CA 19-9, or CEA accurately predicted disease recurrence. Positive serum TAG-72 levels correlated with disease recurrence in 7 of 10 patients, compared with 5 and 2 patients for CA 19-9 and CEA, respectively. The findings suggest that serum TAG-72 as measured by the CA 72-4 assay may be a useful marker for late stage gastric carcinoma and its measurement alone or in combination with CA 19-9 may have utility in the clinical management of gastric carcinoma.