Combining prognostic value of serum carbohydrate antigen 19-9 and tumor size reduction ratio in pancreatic ductal adenocarcinoma

BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a common cancer with increasing morbidity and mortality due to changes of social environment.AIM To evaluate the significance of serum carbohydrate antigen 19-9(CA19-9)and tumor size changes pre-and post-neoadjuvant therapy(NAT).METHODS This retrospective study was conducted at the Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment,Chongqing University Cancer Hospital.This study specifically assessed CA19-9 levels and tumor size before and after NAT.RESULTS A total of 156 patients who completed NAT and subsequently underwent tumor resection were included in this study.The average age was 65.4±10.6 years and 72(46.2%)patients were female.Before survival analysis,we defined the post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level as the CA19-9 ratio(CR).The patients were divided into three groups:CR<0.5,CR>0.5 and<1 and CR>1.With regard to tumor size measured by both computed tomography and magnetic resonance imaging,we defined the post-NAT tumor size/pre-NAT tumor size as the tumor size ratio(TR).The patients were then divided into three groups:TR<0.5,TR>0.5 and<1 and TR>1.Based on these groups divided according to CR and TR,we performed both overall survival(OS)and disease-free survival(DFS)analyses.Log-rank tests showed that both OS and DFS were significantly different among the groups according to CR and TR(P<0.05).CR and TR after NAT were associated with increased odds of achieving a complete or near-complete pathologic response.Moreover,CR(hazard ratio:1.721,95%CI:1.373-3.762;P=0.006),and TR(hazard ratio:1.435,95%CI:1.275-4.363;P=0.014)were identified as independent factors associated with OS.CONCLUSION This study demonstrated that post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level and post-NAT tumor size/pre-NAT tumor size were independent factors associated with OS in patients with PDAC who received NAT and subsequent surgical resection.

High level of preoperative carbohydrate antigen 19-9 is a poor survival predictor in gastric cancer

AIM:To assess the clinical significance and the prognostic value of preoperative serum carbohydrate antigen 19-9(CA 19-9)level in gastric cancer.METHODS:Between January 2005 and December2006,1960 patients underwent surgery for histologically confirmed gastric cancer.Of these,163 patients had elevated serum levels of CA 19-9 preoperatively,and1628 patients had normal serum levels of CA 19-9 preoperatively.For this study,325 patients were selected from the group of 1628 patients by age,sex,and cancer stage to serve as controls.Statistically significant differences in survival rates were calculated using the log-rank test.A P value less than 0.05 was considered statistically significant and was determined using SAS software.RESULTS:The baseline characteristics showed some differences between the two groups with regard to histology.Overall survival(OS)in the elevated and nonelevated group was 37.90 and 68.67 mo,respectively(P<0.001).N stage(P=0.001)was a significant predictor of disease-free survival by multivariate analysis.Also,N stage(P<0.001),and the presence of peritoneal metastasis(P<0.001)remained independent factors in predicting OS by multivariate analysis.Additionally,preoperative serum CA 19-9 levels were significantly associated with OS in univariate(P=0.009)and multivariate(P=0.021)analyses.CONCLUSION:Serum CA 19-9 can be considered an independent prognostic factor in predicting OS in patients anticipating surgery for gastric cancer.

Detection of pancreatic cancer with normal carbohydrate antigen 19-9 using protein chip technology

AIM:To develop a method to differentiate pancreatic cancer patients from healthy or benign individuals when carbohydrate antigen(CA)19-9 is normal.METHODS:Forty-one serum samples from patients with pancreatic lesions and blood samples from 20 healthy individuals were collected at the first stage of the experiment according to the enrolment criteria.General characteristics and some clinical features were carefully compared to ensure that the results were reasonable.All the blood samples were analyzed by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry(SELDI-TOF-MS)combined with CM10 chips and a related bioinformatics analysis program to generate diagnostic models with different proteins.Forty-seven consecutive samples were tested at the next stage to verify the veracity and efficiency of the models.RESULTS:The sex,age,and serum CA19-9 levels among the three groups(malignant,benign,and healthy)were statistically matched(P values were 0.957,0.145,and 0.382,respectively).Two patterns were generated.Pattern 1 with four proteins theoretically had a specificity and sensitivity of 100%in distinguishing pancreatic cancer from healthy individuals,while it was 86.7%and86.4%,respectively,in the subsequent practical verification.The positive predictive value(PPV)of the model was86.4%.One of the four proteins was expressed highly in pancreatic cancer while the other three were expressed weakly.Pattern 2 consisted of six proteins that showed a specificity of 70.0%and sensitivity of 77.3%for differentiating malignancy from benign tumors.Its PPV reached85.0%.Only one of these six proteins showed high expression in the malignant group.CONCLUSION:SELDI-TOF-MS may facilitate diagnosis or differential diagnosis of pancreatic cancer when CA19-9 is normal.Pattern 1 may serve as a useful screening tool.

Carbohydrate antigen 19-9 — tumor marker: Past, present, andfuture

Carbohydrate antigen 19-9 (CA 19-9) is a cell surface glycoprotein complex mostcommonly associated with pancreatic ductal adenocarcinoma (PDAC). Koprowskifirst described it in 1979 using a mouse monoclonal antibody in a colorectalcarcinoma cell line. Historically, it is one of the most commonly used tumormarkers for diagnosing, managing, and prognosticating PDAC. Additionally,elevated CA 19-9 levels are used as an indication for surgery in suspected benignpancreatic conditions. Another common application of CA 19-9 in the biliary tractincludes its use as an adjunct in diagnosing cholangiocarcinoma. However, itsclinical value is not limited to the hepatopancreatobiliary system. The reality isthat the advancing literature has broadened the clinical value of CA 19-9. Thepotential value of CA 19-9 in patients' workup extends its reach to gastrointestinalcancers – such as colorectal and oesophageal cancer – and further beyond thegastrointestinal tract - including urological, gynecological, pulmonary, andthyroid pathologies. Apart from its role in investigations, CA 19-9 presents apotential therapeutic target in PDAC and acute pancreatitis. In a bid toconsolidate its broad utility, we appraised and reviewed the biomarker’s currentutility and limitations in investigations and management, while discussing thepotential applications for CA 19-9 in the works for the future.

Carbohydrate antigen 19-9 as a novel prognostic biomarker in distal cholangiocarcinoma

BACKGROUND Distal cholangiocarcinoma(DCC)presents as one of the relatively rare malignant tumors in the digestive system and has a poor long-term prognosis.Curative resection is currently the most appropriate therapy for patients with DCC because of the lack of effective adjuvant therapies.Therefore,it is important to accurately predict the prognosis for formulating a reasonable treatment plan and avoiding unnecessary surgical trauma.AIM To minimize the interference of obstructive jaundice on carbohydrate antigen 19-9(CA19-9)level by adapting CA19-9 toγ-glutamyltransferase(GGT)as an indicator,to determine the strong associations between CA19-9/GGT and postoperative neoplasm recurrence and long-term outcome of DCC.METHODS We enrolled 186 patients who were diagnosed with DCC between January 2010 and December 2019 and performed radical excision with strict criteria as follows in our hospital.Receiver operating characteristic curves were drawn according to preoperative CA19-9/GGT and 1-year survival.Based on this,patients were divided into two groups(group 1,low-ratio,n=81;group 2,high-ratio,n=105).Afterwards,by the way of univariate and multivariate analysis,the risk factors influencing postoperative tumor recrudesce and long-term prognosis of patients with DCC were screened out.RESULTS Optimum cut-off value of CA19-9/GGT was 0.12.Patients in group 2 represented higher CA19-9 and lymphatic metastasis rate accompanied by lower GGT,when compared with group 1(P<0.05).The 1-,3-and 5-year overall survival rates of patients in groups 1 and 2 were 88.3%,59.2%and 48.1%,and 61.0%,13.6%and 13.6%,respectively(P=0.000).Multivariate analysis indicated that CA19-9/GGT,lymphatic metastasis and tumor differentiation were independent risk factors for tumor recurrence and long-term prognosis of DCC.CONCLUSION Elevation of CA19-9/GGT performed better as a biomarker of aggressive carcinoma and predictor of poor clinical outcomes by reducing the effect of obstruction of biliary tract on CA19-9 concentration in patients with DCC.

Clinical characteristics and outcomes in carbohydrate antigen 19-9 negative pancreatic cancer

BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a leading cause of death from cancer worldwide.Tumor markers like carbohydrate antigen 19-9(CA 19-9)have been proven valuable as a diagnostic tool and a predictor for tumor staging and response to therapy.AIM To delineate the phenotype of normal CA 19-9 PDAC according to clinical features,disease staging and prognosis as compared with high CA 19-9 PDAC cases.METHODS We performed a retrospective single-center analysis of all PDAC cases admitted in our Gastroenterology department over a period of 30 mo that were diagnosed by endoscopic ultrasound-guided tissue acquisition.Patients were divided into two groups according to CA 19-9 levels over a threshold of 37 U/mL.We performed a comparison between the two groups with regard to demographic and clinical data,biomarkers,tumor staging and 6-mo survival.RESULTS Altogether 111 patients were recruited with 29 having documented normal CA 19-9(<37 U/mL).In the CA 19-9 negative group of patients,20.68%had elevated levels of both CEA and CA 125,13.79%for CA 125 only whilst 17.24%for CEA only.The two groups had similar demographic characteristics.Abdominal pain was more frequently reported in positive vs negative CA 19-9 PDAC cases(76.83%vs 55.17%),while smoking was slightly more prevalent in the latter group(28.04%vs 31.03%).Tumors over 2 cm were more frequently seen in the positive CA 19-9 group,reflecting a higher proportion of locally advanced and metastatic neoplasia(87.7%vs 79.3%).Sixmonth survival was higher for the negative CA 19-9 group(58.62%vs 47.56%).CONCLUSION Elevated CA 19-9 at diagnosis seems to be associated with a more pronounced symptomatology,high tumor burden and poor prognosis compared to negative CA 19-9 PDAC cases.CEA and CA 125 can be adjunctive useful markers for PDAC,especially in CA 19-9 negative cases.

Preoperative serum carbohydrate antigen 19-9 levels predict early recurrence after the resection of early-stage pancreatic ductal adenocarcinoma

BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a serious disease with a poor prognosis.Only a minority of patients undergo surgery due to the advanced stage of the disease,and patients with early-stage disease,who are expected to have a better prognosis,often experience recurrence.Thus,it is important to identify the risk factors for early recurrence and to develop an adequate treatment plan.AIM To evaluate the predictive factors associated with the early recurrence of earlystage PDAC.METHODS This study enrolled 407 patients with stage I PDAC undergoing upfront surgical resection between January 2000 and April 2016.Early recurrence was defined as a diagnosis of recurrence within 6 mo of surgery.The optimal cutoff values were determined by receiver operating characteristic(ROC)analyses.Univariate and multivariate analyses were performed to identify the risk factors for early recurrence.RESULTS Of the 407 patients,98 patients(24.1%)experienced early disease recurrence:26(26.5%)local and 72(73.5%)distant sites.In total,253(62.2%)patients received adjuvant chemotherapy.On ROC curve analysis,the optimal cutoff values for early recurrence were 70 U/mL and 2.85 cm for carbohydrate antigen 19-9(CA 19-9)levels and tumor size,respectively.Of the 181 patients with CA 19-9 level>70 U/mL,59(32.6%)had early recurrence,compared to 39(17.4%)of 226 patients with CA 19-9 level≤70 U/mL(P<0.001).Multivariate analysis revealed that CA 19-9 level>70 U/mL(P=0.006),tumor size>2.85 cm(P=0.004),poor differentiation(P=0.008),and non-adjuvant chemotherapy(P=0.025)were significant risk factors for early recurrence in early-stage PDAC.CONCLUSION Elevated CA 19-9 level(cutoff value>70 U/mL)can be a reliable predictive factor for early recurrence in early-stage PDAC.As adjuvant chemotherapy can prevent early recurrence,it should be recommended for patients susceptible to early recurrence.

Neutrophil-to-lymphocyte ratio and carbohydrate antigen 19-9 as prognostic markers for advanced pancreatic cancer patients receiving first-line chemotherapy

BACKGROUND A decline in serum carbohydrate antigen 19-9(CA19-9)levels during systemic chemotherapy is considered as a prognostic marker for patients with advanced pancreatic cancer.Neutrophil-to-lymphocyte ratio(NLR)has been extensively studied as a simple and useful indicator of prognosis in various cancers including pancreatic cancer.AIM To assess the prognostic significance of NLR and CA19-9 in patients with advanced pancreatic adenocarcinoma received first-line chemotherapy according to CA19-9 positivity.METHODS We retrospectively analyzed patients diagnosed with advanced pancreatic cancer who received first-line chemotherapy between January 2010 and July 2017 at the Catholic University of Seoul St.Mary’s Hospital.Patients were divided according to CA19-9 positivity(CA19-9-positive vs-negative groups)and pre-and posttreatment NLR levels.To determine cut-off value of NLR and CA19-9 reduction,time-dependent receiver operating characteristic curve was applied.We evaluated overall survival(OS)and progression-free survival(PFS)for each group using Kaplan-Meier method,and we performed multivariate analyses on the entire cohort.RESULTS We included 271 patients in this study.Cut-off value of NLR and CA19-9 reduction was determined as 2.62 and 18%.Multivariate analysis showed that post-treatment NLR<2.62 and reduction of≥18%of baseline CA19-9 were significantly associated with OS and PFS.Post-treatment NLR≥2.62 showed hazard ratio(HR)of 2.47[95%confidence interval(CI):1.84-3.32,P<0.001]and CA19-9 decline(≥18%)showed HR of 0.51(95%CI:0.39-0.67,P<0.001)for OS.When CA19-9-positive patients were divided into groups according to CA19-9 response(responder vs non-responder)and post-treatment NLR(<2.62 vs≥2.62),CA19-9 responder and post-treatment NLR<2.62 group showed better survival than CA19-9 non-responder and post-treatment NLR≥2.62 group(OS 11.0 mo vs 3.9 mo,P<0.001;PFS 6.3 mo vs 2.0 mo,P<0.001).The combination of CA19-9 decline and post-treatment NLR showed a significant correlation with clinical response in CA 19-9 positive group.Within the CA19-9-negative group,the posttreatment NLR<2.62 group showed better survival than the post-treatment NLR≥2.62 group(OS 12.7 mo vs 7.7 mo,P<0.001;PFS 6.7 mo vs 2.1 mo,P<0.001),and post-treatment NLR showed correlation with clinical response.CONCLUSION In advanced pancreatic cancer patients positive for CA19-9 and treated with systemic chemotherapy,the combination of post-treatment NLR<2.62 and 18%decline of CA19-9 at the first response evaluation is a good prognostic marker.Post-treatment NLR<2.62 alone could be used as a prognostic marker and an adjunctive tool for response evaluation in CA19-9-negative patients.

Endoscopic ultrasonography in patients with elevated carbohydrate antigen 19-9 of obscure origin

AIM:To evaluate the efficacy of endoscopic ultrasonography(EUS) in patients with elevated carbohydrate antigen(CA) 19-9 levels of obscure origin.METHODS:Patients who had visited Pusan National University Hospital because of elevated serum CA 19-9 levels,between January 2007 and December 2009,were retrospectively enrolled.EUS had been performed on all subjects,in addition to routine blood tests,endoscopy,abdominal computed tomography(CT) and other clinical exams,which had not revealed any abnormal findings suggestive of the origin of the elevated CA 19-9 levels.RESULTS:Of the 17 patients,gallbladder sludge was detected in 16 patients(94.1%) and common bile duct sludge was observed in 3 patients(17.6%).After the administration of ursodeoxycholic acid to 12 of the patients with gallbladder sludge,CA 19-9 levels normalized in 6 of the patients after a median of 4.5 mo.CONCLUSION:EUS is a useful diagnostic method for patients with elevated CA 19-9 levels of obscure origin,even if the reason for abnormal levels of this serum marker cannot be determined through prior examinations,including abdominal CT.

Diagnostic Value of VEGF,CA 19-9,and CEA in Pancreatic Cancer and Risk Factors of Vascular Invasion

Background:Pancreatic cancer is a malignant tumor of the gastrointestinal tract.Due to its insidious onset,most patients with newly diagnosed pancreatic cancer have missed the opportunity for radical surgery,which offers patients the best chance of survival.The 5-year survival rate of patients with pancreatic cancer can be improved with early diagnosis,and serum tumor makers are an inexpensive and convenient diagnostic tool that is widely used in the diagnosis of malignancies.Objective:To determine the diagnostic value of vascular endothelial growth factor(VEGF),carbohydrate antigen 19-9(CA 19-9),and carcinoembryonic antigen(CEA)in patients with pancreatic cancer and the risk factors of vascular invasion.Methods:An experimental group comprising 52 patients with pancreatic cancer admitted to our department from July 2021 to July 2022 and a control group comprising 21 patients with benign pancreatic diseases during the same period were included in our study.Their serum VEGF,CA 19-9,and CEA levels were detected and compared between the two groups,and the correlation between the three markers in the invaded vessel and non-invaded vessel groups was investigated.The diagnostic value of a single tumor marker and in combination for pancreatic cancer was analyzed,and the three tumor marker levels of the experimental group in different pathological characteristics were detected and compared.Results:The experimental group had higher serum VEGF,CA 19-9,and CEA levels than the control group(P<0.05).Through a receiver operating characteristic(ROC)curve analysis,the combined detection had the highest value for the diagnosis of pancreatic cancer,in which the area under the curve(AUC)was 0.9158(95%CI:0.8415-0.9900),while the sensitivity and specificity were 76.19%and 98.08%,respectively.Serum VEGF and CA 19-9 levels were higher in stage Ⅲ-Ⅳ pancreatic cancer patients and those with tumor metastasis compared with stage Ⅰ-Ⅱ patients and those without metastasis(P<0.05),respectively.Binary logistic regression analysis was performed to determine the risk factors of vascular invasion in pancreatic cancer,and the results showed that only serum VEGF was a risk factor(P<0.05),OR(95%CI):1.001-1.006.Conclusion:Patients with pancreatic cancer have significantly higher serum VEGF,CA 19-9,and CEA levels,and the combined detection of tumor markers is of high clinical value in its diagnosis.In addition,serum VEGF is an independent risk factor of vascular invasion in pancreatic cancer,which can predict vascular invasion to a certain extent.

CA19-9与hTERC基因联合检测在宫颈上皮内瘤变诊断中的价值

目的探讨血清糖类抗原19-9(CA19-9)联合人端粒酶RNA基因(hTERC)在诊断宫颈上皮内瘤变中的价值。方法选取2010年1月至2014年11月右江民族医学院附属医院妇科门诊采集的392例宫颈脱落细胞标本作为研究对象,利用全自动酶免疫分析系统测定血清CA19-9的变化水平,荧光原位杂交(FISH)方法检测hTERC基因的表达水平。结果 CA19-9的总体阳性率38.78%(152/392);hTERC的总体阳性率26.79%(105/392);HPV检测阳性率64.54%(253/392);χ2趋势检验显示,随着宫颈病变病理级别的升高,CA19-9和hTERC阳性率均呈现逐步上升的趋势(χ2CA19-9=-4.089,P<0.05;χ2hTERC=7.795,P<0.05);Spearman分析结果显示,CA19-9水平和hTERC基因表达均与宫颈病变的程度呈正相关关系(rCA19-9=0.308,P<0.05;rhTERC=0.256,P<0.05);CA19-9水平的检测灵敏度71.64%,hTERC基因的检测灵敏度65.67%,CA19-9联合hTERC基因的检测灵敏度则可达92.54%,联合检测策略的灵敏度明显高于单独CA19-9或hTERC基因检测(χ2CA19-9=6.292,P<0.05;χ2hTERC=5.121,P<0.05);CA19-9和hTERC基因检测有4种类型结果,分别是:CA19-9(+)/hTERC(+)、CA19-9(+)/hTERC(-)、CA19-9(-)/hTERC(+)和CA19-9(-)/hTERC(-)。检测结果 CA19-9(+)/hTERC(+)的构成比随宫颈病变级别的增高而逐渐增加(P<0.05)。结论 CA19-9联合hTERC检测有助于提高宫颈上皮内瘤变诊断的灵敏度。

两种化学发光检测系统对糖链抗原19-9测定结果的可比性研究

目的：探讨2种化学发光检测系统（A ：Cobas e 411，B：Beckman Dxi800）测定血清糖链抗原（CA）19-9结果的可比性。方法按照EP9-A2方案，收集江门市中心医院2013年7月8～18日检测CA19-9的新鲜血清，取40份不同浓度新鲜患者血清在2种化学发光检测系统上进行CA19-9检测，对结果进行统计分析。以A系统为基准系统对B系统作临床可接受性能评价。结果2种系统检测结果经秩和检验差异无统计学意义（P＞0．05）。B系统与A 系统相关回归方程为YB＝1．0812XA -4．8484，r2＝0．9622。CA19-9在给定结果25 U/mL和250 U/mL 处，B系统相对偏倚为11．28％和6．00％。以CA19-9生物学变异的最佳允许总误差22．1％为标准，临床全部可接受。结论使用Cobas e 411检测系统和Beckman Dxi800检测系统对CA19-9测定结果具有可比性。

The prognostic value of preoperative serum levels of CEA,CA19-9 and CA72-4 in patients with colorectal cancer

INTRODUCTIONCarcinoembryonic antigen ( CEA) , originally described by Gold and Freedman [1] in 1965, is now an acknowledged member of immunoglobulin superfamily[2],with a role as an intracellular adhesion molecule[3].Carbohydrate antigen 19-9(CA19-9), obtained with a monoclonal antibody produced by immunizing a monoclonal antibody produced by immunizing a mouse with a colonic cancer cell line in 1979[4],is a ligand for E-selectin that plays an important role in the addhesion of cancer cells to endothelial cells [5,6].

Usefulness of CA 19–9 for pancreatic cancer screening in patients with new-onset diabetes

Background： Generally, carbohydrate antigen 19–9 （CA 19–9） is not useful for screening pancreatic cancerin the asymptomatic general population. This study aimed to evaluate the utility of CA 19–9 level as a screening indicator of pancreatic cancer in asymptomatic patients with new-onset diabetes.

Lymph node ratio and preoperative CA 19-9 levels predict overall survival and recurrence-free survival in patients with resected pancreatic adenocarcinoma

AIM:Clinicopathologic factors predicting overall survival (OS) would help identify a subset to benefit from adjuvant therapy. METHODS: One hundred and sixty-nine patients patients from 1984 to 2009 with curative resections for pancreatic adenocarcinoma were included. Tumors were staged by American Joint Committee on Cancer 7th edition criteria. Univariate and multivariable analyses were performed using Kaplan-Meier methodology or Cox proportional hazard models. Log-rank tests were performed. Statistical inferences were assessed by two-sided 5% significance level. RESULTS: Median age was 67.1 (57.2-73.0) years with equal gender distribution. Tumors were in the head (89.3%) or body/tail (10.7%). On univariate analysis, adjuvant therapy, lymph node (LN) ratio, histologic grade, negative margin status, absence of peripancreatic extension, and T stage were associated with improved OS. Adjuvant therapy, LN ratio, histologic grade, number of nodes examined, negative LN status, and absence of peripancreatic extension were associated with improved recurrence-free survival (RFS). On multivariable analysis, LN ratio and carbohydrate antigen (CA) 19-9 levels were associated with OS. LN ratio was associated with RFS. CONCLUSION: The LN ratio and CA 19-9 levels are independent prognostic factors following curative resections of pancreatic cancer.

Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma: A single-center retrospective study in South Korea

BACKGROUND Intrahepatic duct(IHD)stones are among the most important risk factors for cholangiocarcinoma(CCC).Approximately 10%of patients with IHD stones develop CCC;however,there are limited studies regarding the effect of IHD stone removal on CCC development.AIM To investigate the association between IHD stone removal and CCC development.METHODS We retrospectively analyzed 397 patients with IHD stones at a tertiary referral center between January 2011 and December 2020.RESULTS CCC occurred in 36 of the 397 enrolled patients.In univariate analysis,chronic hepatitis B infection(11.1%vs 3.0%,P=0.03),carbohydrate antigen 19-9(CA19-9,176.00 vs 11.96 II/mL,P=0.010),stone located in left or both lobes(86.1%vs 70.1%,P=0.042),focal atrophy(52.8%vs 26.9%,P=0.001),duct stricture(47.2%vs 24.9%,P=0.004),and removal status of IHD stone(33.3%vs 63.2%,P<0.001)were significantly different between IHD stone patients with and without CCC.In the multivariate analysis,CA19-9>upper normal limit,carcinoembryonic antigen>upper normal limit,stones located in the left or both lobes,focal atrophy,and complete removal of IHD stones without recurrence were independent factors influencing CCC development.However,the type of removal method was not associated with CCC risk.CONCLUSION Complete removal of IHD stones without recurrence could reduce CCC risk.

An evaluation of the diagnostic value of CA19-9 and CEA levels in patients with pancreatic cancer

Objective：The use of a combination of tumor markers may be an important tool in the early diagnosis of pancreatic cancer, which is the key to improving prognosis. The study aim was to investigate the diagnostic value of carbohydrate antigen 19-9（CA 19-9） and carcinoembryonic antigen（CEA） levels in patients with pancreatic cancer. Methods：An immunoradiometric assay was used to homochronously measure the serum CA19-9 and CEA levels in 78 pancreatic cancer cases and 64 healthy examinees in hospital. The normal reference values were CA19- 9（0-39 U/ml） and CEA（0-3.4 ng/ml）. Results： Mean serum CA19-9 and CEA levels in patients with pancreatic cancer（406.55±60.18 U/ml, 12.43 ± 1.25 ng/ml） were significantly higher（P〈 0.01） than those in healthy examinees（16.54 ±1.95 U/ml, 2.37 ±0.17 ng/ml）. The sensitivity of the combined detection of CA 19-9 and CEA （92.31%） was significantly higher（P 〈 0.05） than that of either marker alone （79.49%, 71.79%, respectively）. In addition, the sensitivity to diagnose pancreatic cancer by detecting the serum CA19-9 and CEA levels was higher（P〈 0.05） in stage Ⅱ B ＋ Ⅲ＋ Ⅳ（87.04%, 79.23%） than stage Ⅰ ＋ Ⅱ A（62.50%, 54.17%）. Conclusion： The combined detection of CA19-9 and CEA could overcome the deficiency of using single marker detection by improving the sensitivity to diagnose pancreatic cancer. At the same time, CA19-9 and CEA detection could be used to assess mesenteric artery invasion and the metastasis of lymphatics and distant organs in pancreatic cancer.

The Diagnostic Value of Fecal Fusobacterium nucleatum Combined with FIT and CA199 in the Diagnosis of Colorectal Cancer

Objective:To analyze the diagnostic value of fecal Fusobacterium nucleatum detection,fecal immunochemical test(FIT),and carbohydrate antigen 19-9(CA19-9)detection for colorectal cancer(CRC).Method:Atotal of 78 CRC patients and 60 healthy individuals were enrolled in this study.Stool and blood samples were collected for the 3 diagnoses,and ROC curves were analyzed for diagnostic value.Result:The 3 diagnoses’positive detection rates in CRC samples were significantly higher than those of healthy samples(P<0.05).The combined CRC diagnoses showed significantly higher sensitivity as compared to individual fecal F.nucleatum detection(χ^(2)=6.495,P=0.011),FIT(χ^(2)=4.871,P=0.027),and serum CA19-9 detection(χ^(2)=7.371,P=0.007).The area under the ROC curve for fecal F.nucleatum detection was 0.63[95%confidence interval(CI)=1.124–6.238],with a sensitivity of 73.08%and specificity of 85.00%,whereas FIT was 0.65(95%CI=1.365–9.241),with a sensitivity of 51.28%and specificity of 96.67%,meanwhile,serum CA19-9 detection was 0.62(95%CI=1.517–12.342),with a sensitivity of 69.23%and specificity of 98.33%.The combined CRC diagnoses showed an area under the ROC curve of 0.76(95%CI=1.213–6.254),with a sensitivity of 87.18%and specificity of 70.00%.Conclusion:The combined diagnoses of fecal F.nucleatum detection,FIT,and serum CA19-9 detection can significantly improve the sensitivity and accuracy of CRC diagnosis,which has high clinical application value to provide guidance for clinical CRC screening and early intervention treatment.

Diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging parameters and serum tumor markers in rectal carcinoma prognosis

BACKGROUND Rectal carcinoma(RC),one of the most common malignancies globally,presents an increasing incidence and mortality year by year,especially among young people,which seriously affects the prognosis and quality of life of patients.At present,dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)parameters and serum carbohydrate antigen 19-9(CA19-9)and CA125 Levels have been used in clinical practice to evaluate the T stage and differentiation of RC.However,the accuracy of these evaluation modalities still needs further research.This study explores the application and value of these methods in evaluating the T stage and differentiation degree of RC.AIM To analyze the diagnostic performance of DCE-MRI parameters combined with serum tumor markers(TMs)in assessing pathological processes and prognosis of RC patients.METHODS A retrospective analysis was performed on 104 RC patients treated at Yantai Yuhuangding Hospital from May 2018 to January 2022.Patients were categorized into stages T1,T2,T3,and T4,depending on their T stage and differentiation degree.In addition,they were assigned to low(L group)and moderate-high differentiation(M+H group)groups based on their differentiation degree.The levels of DCE-MRI parameters and serum CA19-9 and CA125 in different groups of patients were compared.In addition,the value of DCE-MRI parameters[volume transfer constant(Ktrans),rate constant(Kep),and extravascular extracellular volume fraction(Ve)in assessing the differentiation and T staging of RC patients was discussed.Furthermore,the usefulness of DCE-MRI parameters combined with serum CA19-9 and CA125 Levels in the evaluation of RC differentiation and T staging was analyzed.RESULTS Ktrans,Ve,CA19-9 and CA125 were higher in the high-stage group and L group than in the low-stage group and M+H Group,respectively(P<0.05).The areas under the curve(AUCs)of the Ktran and Ve parameters were 0.638 and 0.694 in the diagnosis of high and low stages,respectively,and 0.672 and 0.725 in diagnosing moderate-high and low differentiation,respectively.The AUC of DCE-MRI parameters(Ktrans+Ve)in the diagnosis of high and low stages was 0.742,and the AUC in diagnosing moderate-high and low differentiation was 0.769.The AUCs of CA19-9 and CA-125 were 0.773 and 0.802 in the diagnosis of high and low stages,respectively,and 0.834 and 0.796 in diagnosing moderate-high and low differentiation,respectively.Then,we combined DCE-MRI(Ktrans+Ve)parameters with CA19-9 and CA-125 and found that the AUC of DCE-MRI parameters plus serum TMs was 0.836 in the diagnosis of high and low stages and 0.946 in the diagnosis of moderate-high and low differentiation.According to the Delong test,the AUC of DCE-MRI parameters plus serum TMs increased significantly compared with serum TMs alone in the diagnosis of T stage and differentiation degree(P<0.001).CONCLUSION The levels of the DCE-MRI parameters Ktrans and Ve and the serum TMs CA19-9 and CA125 all increase with increasing T stage and decreasing differentiation degree of RC and can be used as indices to evaluate the differentiation degree of RC in clinical practice.Moreover,the combined evaluation of the above indices has a better effect and more obvious clinical value,providing important guiding importance for clinical condition judgment and treatment selection.

EXPLORE ON DIAGNOSTIC AND PROGNOSTIC VALUES OF EXTRAHEPATIC CHOLANGIOCA RCINOMA: UTILITY OF SERUM CA19-9 AND SERUM CEA

Objective To evaluate th e validity of a serum carbohydrate antigen 19-9(CA19-9) determination in the dia gnosis of extrahepatic cholangiocarcinoma(EHCC). Methods Serum CA19-9 concentration and serum carcinoembryonic antigen(CEA) concentration wer e prospectively measured by an immunoradiometric assay without knowledge of the clinical diagnosis in patients with EHCC (n=51), benign biliary diseases ( n=42), and healthy individuals (n=15). Using a receiver operating characte ristic (ROC) curve define a new strategy for interpreting CA19-9 and CEA in EHC C. Results The sensitivity of CA19-9 and CEA in diagnosing E HCC were 86.3% (44/51) and 25.5%(13/51), respectively. When compared with the be nign biliary diseases group, the true negative rates of serum CA19-9 and serum CEA were 85.7% (36/42) and 95.2%(40/42), respectively. The false positive rates of serum CA19-9 and serum CEA were 14.3 %( 6/42) and 4.8 %( 2/42), whereas the accuracy of serum CA19-9 and serum CEA were 57.0%(53/93) and 86.0%(80/93), resp ectively. Serum CA19-9 concentration and serum CEA concentration were significa ntly elevated (P<0.01 and P<0.05) in patients with EHCC \[(489.6±150.2 )kU·L -1 and (22.0±2.4)μg·L -1)\] compared with patients with beni gn biliary diseases\[ (20.2±4.7) kU·L -1 and (14.8± 0.8)μg·L -1)\] and healthy individuals \[(12.8±3.7) kU·L -1 and (11.5±3.4μ g·L -1)\]. The ROC curves analysis showed that the area under the ROC cu rve(AUC)of serum CA19-9 and serum CEA were 0.942 (P<0.001) and 0.516 (P >05), respectively. In 22 patients undergoing curative resection of EHCC, the mean serum CA19-9 concentration decreased from preoperative level of (456.6±1 20.4) kU·L -1 to postoperative level (62.8±17.3) kU·L -1(P< 0. 001). The outcomes showed that serum CA19-9 had greater diagnosis performance s than serum CEA. Conclusion Serum CA19-9 is an effective tum or marker in diagnosing of cholangiocarcinoma, deciding whether the tumor has be en radically resected and monitoring effect of treatment