Serum level of TSGF,CA242 and CA19-9 in pancreatic cancer

AIM: To establish a method to detect the expression of the tumor specific growth factor TSGF, CA242 and CA19-9 in serum and evaluate their value in diagnosis of pancreatic cancer. METHODS: ELISA and Biochemical colorimetric assay were used to detect the serum content of TSGF, CA242 and CA19-9 in 200 normal cases, 52 pancreatitis patients and 96 pancreatic cancer patients. RESULTS: The positive likelihood ratios of TSGF, CA242 and CA19-9 were 5.4, 12.6 and 6.3, respectively, and their negative likelihood ratios were 0.10, 0.19 and 0.17, respectively. With single tumor marker diagnosed pancreatic cancer, the highest sensitivity and specificity of TSGF were 91.6% and 93.5%. In combined test with 3 markers, when all of them were positive, the sensitivity changed to 77.0% and the specificity and the positive predictive value were 100%. The levels of TSGF and CA242 were significantly higher in the patients with pancreatic cancer of head than those in the patients with pancreatic cancer of body, tail and whole pancreas, but the expression of CA19-9 had no correlation with the positions of the pancreatic cancer. The sensitivity of TSGF, CA242 and CA19-9 was increased with the progress in stages of pancreatic cancer. In stage I, the sensitivity of TSGF was markedly higher than CA242 and CA19-9. CONCLUSION: The combined use of TSGF, CA242 and CA19-9 expressions can elevate the specificity for pancreatmc cancer diagnosis. And it shows that it plays an important role to differentiate positions and tissue typing. It is a forepart diagnosis for the pancreatic cancer by combination checking. There is very important correlation between the three markers and the pancreatic cancer.

Combined preoperative platelet-to-lymphocyte ratio and serum carbohydrate antigen 19–9 level as a prognostic factor in patients with resected pancreatic cancer

Background: Carbohydrate antigen 19–9(CA19-9) is the most frequently used tumor marker and serves as a prognostic indicator in patients with pancreatic cancer(PC). The platelet-to-lymphocyte ratio(PLR) is thought to be an inflammation-related serum marker. An elevated PLR represents increased inflammatory status and is associated with poor prognosis in patients with various cancers including PC. Methods: This study involved 103 patients with a histopathological diagnosis of pancreatic ductal adenocarcinoma who underwent pancreatectomy. The patients were assessed to determine the prognostic significance of the combination of the PLR and CA19-9 level. Results: Based on the receiver operating characteristic analysis results, the patients were divided into PLR H igh(PLR ≥ 129.1) andPLRLow(PLR < 129.1) groups and into CA19-9High(CA19-9 ≥ 74.0 U/mL) and CA19-9Low(CA19-9 < 74.0 U/mL) groups. The cumulative 5-year overall survival(OS) and disease-specific survival(DSS) rates significantly differed by both the PLR(PLR H igh group: 19.5% and 22.9%;PLRLow group: 39.1% and 45.9%) and CA19-9(CA19-9 H igh group: 19.1% and 25.6%;CA19-9Low group: 41.0% and 41.0%). We then divided the patients into Groups A(PLR L ow/CA19-9Low), B(PLR Low/CA19-9High or PLRHigh/CA19-9Low), and C(PLR H igh/CA19-9High). The cumulative 5-year OS rates in Groups A, B, and C were 44.0%, 31.9%, and 11.9%, respectively( P = 0.002). The cumulative 5-year DSS rates in Groups A, B, and C were 47.7%, 36.4%, and 16.8%, respectively( P = 0.002). Multivariate analysis revealed that the combination of the PLR and CA19-9 was an independent prognostic factor in patients with resected PC. Conclusions: The combination of the PLR and CA19-9 is useful for predicting the prognosis of patients with resected PC.

CA19-9 level determines therapeutic modality in pancreatic cancer patients with para-aortic lymph node metastasis

Background: In general, para-aortic lymph node(LN16) metastasis has been considered as a contraindication for pancreatic resection. However, some pancreatic cancer patients with LN16 metastasis have been reported to survive for longer than expected after pancreatectomy. The purpose of this study was to determine whether pancreatic cancer patients with LN16 metastasis might benefit from surgery.Methods: We retrospectively reviewed 201 consecutive patients with invasive pancreatic ductal adenocarcinoma who underwent surgery at Osaka National Hospital between April 2003 and December 2012.These patients included 22 patients with LN16 metastasis who underwent an extended lymphadenectomy and 25 patients who underwent a palliative surgical biliary and gastric bypass. The clinicopathological data and outcomes were evaluated using univariate and multivariate analyses.Results: The overall survival of the patients with LN16 metastasis was poorer than that of the LN16-negative patients(P = 0.0014). An overall survival analysis of the LN16-positive patients stratified according to the preoperative CA19-9 level showed a significant difference between patients with a low preoperative CA19-9 level(≤360 U/mL) and those with a high preoperative CA19-9 level(>360 U/mL)(P = 0.0301). No significant difference in overall survival of patients was observed between those with LN16 positivity and those who underwent bypass surgery. However, the overall survival of the LN16-positive patients with a CA19-9 level ≤360 U/mL(n = 11) was significantly higher than that of those who underwent bypass surgery(P = 0.0452).Conclusion: Surgical resection and extended lymphadenectomy remains an option for pancreatic cancer patients with LN16-positivity whose CA19-9 level is ≤360 U/mL.

Value of CA19-9, CA125 and CEA combined magnetic resonance imaging in the diagnosis of pancreatic cancer

Objective:To study the value of CA19-9, CA125 and CEA combined magnetic resonance imaging (MRI) in the diagnosis of pancreatic cancer, and to provide a reference for clinical diagnosis and treatment.Methods:A total of 110 cases of pancreatic cancer admitted to our hospital from November 2015 to November 2017 were selected as the observation group, and another 80 normal pancreas organizers who participated in the physical examination in the same period were selected as the control group. The change of magnetic resonance scanning parameters and serum CA19-9, CA125 and CEA detection were compared between the two groups of subjects at the same time, contrast scan and serum magnetic resonance detection of CA19-9, CA125 and CEA positive rate, and to evaluate the four alone and in combination with the diagnosis of pancreatic cancer specificity, sensitivity, negative predictive value and positive predictive value.Results:The T1WI of the observation group was low or slightly low signal, T2WI was slightly high signal, and the tumor of fat suppression sequence was low signal, which was in line with the typical characteristics of pancreatic cancer. The serum levels of CA19-9, CA125 and CEA in the observation group were significantly higher than those in the control group, and the difference was statistically significant. Compared with the two groups, the positive rates of MRI and serum CA19-9, CA125 and CEA in the observation group were higher than those in the control group, and the difference was statistically significant. The sensitivity and accuracy of MRI scan combined with three serological markers were higher than those of single detection. The specificity was between four.Conclusion: CA19-9, CA125 and CEA combined magnetic resonance imaging (MRI) have good sensitivity and accuracy in diagnosis of pancreatic cancer, but their specificity is common, which should be used for reference.

Pancreatic Cancer with Normal CA 19-9 and Lewis Antigen Negative--Case Report

Pancreatic cancer is an aggressive and lethal disease that affects especially older population. Its more relevant tumor marker is CA 19-9 （carbohydrate antigen 19-9）, although it can be elevated in others clinical situations, like cholangitis and cholestasis. Otherwise, a small people subset, like our patient, do not produce this tumor marker, as on blood as in the tumor, because they are incapable to express the Lewis Antigen. Therefore, this case report is about a patient without Lewis Antigen express and CA 19-9 low levels. We will report a rapid disease progression, despite of low CA 19-9, comparing with available data that often show better prognosis in this setting. Conclusion： Low levels of CA 19-9 do not predict good response or better prognosis in patients that do not express Lewis Antigen.

CA19-9 antigen levels can distinguish between benign and malignant pancreaticobiliary disease

BACKGROUND:CA19-9 is a carbohydrate tumor-associated antigen which is frequently upregulated in pancreatobiliary neoplasia.However,it may also be elevated in patients with jaundice in the absence of a tumor due to biliary obstruction,and in other non-hepato-pancreatico-biliary conditions.This study aimed to evaluate whether CA19-9 levels could accurately differentiate between benign and malignant pancreatobiliary disease.METHODS:All patients referred to a single surgeon for investigation of pancreaticobiliary disease in 2003 in whom a firm diagnosis had been established were included.For malignant disease,a histological diagnosis was required but for benign disease a firm radiological diagnosis was deemed adequate.The patients were divided into 4 categories:pancreatic adenocarcinoma(PCa);cholangiocarcinoma(CCa);chronic pancreatitis(CP)and biliary calculous disease(Calc).Bilirubin and alkaline phosphatase levels corresponding to the point of assessment of CA19-9 were also noted.RESULTS:Final diagnoses were made of pancreatic adenocarcinoma(PCa,n=73),cholangiocarcinoma(CCa,n=19),ampullary carcinoma(Amp,n=7),neuroendocrine carcinoma(Neu,n=4),duodenal carcinoma(Duo,n=3),chronic pancreatitis(CP,n=115),and biliary calculous disease(Calc,n=27).Median CA19-9 levels(U/ml)were:PCa,653;CCa,408;Duo,403;Calc,27;CP,19;Neu,10.5;Amp,8(reference range:0-37).The CA19-9 levels were significantly greater for malignant than for benign disease,could differentiate PCa from CCa/Duo,and were significantly higher in unresectable than in resectable PCa.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)for CA19-9 were 84.9%,69.7%,67.7%and 86.1%,respectively.A ROC analysis provided an area under the curve for CA19-9 of 0.871(0.820-0.922),giving an optimal CA19-9 of 70.5 U/ml for differentiating benign from malignant pathology.Using this cut-off,the sensitivity was 82.1%,while specificity,PPV and NPV improved to 85.9%,81.3%and 86.5%,respectively.When standard radiology was included(US/ CT/MRCP)in the decision process,the results improved to 97.2%,88.7%,86.6%,and 97.7%.For benign disease,the CA19-9 correlated directly with the serum bilirubin,but for malignant disease,CA19-9 levels were elevated independent of the bilirubin level.CONCLUSIONS:CA19-9 is useful in the differentiation of pancreatobiliary disease and when using an optimized cut-off and combining with routine radiology,the diagnostic yield is improved significantly,thus stressing the importance of a multi-disciplinary approach to pancreatobiliary disease.

Clinical value of serum CA19-9 levels in evaluating resectability of pancreatic carcinoma

AIM:To evaluate the clinical value of serum CA19-9 levels in predicting the respectability of pancreatic carcinoma according to receiver operating characteristic(ROC) curve analysis. METHODS:Serum CA19-9 levels were measured in 104 patients with pancreatic cancer which were possible to be resected according to the imaging. ROC curve was plotted for the CA19-9 levels. The point closest to the upper left-hand corner of the graph were chosen as the cut-off point. The sensitivity,specificity,positive and negative predictive values of CA19-9 at this cut-off point were calculated. RESULTS:Resectable pancreatic cancer was detected in 58(55.77%) patients and unresectable pancreatic cancer was detected in 46(44.23%) patients. The area under the ROC curve was 0.918 and 95% CI was 0.843-0.992. The CA19-9 level was 353.15 U/mL,and the sensitivity and specificity of CA19-9 at this cut-off point were 93.1% and 78.3%,respectively. The positive and negative predictive value was 84.38% and 90%,respectively. CONCLUSION:Preoperative serum CA19-9 level is a useful marker for further evaluating the resectability of pancreatic cancer. Obviously increased serum levels of CA19-9(> 353.15 U/mL) can be regarded as an ancillary parameter for unresectable pancreatic cancer.

胃癌患者血清肿瘤标志物CA_(19-9)、CA_(242)联合检测

目的:探讨血清CA19 9、CA242联合检测在胃癌诊断中的作用。方法:采用放射免疫法,对 20例胃良性疾病患者及 31例胃癌患者血清中CA19 9、CA242进行检测。结果:胃癌患者血清CA19 9、CA242的阳性率分别为 38. 71%、48. 39%,高于胃良性疾病组,差异有统计学意义(P<0. 01),联合测定的灵敏度为 74%,特异度为 90%,且对Ⅲ、Ⅳ期胃癌的敏感度和特异度高于Ⅰ、Ⅱ期胃癌(P<0. 01)。结论:CA19 9、CA242联合测定对胃癌有一定的诊断价值,可作为胃良恶性疾病的鉴别标准之一。

Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions

AIM: To assess the diagnostic accuracy of endoscopic ultrasound (EUS), fluid tumor markers and cytology in distinguishing benign from (pre)malignant pancreatic cystic lesions. METHODS: 46 consecutive patients, referred to a gastroenterologist and surgeon for a symptomatic or incidental pancreatic cyst, were reviewed. EUS, cytology, and carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) levels were compared with the final diagnosis, based on surgical pathology and/or imaging follow-up of at least 12 mo. Cysts were classified as benign (pseudocyst, serous cystadenoma) or malignant/ pre-malignant (mucinous cystic neoplasm). Receiver- operator characteristics (ROC) curve analysis was performed. RESULTS: The mean age was 56 years; 29% were male and median cyst diameter was 3 cm. Final outcome was obtained in 41 (89%) patients. Twenty-three (56%) of these 41 had surgical pathology. Twenty-three (56%) had benign lesions and 18 (44%) had malignant/pre- malignant lesions. Sensitivity, specificity and positive and negative predictive value of EUS alone to distinguish benign from malignant/premalignant pancreatic cystic lesions were 50%, 56%, 36% and 54% and for cytology were 71%, 96%, 92% and 85%, respectively. The corresponding values for the ROC-derived ideal cutoffswere 75%, 90%, 75%, 90% for CA 19-9 (> 37 U/mL) and 70%, 85%, 79% and 78% for CEA (> 3.1 ng/mL). Subgroup analysis of those with surgical pathology yielded almost identical performance and cutoffs. CONCLUSION: Cytology and cyst fluid tumor marker analysis is a very useful tool in distinguishing benign from (pre)malignant pancreatic cystic lesions.

肿瘤标志物CA242与CA19-9对胰腺癌的诊断作用研究

目的：研究肿瘤标志物ＣＡ２４２与ＣＡ１９－９对胰腺癌的诊断作用。方法：选择１９９６年４月至１９９７年６月在北京医院门诊及住院的患者，共有１９７例进行了血清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的患者，１２例为急性胰腺炎患者，１８例为良性阻塞性黄疸患者。结果：胰腺癌患者血清ＣＡ１９－９和ＣＡ２４２较对照组明显增高，其中２５例胰腺癌患者有２１例ＣＡ１９－９阳性，检测的灵敏度为８４％，特异度为７４．４％，有１７例ＣＡ２４２阳性，检测的灵敏度为６８％，特异度为８７．８％。ＣＡ２４２与ＣＡ１９－９比较，灵敏度无显著区别（０．１０＜Ｐ＜０．２５）；而特异度则显著增高（Ｐ＜０．０１）。１２例急性胰腺炎患者有４例血清ＣＡ１９－９阳性（３３．３％），但ＣＡ２４２仅１例阳性（８．３３％）。１８例良性梗阻性黄疸患者ＣＡ１９－９有１６例阳性（８８．８％），而ＣＡ２４２检测仅２例阳性（１１．１％）。结论：血清ＣＡ２４２和ＣＡ１９－９可用于胰腺癌的诊断，且ＣＡ２４２对胰腺癌的诊断优于血清ＣＡ１９－９，在不显著影响检测的灵敏度的情况下，可显著提高诊断的特异度，增加诊断的可靠性。

肿瘤标志物CA19-9、CA242、CA125在胰腺癌诊断和预后评估中的价值

为了评价CA19-9、CA242、CA125单独或联合检测在胰腺癌诊断和预后评估中的作用,对105例确诊的胰腺癌患者,手术前检测血清CA19-9、CA242、CA125值,并检测了70例非胰腺恶性肿瘤患者和30例良性胰腺疾病患者的血清CA19-9、CA242、CA125水平。结果发现,单独应用于胰腺癌诊断时,CA19-9的灵敏度最高,但是其特异性显著低于CA242和CA125(P<0.01)。联合检测CA125和CA242可使诊断特异性达到92%。CA242高于正常值的胰腺癌患者,其生存期明显短于CA242值正常的胰腺癌患者(P<0.05)。三项肿瘤标志物中两项以上高于正常值的患者,其生存期显著低于仅有一项高于正常值或三项皆正常的患者(P<0.05)。CA19-9在胰腺癌诊断率方面优于CA125和CA242。联合使用CA125和CA242可以提高诊断的特异性。肿瘤标志物高水平与胰腺癌进展期相关。三项肿瘤标志物中两项或三项高于正常值的患者其生存期较短。

结直肠癌中血清CEA、CA19-9和CA242的水平

目的:探讨血清CEA、CA19-9和CA242在结直肠癌临床病理中的特点。方法:收集2006年1-9月,上海交通大学医学院附属新华医院普外科手术治疗结直肠癌患者192例(C组),正常对照者50例(A组)和结直肠良性病患者50例(B组),术前测定血清CEA、CA19-9和CA242含量,结直肠癌标本做免疫组化检测p53和Ki67蛋白表达,统计分析结果。结果:C组血清CEA[(22.03±16.42)ng/mL]和CA242[(29.22±22.40)U/mL]均明显升高(均P<0.01),且在D期呈显著上升。血清CEA[(38.18±27.43)ng/mL]和CA19-9[(86.85±69.32)U/mL]在近端结肠癌中表达水平较远端结肠癌和直肠癌升高(均P<0.05)。CEA在低分化癌[(31.69±28.72)ng/mL]和黏液腺癌[(35.42±20.01)ng/mL]中明显升高(均P<0.01)。p53蛋白表达(+++)者的CEA[(34.21±14.33)ng/mL]和CA242[(37.42±29.05)U/mL]显著高于其他组(均P<0.01)。Ki67表达(+++)者的CEA[(37.79±26.79)ng/mL]和CA242[(32.94±23.78)U/mL]亦均明显高于其他组(均P<0.01)。结论:CEA、CA242和CA19-9水平升高预示结直肠癌肿瘤分期较晚、肿瘤细胞增殖较强,尤其CEA更提示肿瘤低分化和较差病理类型。

胃癌患者血清CA19-9,CA242联合检测

检测 2 0例胃良性疾病患者及 31例胃癌患者血清中的CA1 9- 9及CA2 4 2。结果显示 :胃癌患者血清CA1 9- 9,CA2 4 2的阳性率分别为 38.7%和 48.4 % ,高于胃良性疾病组 (P <0 .0 1 ) ;联合检测的灵敏度为 74.2 % ,特异度为 90 .0 %。提示CA1 9- 9,CA2 4 2联合检测对胃癌有一定的诊断价值 ,可作为鉴别胃良、恶性疾病的参考指标之一。

联合检测血清CA19-9、CA242、CEA对胰腺癌的诊断价值

目的探讨肿瘤标志物CA19-9、CA242、CEA联合检测在胰腺癌诊断及疗效监测中的应用。方法采用美国Beckman-coulter公司生产的DXI800化学发光仪对80例胰腺癌患者及80例正常对照组血清中的CA19-9、CA242、CEA水平进行检测。结果胰腺癌患者血清中CA19-9、CA242、CEA较正常对照组明显增高(P<0.01),CA19-9、CA242、CEA的阳性率分别为92.5%(74/80)、78.75%(63/80)、50.0%(40/80)。经手术治疗后CA19-9的均值(44.6±20.4)u/ml与手术前的CA19-9的均值(215.8±56.6)u/ml比较非常显著的降低(P<0.01);CA242的均值(31.8±27.9)u/ml与手术前的CA242的均值(256.2±57.6)u/ml比较非常显著的降低(P<0.01);CEA的均值(8.2±2.5)u/ml与手术前的CEA的均值(27.3±12.4)u/ml比较非常显著的降低(P<0.01)。结论CA19-9、CA242、CEA联合检测有助于提高胰腺癌的诊断符合率,同时也是对胰腺癌患者术后疗效监测的一种有效检测手段。

肿瘤标记物CA19-9、CA242对胰腺癌转移和预后预测价值的分析

目的:探讨肿瘤标记物糖类抗原19-9(CA19-9)、糖类抗原242(CA242)对胰腺癌转移和预后的预测价值。方法:选取80例胰腺癌患者和20例健康人群的血清样本,测定血清中CA19-9、CA242水平。探讨两者与胰腺癌临床分期、分型、肿瘤大小、淋巴转移情况和预后的关系。结果:胰腺癌患者血清CA19-9、CA242水平显著高于健康人群(P<0.01)。胰腺癌患者中III+IV期患者血清CA19-9、CA242水平显著高于I+II期患者(P<0.05),淋巴转移患者血清CA19-9、CA242水平显著高于无转移患者(P<0.05),生存期小于8个月患者血清CA19-9、CA242水平显著高于大于8个月患者(P<0.05)。以CA19-9 37.0U/ml、CA242 20.0U/ml为阳性阈值,以CA19-9阳性且CA242阳性组的正确指数最高。结论:胰腺癌患者血清CA19-9、CA242水平对胰腺癌患者术前诊断和预后分析具有一定参考价值。

血清CEA、CA19-9和CA242单独和联合检测在胰腺癌诊断和预后中的价值

目的探讨血清CEA、CA19-9和CA242单独和联合检测在胰腺癌诊断和预后中的作用。方法回顾性分析了105例胰腺癌患者,70例非胰腺外分泌恶性肿瘤以及30例胰腺良性疾病患者术前血清CEA、CA19-9和CA242水平。结果CA19-9对胰腺癌诊断的敏感性最高(80%),但其特异性明显低于CEA和CA242(P<0.01)。CEA和CA242联合检测可将胰腺癌诊断的特异性提高到92%。CEA、CA19-9和CA242水平不受肿瘤大小以及可切除性的影响(P>0.05),但在Ⅳ期胰腺癌患者中明显提高(P<0.05)。血清CEA和CA19-9的水平与患者的生存时间无明显的相关性,而血清CA242阳性的胰腺癌患者的生存时间较阴性患者的生存时间明显缩短(P<0.05)。结论CA19-9对胰腺癌的诊断阳性率优于CEA和CA242。联合检测CEA和CA242明显提高诊断的特异性。3者水平明显升高提示病情进入晚期,血清CA242明显升高提示生存期短,预后差。