Background: Gastric cancer (GC) is a rare malignancy in Western countries, accounting approximately for 1.5% of all cancers in the USA. However, worldwide, the expected new cases in 2015 were 630,000 and 320,000 among men and women, respectively, with more than 700,000 deaths. Also in the European Union the incidence of GC has been progressively reduced during the last 20 years. The use of serum tumor markers is common in patients with cancer, including GC. Unfortunately, none have shown a high sensitivity to be routinely considered in the screening of patients. We evaluated the usefulness of combined carcinoembryonic antigen (CEA), carcinoma antigen 19-9 (CA 19-9) and 125 (CA-125) measurement in early diagnosis of GC. Methods: We performed a retrospective review of 32 consecutive patients with stage IA (pT1pN0) and IB (pT1pN1/pT2pN0) GC (cases) who underwent curative surgical resection. There were 24 (75%) men and 8 (25%) women, with an overall median age of 60 years (range 35-79 years). Patients with a history of other malignancy, current smoking, or who used drugs potentially interfering with liver function were excluded from the study. Controls were 45 randomly selected sex- and age-matched healthy patients who underwent standard gastroscopy, which excluded presence of cancer or peptic ulcer. Simultaneous measurement of CEA, CA 19-9 and CA 125 before any medical treatment was obtained an all patients using standard commercially available immunoassays, according to the manufacturer’s instructions. CEA by automated homogeneous chemiluminescent immunoassay (luminescent oxygen channeling immunoassay-LOCI), while CA 19-9 and CA 125 by a sandwich assays based on the streptavidin-biotin technology (ELISA). The normal cut-off values were 5 ng/mL, 34 kU/L, and 35 kU/L, respectively. Written informed consent was obtained from all the participants. Results: Overall (cases vs. controls), CEA, CA 19-9, and CA 125 were 11.5±26.7 vs. 2.1±3.6 ng/mL (p=0.022), 21.7±36.8 vs. 9.12±4.1 kU/L (p=0.025), and 20.3±31.6 vs. 10.7±6.4 kU/L (p=0.050), respectively. The other results are reported in the Table. The sensitivity (χ2=5.05, p=0.025) and positive predictive value (χ2=5.53, p=0.019) of the three markers together were significantly higher than that of each single marker, but the accuracy increased slightly (57.0%-65.8% vs. 73.4%, χ2=1.50, p=0.22). Conclusion: In patients with GC, when an improvement of sensitivity is required, the simultaneous measurement of serum CEA, CA 19-9, and CA 125 could be suggested.
Simultaneous carcinoembryonic antigen (CEA), carcinoma antigen 19-9 (CA 19-9) and 125 (CA-125) measurement in patients with gastric cancer (stage IA-IB). A case-control study.
LUMACHI, FRANCO;
2016
Abstract
Background: Gastric cancer (GC) is a rare malignancy in Western countries, accounting approximately for 1.5% of all cancers in the USA. However, worldwide, the expected new cases in 2015 were 630,000 and 320,000 among men and women, respectively, with more than 700,000 deaths. Also in the European Union the incidence of GC has been progressively reduced during the last 20 years. The use of serum tumor markers is common in patients with cancer, including GC. Unfortunately, none have shown a high sensitivity to be routinely considered in the screening of patients. We evaluated the usefulness of combined carcinoembryonic antigen (CEA), carcinoma antigen 19-9 (CA 19-9) and 125 (CA-125) measurement in early diagnosis of GC. Methods: We performed a retrospective review of 32 consecutive patients with stage IA (pT1pN0) and IB (pT1pN1/pT2pN0) GC (cases) who underwent curative surgical resection. There were 24 (75%) men and 8 (25%) women, with an overall median age of 60 years (range 35-79 years). Patients with a history of other malignancy, current smoking, or who used drugs potentially interfering with liver function were excluded from the study. Controls were 45 randomly selected sex- and age-matched healthy patients who underwent standard gastroscopy, which excluded presence of cancer or peptic ulcer. Simultaneous measurement of CEA, CA 19-9 and CA 125 before any medical treatment was obtained an all patients using standard commercially available immunoassays, according to the manufacturer’s instructions. CEA by automated homogeneous chemiluminescent immunoassay (luminescent oxygen channeling immunoassay-LOCI), while CA 19-9 and CA 125 by a sandwich assays based on the streptavidin-biotin technology (ELISA). The normal cut-off values were 5 ng/mL, 34 kU/L, and 35 kU/L, respectively. Written informed consent was obtained from all the participants. Results: Overall (cases vs. controls), CEA, CA 19-9, and CA 125 were 11.5±26.7 vs. 2.1±3.6 ng/mL (p=0.022), 21.7±36.8 vs. 9.12±4.1 kU/L (p=0.025), and 20.3±31.6 vs. 10.7±6.4 kU/L (p=0.050), respectively. The other results are reported in the Table. The sensitivity (χ2=5.05, p=0.025) and positive predictive value (χ2=5.53, p=0.019) of the three markers together were significantly higher than that of each single marker, but the accuracy increased slightly (57.0%-65.8% vs. 73.4%, χ2=1.50, p=0.22). Conclusion: In patients with GC, when an improvement of sensitivity is required, the simultaneous measurement of serum CEA, CA 19-9, and CA 125 could be suggested.
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