Limited usefulness of serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for gastrointestinal and whole-body cancer screening

Masau Sekiguchi,Takahisa Matsuda

doi:10.1038/s41598-020-75319-8

Masau Sekiguchi, Takahisa Matsuda

Open Access

https://doi.org/10.1038/s41598-020-75319-8

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Journal: Scientific Reports	Publication Date: Oct 23, 2020
Citations: 19	License type: open-access

Affiliation: National Cancer Center Hospital East

Abstract

The diagnostic performance of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels for multiple-organ cancer screening has not been fully elucidated. However, they are widely used for real-world opportunistic screening of multiple-organ cancers. This study aimed to examine the diagnostic performance of these serum markers in multiple-organ cancer screening. Data from asymptomatic individuals subjected to opportunistic cancer screening were analyzed. The diagnostic performance of CEA and CA 19-9 was assessed for (A) upper/lower gastrointestinal cancers and (B) whole-body cancers (including both gastrointestinal and other organ cancers) using the results of upper/lower gastrointestinal endoscopy and whole-body imaging as reference. Data from 12,349 and 7616 screened individuals were used to assess the diagnostic performance of CEA and CA 19-9 for (A) and (B), respectively. For (A), the sensitivity and positive predictive value (PPV) of CEA (cut-off: 5 ng/mL) were 7.8% and 3.7%, respectively; those of CA19-9 (cut-off: 37 U/mL) were 7.4% and 2.7%, respectively. For (B), the sensitivity and PPV of CEA were 6.6% and 4.1%, respectively, and those of CA19-9 were 10.8% and 5.8%, respectively. Considering even multiple cancers, the sensitivity and PPV of CEA and CA 19-9 were low, thus confirming their limited usefulness in multiple-organ cancer screening.

Highlights

Cancer is the leading cause of death worldwide, and much effort is being put into cancer s creening[1]
This study aimed to elucidate the diagnostic performance of serum carcinoembryonic antigen (CEA) and CA19-9 for multi-organ cancer screening via the analysis of data obtained from a large number of asymptomatic screened individuals
The present study explored the diagnostic performance of the tumor markers CEA and CA19-9 in GI and whole-body cancer screening, and clearly demonstrated their very low sensitivities and positive predictive value (PPV) even when targeting multiple GI and whole-body cancers instead of single-organ cancers

Summary

Introduction

Cancer is the leading cause of death worldwide, and much effort is being put into cancer s creening[1]. Serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are the most common tumor markers targeting multiple cancers, including colorectal cancer, gastric cancer, pancreaticobiliary cancer, lung cancer, and breast cancer; they are used in cancer care as prognostic markers and markers for the monitoring of response to therapy and recurrence[2,3,4,5,6] Both markers are not recommended by any guidelines for cancer screening, due to their low sensitivity for single-cancer detection at an early stage[2,3,4,5,6]. Their diagnostic abilities for gastrointestinal (GI) cancers, which were reportedly their major target cancers, and whole-body cancers (including GI cancers and cancers of organs other than the GI tract) were assessed by analyzing the data of the screened individuals who underwent tumor marker measurements, esophagogastroduodenoscopy (EGD), total colonoscopy (CS), computed tomography (CT) colonography (CTC), and those who further underwent whole-body imaging tests such as 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET)[2,3,4,5,6,7,8,9,10,11]

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