Carcinoembryonic Antigen Measurements Research Articles

Label free and ultrasensitive electrochemical detection of carcinoembryonic antigen using a disposable aptasensor based on Pd and graphene

We prepared an electrochemical aptasensor for label-free analysis of carcinoembryonic antigen (CEA). Herein, PdNPs were synthesized on the surface of graphene-modified screen-printed carbon electrodes (Pd-GN/SPCE) via electrochemical method for immobilisation of CEA aptamer as a bio-recognition element. The morphological characterizations of the fabricated Pd-GN/SPCE were performed using SEM, EDX, and elemental mapping that confirmed the successful electrochemical deposition of PdNPs. A disposable aptasensor for ultrasensitive electrochemical measurement of CEA was proposed by immobilising CEA aptamer on Pd-GN/SPCE. The electrochemical measurements were performed using 5 mM [Fe(CN)6]3-/4- as a redox probe. The electrochemical deposition of PdNPs improved the electrical conductivity resulting in enhanced current response for the redox probe. When CEA antigen interacts with CEA aptamer, it reduces the oxidation and reduction current of [Fe(CN)6]3-/4- due to the attachment of biomolecules to the electrode surfaces that hinders the electron transfer. The current changes of the redox species before and after CEA binding were measured using DPV. The developed aptasensor possessed a wide calibration range of 0.002–200 ng/mL and detection limit of 1.0 pg/mL. The aptamer-immobilised electrode provides an exceptional selectivity, reproducibility, and sensitive measurement of CEA. Moreover, the effective sensing of CEA in human serum samples with great recoveries (99.4––106 %) demonstrated its capability for clinical analysis.

Feasibility, reliability and satisfaction of (automated) capillary carcinoembryonic antigen measurements for future home-based blood sampling: the prospective CASA-I study.

Follow-up for colorectal cancer (CRC) necessitates regular monitoring of carcinoembryonic antigen (CEA) at the hospital. Capillary home-based blood collection, including minimally invasive techniques such as lancet sampling or an automated upper arm device (TAP-II), has the potential to replace a significant portion of hospital-based blood sampling, thereby enhancing self-reliance and quality of life. The objectives of this study were to assess the feasibility, reliability and preference for CEA blood collection. Baseline venous and capillary (by lancet and TAP-II) blood samples were collected from 102 participants, including 20 CRC patients with elevated CEA levels, 60 CRC patients undergoing postoperative outpatient monitoring and 20 healthy volunteers. The second group performed capillary blood collections at home on two consecutive follow-up appointments and subsequently sent them to the hospital. Satisfaction was assessed via patient reported outcome measures on pain, burden, ease of use and preference. The Pearson's correlation test of all usable samples resulted in a linear coefficient of 0.998 (95% CI 0.997-0.998) for the TAP-II method and 0.997 (95% CI 0.996-0.998) for the lancet method, both compared to venipuncture. Following the initial blood collection, 86% of the participants (n = 102) favoured the TAP-II, rating it as the least painful and burdensome option. After two home-based blood samples, the preference for the TAP-II method persisted, with 64% of the patients endorsing its use. This study demonstrated the feasibility of home-based capillary sampling of CEA. The TAP-II blood collection is the most reliable method and is preferred by patients over venipuncture and lancet sampling.

Elevated Procalcitonin Levels can Occur in Bacterial Infections and also in Medullary Thyroid Carcinoma.

Procalcitonin (PCT) is a more stable and reliable biomarker than calcitonin for diagnosing and monitoring medullary thyroid carcinoma (MTC).Elevated carcinoembryonic antigen (CEA) levels effectively monitor MTC progression, especially when calcitonin levels are inconsistent.Incorporating PCT and CEA measurements into routine practice enhances MTC management, providing reliable biomarkers for diagnosis and monitoring.

Abstract 3637: Ultrasensitive assays for combined detection of CEA+ extracellular vesicles and soluble CEA

Abstract Colorectal cancer (CRC) is the third most common cancer worldwide and is the second leading cause of cancer death in the United States. Carcinoembryonic antigen (CEA) is a biomarker commonly used in the management of CRC. It is typically present at low levels in the blood of healthy adults but is elevated in CRC samples and some other cancers. CEA is most commonly used to monitor treatment efficacy and as a critical part of post-treatment surveillance for residual disease, recurrence, and/or progression/metastasis. The CRC recurrence rate averages >25%, and liver metastasis occurs in 25-30% of cases. Improved CEA assays could enable earlier determination of treatment failure, detection of lower levels of minimal residual disease (MRD) after treatment, or earlier detection of recurrence. CEA is a GPI-linked membrane protein secreted from CRC cells mainly by enzymatic cleavage of its GPI anchor. However, we have identified alternative secretion of CEA in association with extracellular vesicles (EVs). We hypothesized that the soluble CEA produced by canonical shedding and the alternatively secreted CEA may provide distinct information about the tumor or its microenvironment and serve as independent but complementary biomarkers of CRC. We developed ultrasensitive, multi-marker electrochemiluminescence (ECL) immunoassays for measuring intact EVs presenting CEA, CD73, or both in human plasma. We observed that plasma levels of CEA+EVs and CD73+EVs were elevated in some late-stage CRC samples compared to controls. CEA and CD73 double-positive EV (CEA+CD73+EVs) levels were also elevated in the same samples, exhibiting a 3-fold improved separation of these samples with CRC from controls, compared to detection of CEA+EVs. Additionally, approximately 25% of stage IV CRC samples had elevated CEA+EV and CEA+CD73+EV levels while exhibiting low soluble CEA. We confirmed this result in an independent sample set that included samples across all CRC stages, and also identified a few earlier-stage samples that exhibited high CEA+EVs and CEA+CD73+EVs without elevated soluble CEA. Since CEA+CD73+EVs and soluble CEA assays identified different subsets of samples, we combined the two assays into a single classifier for late stage CRC and controls, yielding improved receiver operator characteristic (ROC) with area under the curve (AUC) of 0.975 versus 0.927 for the standard soluble CEA assay or 0.788 for CEA+CD73+EVs alone. These results suggest that assaying EVs presenting multiple surface markers can increase specificity for the detection of tumor-derived EVs relative to a single marker and that assaying both soluble and EV-associated forms of CEA in plasma may improve the value of CEA measurement in CRC. Citation Format: Lucie Hebert, Misk Al-Ameen, Talis Spriggs, Collin Nelson, Evan A. Gizzie, Jeffrey L. Franklin, Robert J. Coffey, David A. Routenberg, Jacob N. Wohlstadter. Ultrasensitive assays for combined detection of CEA+ extracellular vesicles and soluble CEA [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3637.

Clinical and biological significance of microRNA-127 and microRNA-138 expression in women with breast cancer: response to treatment and survival impact

Background and ObjectiveGenetic and epigenetic changes characterize the multi-step process of breast carcinogenesis. It is believed that abnormal microRNA (miRNA) expression has a role in the onset and progression of breast cancer. This study aimed to examine the link between miRNA-127 and miRNA-138 and metastasis, tumor invasion, and apoptosis in Egyptian women with breast cancer, as well as their correlation with its molecular types.MethodologyA total of 150 participants were included in this study, including 75 women with breast cancer and 75 supposedly healthy women who were age and gender-matched. Every patient underwent a thorough physical examination, a general clinical examination, a mammogram, and lab tests, such as the determination of the levels of miRNA-127 and miRNA-138 expression by real-time PCR and the measurement of blood carcinoembryonic antigen (CEA) and carcinoma antigen 15–3 (CA15-3) and CA15-3 and CEA levels.ResultsThere was a significant low expression of miRNA-127 in favor of high TNM stage (Classification of Malignant Tumors), left-sided tumor, metastasis, high-grade disease, increased axillary nodal involvement, absence of estrogen and progesterone receptors, and low antigen Kiel 67 (Ki67) expression. Also, a significant expression of miRNA 127 in triple-negative breast cancer was found, followed by human epidermal growth factor receptor 2 (HER2/neu) overexpression, then luminal B, and the highest expression was with the Luminal A molecular subtype. A significant negative correlation existed between miRNA 127 and miRNA 138 with CEA and CA15.3 levels.ConclusionThe miRNA-127 and miRNA-138 suppression may promote metastasis. Consequently, the restoration of miRNA-127 and miRNA-138 in breast cancer may have therapeutic potential; so, the miRNA-127 and miRNA-138 may play a role in breast cancer development.

Prognostic models for colorectal cancer recurrence using carcinoembryonic antigen measurements.

Colorectal cancer (CRC) is one of the most prevalent cancers worldwide. A considerable percentage of patients who undergo surgery with curative intent will experience cancer recurrence. Early identification of individuals with a higher risk of recurrence is crucial for healthcare professionals to intervene promptly and devise appropriate treatment strategies. In this study, we developed prognostic models for CRC recurrence using machine learning models on a limited number of CEA measurements. A dataset of 1927 patients diagnosed with Stage I-III CRC and referred to Zuyderland Hospital for surgery between 2008 and 2016 was utilized. Machine learning models were trained using this comprehensive dataset, which included demographic details, clinicopathological factors, and serial measurements of Carcinoembryonic Antigen (CEA). In this study, the predictive performance of these models was assessed, and the key prognostic factors influencing colorectal cancer (CRC) recurrence were pinpointed. Among the evaluated models, the gradient boosting classifier demonstrated superior performance, achieving an Area Under the Curve (AUC) score of 0.81 and a balanced accuracy rate of 0.73. Recurrence prediction was shown to be feasible with an AUC of 0.71 when using only five post-operative CEA measurements. Furthermore, key factors influencing recurrence were identified and elucidated. This study shows the transformative role of machine learning in recurrence prediction for CRC, particularly by investigating the minimum number of CEA measurements required for effective recurrence prediction. This approach not only contributes to the optimization of clinical workflows but also facilitates the development of more effective, individualized treatment plans, thereby laying the groundwork for future advancements in this area. Future directions involve validating these models in larger and more diverse cohorts. Building on these efforts, our ultimate goal is to develop a risk-based follow-up strategy that can improve patient outcomes and enhance healthcare efficiency.

Diagnostic performance of intracystic carcinoembryonic antigen (CEA) versus glucose in differentiation of mucinous and non-mucinous pancreatic cysts.

Pancreatic cysts have various potential for malignant transformation. Differentiating mucinous from non-mucinous cysts is crucial to make the right decision about further management, since mucinous cysts carry the risk of malignancy. Using endoscopic ultrasound (EUS) guided fine needle aspiration to determine intracystic carcinoembryonic antigen (CEA) levels is the recommended method for identifying mucinous cysts, although intracystic glucose assessment has also proved to be an effective tool. This study aims to compare the diagnostic performance of intracystic glucose and CEA in distinguishing between mucinous and non-mucinous pancreatic cystic lesions. In this single center study, we prospectively collected and analyzed the data of 91 consecutive patients who underwent endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) with cytological analysis and measurement of intracystic CEA and glucose levels. The cyst type was classified based on radiological and EUS morphology, string sign, CEA, cytological and histological findings in resected cases. The diagnosis was established retrospectively by three experienced gastroenterologists blinded for glucose level in cases without definitive cytology or histology. We calculated the sensitivity, specificity, the positive- and negative predictive value of glucose and CEA respectively, and compared the two methods. The sensitivity of intracystic glucose versus CEA proved to be 96.2% vs. 69.2% in identifying mucinous cysts, while the specificity of glucose was shown to be 79.5%, compared to 100% for CEA. Intracystic glucose is a sensitive, easily accessible biomarker in identifying mucinous pancreatic cysts, however, the specificity is lower compared to CEA. The measurement of intracystic glucose level could help in decision-making in daily clinical practice, however the diagnostic performance of the method remains inferior to "through-the-needle" techniques, such as confocal laser endomicroscopy and Moray forceps biopsy.

A biosensor based on graphene oxide nanocomposite for determination of carcinoembryonic antigen in colorectal cancer biomarker

Colorectal cancer is still a major global health concern, and early detection and accurate biomarker analyses are critical to its successful management. This paper describes the design and testing of a new biosensor based on a graphene oxide (GO) nanocomposite for the exact measurement of carcinoembryonic antigen (CEA), a well-known biomarker for colorectal cancer. The current study attempted to create a highly sensitive immunosensor for sensitive measurement of CEA based on a polypropylene-imine-dendrimer (PPI) and GO nanocomposite on GCE (PPI/GO/GCE). The PPI/GO nanocomposite served as an appropriate biocompatible nanostructure with a large surface area for immobilizing carcinoembryonic antigen (anti-CEA) and bovine serum albumin (BSA) molecules (BSA/anti-CEA/PPI/GO/GCE), thereby promoting the selectivity of electrochemical immunosensors, according to structural and electrochemical studies. Results showed that the BSA/anti-CEA/PPI/GO/GCE as a selective, sensitive, and stable immunosensor revealed a wide linear response from 0.001 to 2000 ng/mL, and a limit of detection of 0.3 pg/mL, which indicated comparable or better performance towards the CEA immunosensors in recent reports in the literature. This was due to the synergetic effect of the GO nanosheets and PPI with porous structure and more conductivity. Analytical results showed values of RSD (4.49%–5.04%) and recovery (90.00%–99.98%) are suitable for effective and accurate practical assessments in CEA in clinical samples. The capacity of the BSA/anti-CEA/PPI/GO/GCE to determine CEA in human blood was studied.

Carcinoembryonic antigen (CEA) expression in human tumors: A tissue microarray study on 15,413 tumors.

e15181 Background: Carcinoembryonic antigen (CEA) is a cell surface glycoprotein which is overexpressed in various cancers but reported prevalence data vary considerably for many tumor types. Because of its overexpression in various cancer types and the limited expression in normal tissue CEA has become a potential drug target with several potential drug candidates currently being evaluated. CEA is also shed into the blood stream, so that CEA measurement in the serum is used as a tool for early detection and recurrence monitoring of cancer. Methods: To comprehensively determine CEA expression in normal and neoplastic tissues, a tissue microarray containing 15,413 samples from 120 different tumor types and subtypes as well as 76 different normal tissue types were analyzed by immunohistochemistry. Results: CEA was detectable in 65 (54.2%) of 120 tumor categories including 49 (40.8%) tumor types with at least one strongly positive case. CEA positivity was most common in colorectal adenomas (100%) and carcinomas (98.7%), other gastrointestinal adenocarcinomas (61.1%-80.3%), medullary carcinomas of the thyroid (96.3%), pulmonary adenocarcinoma (73.7%), mucinous carcinomas of the ovary (79.8%) and the breast (43.2%), squamous cell carcinomas of various sites (30.2%-69.1%), and small cell carcinomas of the lung (64.3%), the urinary bladder (38.9%), and the prostate (50.0%) as well as non-invasive papillary urothelial carcinoma pTa G3 (33,6%), pTa G2 high-grade (25,0%) and pTa G2 low-grade (5,7%). High CEA expression was linked to high grade tumors (p < 0.0001) and invasive growth (p < 0.0001) in urinary bladder cancer as well as estrogen receptor positivity (p = 0.0005) and HER2 positivity (p = 0,0158) in invasive breast cancer of no special type. In 1.250 colorectal adenocarcinomas, reduced CEA expression was associated with mismatch repair deficiency (p < 0.0001) but not with pT and pN stage. CEA expression level was unrelated to clinico-pathological tumor parameters in adenocarcinomas of the pancreas and the stomach, endometroid endometrium carcinoma as well as in serous and endometroid carcinomas of the ovaries. Conclusions: In summary, CEA is abundantly expressed in a broad range of epithelial neoplasms. Our data thus identify various tumor entities where CEA positive cancers might best benefit from CEA serum monitoring and anti-CEA therapies.

Carcinoembryonic antigen kinetics predict response to first-line treatment in metastatic colorectal cancer: Analysis from PRODIGE 9 trial.

To examine the relationship between carcinoembryonic antigen (CEA) kinetics and prognosis in metastatic colorectal cancer (mCRC) patients receiving first-line chemotherapy in the PRODIGE9 trial. Associations between monthly CEA measurements within 6 months since baseline and progression-free survival (PFS) were evaluated using a joint-latent class-mixed model. A validation set was used to test our prognosis model. Correlations between CEA trajectories (classes) and baseline characteristics were also investigated. Three classes were identified. Class 1 had low baseline CEA with small variations. Class 2 had high baseline CEA with a rapid decrease reaching the same CEA level at 6 months as in class 1. Class 3 had high baseline CEA with a transient decrease followed by an increase to reach, at 6 months, the same CEA level as at baseline. Six-month PFS was significantly lower in class 3 than in classes 1 and 2 (57% vs. 91% and 93% respectively; p<0.01). Class 3 was significantly associated with ECOG 2 status, a high LDH level and non-resected primary tumor. Variations in CEA kinetics correlate with prognosis in patients receiving first-line chemotherapy for mCRC. We propose here a user-friendly application to classify CEA trajectory.

Accurate method for value assignment of carcinoembryonic antigen reference materials.

In this study, we explored the commutability of reference materials (RMs) for carcinoembryonic antigen (CEA), selected the appropriate diluent matrix of the first International Reference Preparation (IRP) 73/601 of the World Health Organization (WHO 73/601) for CEA, and improved the comparability of CEA measurement results among different assay systems. Forty serum samples were divided into five aliquots. WHO 73/601 was diluted into nine concentrations using five diluents with different components, and the candidate RMs for CEA at five concentrations (C1-C5) were prepared by the Beijing Clinical Laboratory Center (BCCL). The samples were analyzed via five automated CEA immunoassays. Carcinoembryonic antigen candidate RMs were commutable among all immunoassays based on the CLSI approach and among 7 of 10 assay combinations based on the IFCC approach. WHO 73/601 diluted in phosphate-buffered saline (PBS) was commutable among all assays based on the CLSI approach and among 5 of 10 pairwise comparisons based on the IFCC approach with correction of bias at diluted concentrations, except for the lowest concentration, which had the smallest variation among systems. The median percentage biases among assays were decreased after calibration. The BCCL candidate RMs (C2-C5) for CEA were commutable among all immunoassays. WHO 73/601 RMs diluted in a PBS buffer matrix were selected as common calibrators for five immunoassays, which reduced bias, thereby effectively improving the harmonization of CEA detection; therefore, they could be used to assign values to CEA candidate RMs developed by BCCL. Our findings promote the harmonization of CEA detection in immunoassays.

Reliable capillary sampling of carcinoembryonic antigen at home: the CASA feasibility study.

Follow-up after colorectal cancer requires frequent surveillance of the tumour marker carcinoembryonic antigen (CEA). Home-based blood sampling could be beneficial in terms of patients' well-being and societal cost-effectiveness. Blood sampling by venepuncture is unsuitable for home-based sampling. The aim of this feasibility study is to evaluate the long-term whole-blood stability of CEA. In this prospective feasibility study capillary blood withdrawal was collected in a Hem-Col® microtube containing a patented stabilization buffer using an internal lithium standard to correct for dilution. Long-term whole-blood stability was considered adequate if the relative bias in CEA concentration between delayed analysis of capillary samples and directly processed venepuncture is within the total error margin of CEA. Twenty two colorectal cancer patients were included to determine the stability of CEA in capillary sampling compared with directly processed (i.e. within 2h) venepuncture sampling. The median time between venous sampling and CEA analysis and capillary sampling and CEA analysis was 2h (interquartile range 1-4h) and 76 h (interquartile range 74-95 h), respectively. A Bland-Altman difference plot excluding outliers showed an overall relative bias of -1.23%. The two capillary samples in our outlier analysis also showed the highest lithium concentrations. Home-based capillary sampling with the use of the Hem-Col® buffer is a feasible method for CEA determination when analysed within 4 days after blood withdrawal, allowing monitoring for colorectal cancer patients from home. High lithium concentrations due to insufficient filling of the Hem-Col® tube suggest less reliable CEA measurements.

Value of peripheral blood circulating tumor cell detection in the diagnosis of thoracic diseases and the prediction of severity.

Circulating tumor cell (CTC) detection, as a noninvasive liquid biopsy method, has been used in the diagnosis, prognostic indication, and monitoring of a variety of cancers. In this study, we aimed to investigate whether CTC detection could be used in the early diagnosis and prediction of severity of thoracic diseases. We enrolled 168 thoracic disease patients, all of whom underwent pathological biopsy. Carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) measurement was also performed in 146 patients. There were 131 cases of malignant thoracic diseases and 37 cases of benign lesions. We detected CTCs in a 5ml peripheral blood sample with the CTCBiopsy® system and analyzed the value of CTC count for predicting disease severity. Of 131 patients with a diagnosis of thoracic malignancy, CTCs were found in blood samples from 122 patients. However, only 2 out of 37 patients with benign thoracic disease had no detectable CTCs. There was no significant correlation between CTC count and benign and malignant lesions (P = 0.986). However, among 131 patients who had been diagnosed with malignant lesions, 33 had lymph node metastasis or distant metastasis. The presence of CTCs was significantly correlated with metastasis (P = 0.016 OR = 1.14). The area under the receiver operating characteristic (ROC) curve was 0.625 (95% confidence interval (CI), 0.519 to 0.730 P = 0.032). In addition, with stage IA1 as the cutoff, all patients were further divided into an early-stage group and a late-stage group. CTC count was significantly correlated with disease progression (P = 0.031 OR = 1.11), with an area under the curve (AUC) of 0.599 (95% CI, 0.506-0.692 P = 0.47). The sensitivity and specificity of CTC detection for the diagnosis of disease stage were 72.3% and 45.5%, respectively. In addition, the cutoff of 2.5 CTCs was the same when predicting disease metastasis and staging. Furthermore, the combination of CTC count, demographic characteristics and tumor markers had better predictive significance for disease staging. CTC count can effectively indicate the stages and metastasis of thoracic diseases, but it cannot differentiate benign and malignant diseases.

3D porous CS-AuNPs-PEDOT-PB nanocomposite cryogel for highly sensitive label-free electrochemical immunosensor for carcinoembryonic antigen determination

An electrochemical immunosensor was developed to determine carcinoembryonic antigen (CEA). A sensor platform was created using a three-dimensional (3D) porous chitosan cryogel incorporating poly(3,4-ethylenedioxythiophene), Prussian blue, and gold nanoparticles modified screen-printed carbon electrode (CS-AuNPs-PEDOT-PB cry/SPCE). The platform was activated with anti-CEA and measurement of CEA was based on the formation of an immunocomplex proportional to CEA concentration in the sample. CEA was detected using differential pulse voltammetry, which measured the change in reduction peak current of PB in response to the immunocomplex formed. Crucially, PEDOT stabilized PB and amplified the redox current of PB. Under optimal conditions, the proposed immunosensor displayed a high sensitivity, a linear range from 1.0 × 10−4 to 1.0 × 103 pg mL−1, and a detection limit of 5.05 × 10−5 pg mL−1 in 0.10 mol L−1 phosphate buffer containing 0.10 mol L−1 KCl (PBS) (pH 7.00). Reproducibility was excellent (RSD of less than 5.3 %, n = 6), and reusability (sensitivity > 90 % for 36 individual CEA measurements), stability (90 % sensitivity at 5 weeks), and selectivity were good. Additionally, this electrochemical immunosensor successfully quantified CEA in real samples, achieving good recoveries and results agreed (P > 0.05) with the immunoturbidimetry technique.

Electrochemical ratiometric dual-signal immunoassay for accurate detection of carcinoembryonic antigen in clinical serum based on rGO-Pd@Au-Thi and Chi-Fc-Au

For prevention and early diagnosis of carcinoembryonic antigen (CEA), it is necessary to develop more accurate approaches for its detection. In this work, a new sensitive electrochemical ratiometric immunosensor for the determination of CEA was constructed on account of chitosan-ferrocenecarboxaldehyde-gold nanospheres (Chi-Fc-Au) and reduced graphene oxide-Pd@Au nanocomposits-thionine (rGO-Pd@Au-Thi) with dual-signal output. The immunosensor utilized Chi-Fc-Au as the substrate to anchor the primary antibody (Ab1) and rGO-Pd@Au-Thi as the secondary antibody (Ab2) label probe, generating two electrical signals (IFc and IThi) derived from Fc and Thi in the presence of CEA, respectively. With the increase of CEA concentration, the IFc and IThi showed opposite changes, so the peak current ratio of IThi/IFc was positively correlated with CEA concentration. In comparison with other immunosensors especially single-signal mode, the proposed immunosensor exhibited a wider linear range (10–4−200 ng mL−1) and a lower detection limit (14.9 fg mL−1), which could be applied in human serum samples for CEA measurement, and was comparable to commercial electrochemiluminescence (ECL) immunoassay. Given the significantly improved accuracy of the constructed sensor, it is expected to be applied in clinical diagnosis for other protein biomarkers determination.

Prognostic Role of Carcinoembryonic Antigen (CEA) in Colorectal Carcinoma

Background: Preoperative carcinoembryonic antigen (CEA) level is considered as a factor predictive of survival in colorectal cancer patients. Patients with normal (&lt;5 ng/ml) or lower pre- operative CEA levels were reported to have significantly longer survival. Objective: To evaluate the prognostic significance of preoperative CEA levels of patients with colorectal cancer in Taiwan. Methods: Between Jan 2016 and Dec 2017, 39 patients with histologically confirmed colorectal cancers were evaluated retrospectively at the General Surgery Department of Hayatabad Medical Complex Peshawar. All patients had undergone potentially curative surgery. Patients with metastatic diseases were not included. 5-Fluorouracil-based adjuvant chemotherapy was administered if the patients had Dukes’ C disease. Reference to the Dukes’ classification was according to the classical criteria described in 1932 for carcinoma of the rectum and adapted for use in colonic tumors. Data on gender, age, degree of tumor differentiation, location of the tumor, tumor size, lymph node metastasis, penetration of the bowel wall and preoperative CEA levels were analyzed to deter mine their association with survival. Blood samples for CEA measurement were taken a few days before operation and were analyzed using the radioimmunoassay method. Results: Total 39 patients were included in the study. Age ranged between 30-80 years with a mean age of 55 years. There were 26(66.7%) males and 13(33.3%) females, with male to female ratio of 2:1. Patients with preoperative CEA levels of &lt;5 ng/ml had significantly longer survival than those with preoperative CEA levels of &gt;5 ng/ml. The median 5 years survival rate for patients with preoperative CEA &lt;5 ng/ml was 51.2 months, while 35.5 years for &gt;5 ng/ml patients respectively (p &lt; 0.001). The tumour was primary located at the colon in 23(59%) while the rest was found at the rectum 16(41%). Tumour size was &lt;2cm in 25(64.1%) and &gt;2cm in 14(35.9%) patients. ...............

Study of carcinoembryonic antigen tumor marker in gastrointestinal pathology

Background: Cancer mortality and morbidity has been increased in recent years, with gastrointestinal cancers comprising the majority of overall malignant conditions. All Indian cancer registries identify the digestive system as the most common cancer site in males. In women, breast cancer exhibits the highest occurrence, followed by cancers of the genital organs and the digestive system. Tumor markers are usually proteins or glycoproteins produced by the body in response to cancerous growth or by the cancer tissue that are possible to detect in serum, urine, or tissue samples. CEA assay is an inexpensive and easy to perform test; however, repeated measurements to monitor disease, follow up and the response to therapy contribute to higher costs and increase laboratory workload. Materials and Methods: The present study was carried out on 100 patients. Type of sample includes blood sample in plain vacutte received in tumor marker section of the pathology department. Objective: To make a comparative analysis of CEA in various gastrointestinal lesions.  Pre and post operative study of Serum CEA in known case of gastrointestinal carcinoma.  To study the factors affecting serum CEA concentrations. Results: The present study was conducted from June 2018 to December2020 in the Department of Pathology, at tertiary care hospital, 100 cases were studied. Preoperative and postoperative mean CEA value, Mean CEA value in inflammatory, Benign and Malignant lesions as well as in well, moderately and poorly differentiated carcinoma were measured.Conclusion: In general, this study showed that serum CEA levels are increased in people with habit of cigarette smoking and in benign and inflammatory lesions of GIT along with Malignant GI lesions. Carcinoembryonic antigen (CEA) usually normalizes after surgery. After curative resection of primary CRC (colorectal carcinoma), a large number of patients' CEA levels declined to normal values within 4-6 weeks. Amongst many contradictory results, the measurement of CEA is a useful method for screening, diagnosis, follow-up and treatment of CRC but Physiological influences that need to be considered in interpreting the results include effects of aging and smoking. Serum CEA values fails to decline in patients with distant metastasis and advanced disease even after complete surgical removal of the tumour. Serum concentrations of CEA tend to be higher in patients with well-differentiated tumors compared with those with poorly differentiated tumors.

Racial and Ethnic Differences in Elective Versus Emergency Surgery for Colorectal Cancer.

To evaluate differences in presentation and outcomes of surgery for colorectal cancer. Although racial and socioeconomic disparities in colorectal cancer outcomes are well documented, disparities in access affecting disease presentation are less clear. We conducted a statewide retrospective study of patients who underwent resection for colorectal cancer between January 1, 2015, and April 30, 2021. The primary outcome was undergoing emergency surgery. Secondary outcomes included preoperative evaluation and postoperative outcomes. Covariates of interest included race/ethnicity, social deprivation index, and insurance type. A total of 4869 patients underwent surgery for colorectal cancer, of whom 1122 (23.0%) underwent emergency surgery. Overall, 28.1% of Black non-Hispanic patients and 22.5% of White non-Hispanic patients underwent emergency surgery. On multivariable logistic regression, Black non-Hispanic race was independently associated with a 5.8 (95% CI, 0.3-11.3) percentage point increased risk of emergency surgery compared with White non-Hispanic race. Patients who underwent emergency surgery were significantly less likely to have preoperative carcinoembryonic antigen measurement, staging for rectal cancer, and wound/ostomy consultation. Patients who underwent emergency surgery had a higher incidence of 30-day mortality (5.5% vs 1.0%, P <0.001), positive surgical margins (11.1% vs 4.9%, P <0.001), complications (29.2% vs 16.0%, P <0.001), readmissions (12.5% vs 9.6%, P =0.005), and reoperations (12.2% vs 8.2%, P <0.001). Among patients with colorectal cancer, Black non-Hispanic patients were more likely to undergo emergency surgery than White non-Hispanic patients, suggesting they may face barriers to timely screening and evaluation. Undergoing emergency surgery was associated with incomplete oncologic evaluation, increased incidence of postoperative complications including mortality, and increased surgical margin positivity. These results suggest that racial and ethnic differences in the diagnosis and treatment of colorectal cancer impact near-term and long-term outcomes.

Prognostic Role of Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 in Stage IV Colorectal Cancer.

We investigated the association of the levels of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) with prognosis in patients with stage IV colorectal cancer at diagnosis. In this multicenter retrospective cohort study, patients with serum CEA and CA19-9 measured at diagnosis of stage IV colorectal cancer were included. The cutoff values were 5 ng/ml for CEA and 37 U/ml for CA19-9. Patients were categorized into four groups: those with normal levels for both CEA and CA19-9; those with only an elevated CEA level; those with only an elevated CA19-9 level; and those with elevated levels of both. A total of 825 patients were included. Among them, 132 (16.0%) had normal levels for both markers, 258 (31.3%) had an elevated CEA level only, 33 (4.0%) had an elevated CA19-9 level only, and 402 (48.7%) had elevated levels of both CEA and CA19-9. Compared with patients with normal levels for both CEA and CA19-9, the multivariate hazard ratio for overall survival was 1.24 (95% confidence interval=0.95-1.62, p=0.12) for those with elevated CEA only, 2.04 (95% confidence interval=1.31-3.17, p=0.002) for those with elevated CA19-9 only, and 1.82 (95% confidence interval=1.41-2.32, p<0.001) in those with elevation of both CEA and CA19-9. Elevation of CEA alone was not prognostic. Elevation of only CA19-9 at diagnosis was associated with a worse prognosis in patients with stage IV colorectal cancer. The combined measurement of CEA and CA19-9 can be helpful as a predictive tool for the prognosis of stage IV colorectal cancer.

Pre- and Postoperative Levels of Carcinoembryonic Antigen in Microsatellite Stable Versus Instable Colon Cancer: a Retrospective Analysis.

The prognosis of microsatellite stable (MSS) versus instable (MSI) tumors is an ongoing matter of debate, with differences in expression of carcinoembryonic antigen (CEA) in these two tumor subsets being inconsistently reported to date. The aim of this study was to investigate CEA expression in the context of clinical parameters in MSS and MSI tumors. Clinical, pathological, and biochemical parameters of colon cancer patients who underwent curative surgery were documented in a database and compared between MSS and MSI cases. The pre- to postoperative trend of CEA was analyzed. Survival was assessed using the Kaplan-Meier (log rank) test. One hundred sixty-nine patients were included in the study. Compared to those with MSS tumors, there was a higher proportion of preoperatively elevated CEA among those with MSI tumors (p = 0.067). Median CEA values decreased over the pre- to postoperative course with MSS (p = 0.01) but not MSI (p = 0.093) tumors. The distribution of N classification differed between MSS and MSI tumors (p = 0.014). Patients with MSI tumors had superior survival. Despite the better prognosis, MSI tumors are associated with increases in CEA. Our findings shed light on discrepancies related to the prognostic evaluation of MSI tumors. Furthermore, in follow-up of colorectal cancers, CEA measurements should be interpreted differently for MSI and MSS tumors.