Carcinoembryonic Antigen Values Research Articles

Rectal Cancer With Distally Spreading Intramural Metastasis: A Case Report and Review of the Literature

Introduction: Intramural metastasis (IM) is common in esophageal cancer, and it is an important factor in determining the resection area and tumor malignancy. However, IM is rare in rectal cancer; therefore, little is known about IM in rectal cancer, and the clinical significance remains unclear. Case Presentation: We describe a case of rectal cancer with distally spreading IM. A 58-year-old man consulted a primary care physician, with a chief complaint of constipation; tests revealed a high carcinoembryonic antigen value. A colonoscopy revealed a type 2, advanced rectal tumor, which covered two-thirds of the circumference of the upper rectum. In addition, 3 protruding lesions were observed under the normal mucosa on the anal side of the primary tumor. A laparoscopic low anterior resection was performed. Pathologic findings showed that the primary tumor was a moderate-to-well-differentiated adenocarcinoma with a cribriform structure. The 3 lesions on the anal side found under normal mucosa were separate from the primary tumor, but morphologically similar to the primary adenocarcinoma; therefore, these were diagnosed as IMs. Based on a review of previous case reports, rectal carcinomas were often accompanied by vascular invasions and lymph-node metastases. Moreover, in rectal cancer, tumors with IMs often show vascular invasion. Therefore, we assumed that IM could be a marker of poor prognosis. Conclusion: This study revealed that, in surgery, detection of a distally spreading IM is an important finding for determining the optimal surgical resection margin.

Single and combined use of neutrophil–lymphocyte ratio, platelet–lymphocyte ratio and carcinoembryonic antigen in diagnosing gastric cancer

To investigate the value of neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and carcinoembryonic antigen (CEA), alone or in combination, in diagnosing gastric cancer (GC), we retrospectively analyzed a cohort of 201 patients with GC, 161 patients with benign gastric lesions, and 157 healthy subjects. We obtained routine blood indices and CEA levels to evaluate the diagnostic value of NLR, PLR and CEA for GC, based on receiver operating characteristic (ROC) curves. We found that serum NLR, PLR and CEA in the GC group were significantly higher than those in the benign lesion group (PNLR < 0.001,PPLR < 0.001,PCEA = 0.034) or the healthy control group (PNLR < 0.001,PPLR < 0.001,PCEA = 0.028). Moreover, there were significant differences in NLR and PLR among different serosa invasion, lymph node metastasis, tumor size and stage. CEA showed a difference in distant metastasis and tumor size. Combining PLR with CEA produced a larger AUC (AUC: 0.780, 95% CI: 0.734–0.822) than using PLR (P = 0.011) or CEA (P < 0.001) alone. Similarly, NLR + CEA produced a larger AUC (AUC: 0.756, 95% CI:0.709–0.800) than using NLR (P = 0.004) or CEA (P = 0.001) alone. Whereas NLR, PLR and CEA are known to help distinguish GC from benign gastric lesions, combining CEA with PLR or NLR offers better diagnostic value for GC than any of them used alone.

Independent prognostic impact of preoperative serum carcinoembryonic antigen and cancer antigen 15-3 levels for early breast cancer subtypes

BackgroundAlthough the prognosis for operable breast cancers is reportedly worse if serum carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA15-3) levels are above normal, the usefulness of this prognosis is limited due to the low sensitivity and specificity; in addition, the optimal cutoff levels remain unknown.MethodsA total of 1076 patients who were operated for breast cancers (test set = 608, validation set = 468) without evidence of metastasis were recruited, and their baseline and postoperative serum CEA and CA15-3 levels were analyzed. The optimal cutoff values of CEA and CA15-3 for disease-free survival (DFS) were 3.2 ng/mL and 13.3 U/mL, respectively, based on receiver operating characteristic curve and area under the curve analyses.ResultsThe DFS of patients with high CEA levels (CEA-high: n = 191, 5-year DFS 70.6%) was significantly worse (p < 0.0001) than that of CEA-low patients (n = 885, 5-year DFS 87.2%). There was a significant difference in DFS (p < 0.0001) between CA15-3-high and CA15-3-low patients (n = 314 and n = 762, respectively; 5-year DFS 71.8 vs. 89.3%). Significant associations between DFS and CA15-3 levels were observed irrespective of the subtypes. Multivariable analysis indicated that tumor size, lymph node metastasis, tumor grade, and CEA (p = 0.0474) and CA15-3 (p < 0.0001) levels were independent prognostic factors (hazard ratio [HR] 1.520, 95% confidence interval [CI] 1.005–2.245 for CEA; HR 2.088, 95% CI 1.457–2.901 for CA15-3).ConclusionsThese findings suggest that CEA and CA15-3 levels might be useful for predicting the prognosis of patients with operable early breast cancer irrespective of the subtype. Serum levels at baseline may reflect tumor characteristics for metastatic potential even when these levels are within the normal ranges.

Evaluation of the diagnosis value of carcinoembryonic antigen in malignant pleural effusion

Objective: To investigate the diagnostic value of serum and pleural fluid carcinoembryonic antigen (CEA) for malignant pleural effusion (MPE). Methods: The concentration of CEA in serum and pleural fluid of 286 patients with the diagnosis confirmed by pleural biopsy through medical thoracoscopy were retrospectively analyzed. MPE was confirmed in 171 cases which were divided into two groups (adenocarcinoma group with 121cases and non-adenocarcinoma group with 50 cases) and benign pleural effusion in 115 cases. The optimal cutoff for MPE and MPE caused by adenocarcinoma were determined by using the ROC curve. Results: The concentration of serum CEA 12.27(3.80, 58.45) μg/L was significantly higher in MPE caused by adenocarcinoma than that of non-adenocarcinoma 1.91(1.08, 4.55) μg/L and benign effusion 1.32(0.86, 2.27) μg/L (both P<0.001), but there was no statistically significant difference between benign and non-adenocarcinoma effusion (P=0.728). The concentration of pleural fluid CEA 160.70(30.48, 1 000.00) μg/L was significantly higher in MPE caused by adenocarcinoma than that of non-adenocarcinoma 1.77(0.51, 11.39) μg/L and benign effusion 1.09(0.60, 1.68) μg/L (both P<0.001), and higher in non-adenocarcinoma effusion than that of benign effusion (P<0.05). The cutoff value of serum and pleural fluid CEA for MPE was 3.10 and 5.83 μg/L, the sensitivity respectively was 67.3% and 74.3%, the specificity respectively was 87.8% and 98.3%, positive predictive value respectively was 89.2% and 98.5%, negative predictive value respectively was 64.3% and 72.0%. The cutoff value of serum and pleural fluid CEA for MPE caused by adenocarcinoma was 3.54 and 7.30 μg/L, the sensitivity respectively was 76.0% and 91.7%, the specificity respectively was 74.0% and 72.0%, positive predictive value respectively was 87.6% and 88.8%, negative predictive value respectively was 56.1% and 78.3%. Conclusions: The concentration of serum and pleural fluid CEA have diagnostic significance to MPE, especially MPE caused by adenocarcinoma. The diagnostic value of pleural fluid CEA is superior to serum CEA.

Can carcinoembryonic antigen replace computed tomography in response evaluation of metastatic colorectal cancer?

Introduction: Response Evaluation Criteria in Solid Tumours (RECISTs 1.1) define computed tomography (CT) as the gold standard in response evaluation of patients with metastatic colorectal cancer (mCRC) who are undergoing chemotherapy. The aim of this study was to evaluate whether carcinoembryonic antigen (CEA), which is cheaper and easier to perform, can replace repeated CT.Material and methods: The study included 66 patients with non-resectable mCRC participating in a phase I–II study. CEA values were determined, and CT images were taken every 2 months. CT images were externally and retrospectively reviewed according to the RECIST 1.1 criteria. Different cut-off values for CEA change in percent (DeltaCEA%) compared with baseline or nadir value underwent testing to find patients with disease control (that is stable disease, partial or complete response) at 2, 4, 6 and 8 months, in order to identify those who could have continued with chemotherapy based on CEA values alone. CT verification is needed in progressive disease (PD), and therefore identifying PD patients was our secondary endpoint.Results: The results showed that by using a cut-off value of 0 for DeltaCEA%, disease control was seen in all patients at all measuring points (negative predictive value (NPV) = 1.0). Secondarily, increasing CEA was able to identify all PD patients (sensitivity (Se) = 1.0) and in 50–74% of the patients increasing CEA provided a lead time to PD on upcoming CT. It was possible to replace CT with CEA in all patients with decreasing CEA, meaning that 23–47% of CT scans could have been avoided at any given time point.Conclusion: When the CEA level at a certain measuring point is the same or lower than CEA at baseline or at nadir (the measuring point with the lowest CEA value) during treatment, CEA can replace CT.

Inhibitory Effect of Viola odorata Extract on Tumor Growth and Metastasis in 4T1 Breast Cancer Model.

Viola odorata as a medical herb is used in liver disorders and relieving cancer pain. In the present study, the cytotoxic, antioxidant, and anti-metastatic properties of Viola odorata hydro-alcoholic extract (VOE) were investigated in 4T1 breast cancer model. After treatment of 4T1 breast cancer cells with VOE, cell viability was measured by MTT assay. The implanted mice were treated with different concentration of VOE (50, 150 and 250 mg/kg) for 21 days. Levels of lactate dehydrogenase (LDH), γ -glutamyl transferase (GGT), alkaline phosphatase (ALP), carcinoembryonic antigen (CEA) and cancer antigen 15-3(CA15-3) in serum, and also catalase (CAT) and superoxide dismutase (SOD) activities in tumor tissue were measured. Metastatic rate was investigated in liver, spleen and lung tissues. VOE decreased cell viability of 4T1 cells, significantly. VOE significantly inhibited the cell proliferation, but not vasculature in the tumors that revealed by immunohistochemical analysis for Ki-67 and CD31 expression, respectively. VOE increased the Bax/Bcl-2 ratio in VOE250-treated group compared to control group. Serum analysis showed that treatment with 250 mg/kg of VOE significantly reduced LDH (not ALP and GGT) levels compared to controls. No linear correlation was found between the values of CEA and CA15-3 with tumor size. The rate of CAT activity was increased in VOE250-treated rats whereas, CAT and SOD activities were reduced in VOE50 group. VOE250 significantly decreased the metastatic rate in liver and lung compared to the other doses of VOE. Consequently, Viola odorata has cytotoxic effects on 4T1 cells and affects antioxidant activity and metastasis in breast cancer.

Preoperative Serum Markers Prognostic Evaluation in Colon Cancer Patients

Aim: Demonstrate that preoperative tumor markers are prognostic factor in colon rectal cancer and their high levels are correlated with bad prognosis.Methods: We retrospectively analyzed two hundred and thirty-one patients affected by colorectal cancer who underwent radical surgery between January 2012 and August 2016 from a prospectively collected database. The study group consisted of 224 patients: 132 men and 92 women. Demographic details, surgical procedure, histopathologic diagnosis, and survival data were prospectively collected and retrospectively reviewed for this study. Normal cut off values for Carcinoembryonic antigen (CEA) and Carbohydrate Antigen 19.9 (CA 19.9) were respectively 5 ng/ml and 35 UI/ml. A P-value<0.05 was deemed to be statistically significant.Results: Tumor location was 94 times on ascending colon (42%), 13 on transverse colon (5.8%), 77 on descending colon (34.4%) and 40 on rectum (17.8%). All tumors were histologically diagnosed as adenocarcinoma of the colon-rectum and staged according to the TNM staging system. Preoperative serum CEA level was significantly associated only with T stage and serum albumin level; whereas there were no statistically significant differences between preoperative serum CA19.9 and patients’ clinical pathologic characteristics. Overall survival (OS) and disease-free survival (DFS) showed a statistically significant difference in the two groups of patients who are dichotomized according to the normal cut-off value of CEA and Ca 19.9. At the multivariate analysis both preoperative CEA and Ca 19.9 resulted as independent prognostic factor for survival with a p<0.05.Conclusion: These two tumor markers could have a role as prognostic factors leading to a stricter postsurgical follow up in those patients with elevated preoperative values.Core tip: Preoprative measurement of Cea and Ca19.9 is a cheap and routine exam. Their role could help to identify patients with poor prognosis in the preoperative period and to strictly follow up them in the post-surgical setting.

AB016. Pleurectomy/decortication for malignant pleural mesothelioma

AB016. Pleurectomy/decortication for malignant pleural mesothelioma

Clinical significance of carcinoembryonic antigen in peritoneal fluid detected during operation in stage I–III colorectal cancer patients

Background/AimsEarly diagnosis of peritoneal metastases in patients with colorectal cancer (CRC) can influence patient prognosis. The aim of this study was to identify the clinical significance of carcinoembryonic antigen (CEA) in peritoneal fluid detected during operation in stage I–III CRC patients.MethodsBetween April 2009 and April 2015, we reviewed medical records from a total of 60 stage I–III CRC patients who had peritoneal fluid collected during operation. Patients who had positive cytology in the assessment of peritoneal fluid were excluded. We evaluated the values of CEA in peritoneal fluid (pCEA) to predict the long-term outcomes of these patients using Kaplan-Meier curves and Cox regression models.ResultsThe median follow-up duration was 37 months (interquartile range, 21–50 months). On receiver operating characteristic analysis, pCEA had the largest area under the curve (0.793; 95% confidence interval, 0.635–0.950; P=0.001) with an optimal cutoff value of 26.84 (sensitivity, 80.0%; specificity, 76.6%) for predicting recurrence. The recurrence rate was 8.1% in patients with low pCEA (<26.84 ng/mL, n=37), and 52.2% in patients with high pCEA (≥26.84 ng/mL, n=23). In multivariate Cox regression analysis, high pCEA (≥26.84 ng/mL) was a risk factor for poor cancer-free survival (CFS) in stage I–III patients.ConclusionsIn this study, we determined that high pCEA (≥26.84 ng/mL) detected during operation was helpful for the prediction of poor CFS in patients with stage I–III CRC.

Diagnostic Value of Carcinoembryonic Antigen in Ascites for Colorectal Cancer with Peritoneal Carcinomatosis.

Diagnostic tests for carcinoembryonic antigen (CEA) in ascites have been performed in various malignant cases, but there is only few data on the applicability of CEA for colorectal cancer (CRC) patients with peritoneal carcinomatosis. We aimed to determine the usefulness of CEA in ascites (aCEA) as a diagnostic parameter for CRC with peritoneal carcinomatosis. Between January 2000 and May 2013, the medical records of 259 patients who underwent paracentesis for the evaluation of ascites were retrospectively reviewed. CRC patients with ascites (n=82) and patients with non-malignant ascites (n=177) were evaluated. Patients who had other malignancies, including gastric or ovarian cancer, with ascites were excluded. The optimal diagnostic cut-off value of aCEA for CRC with peritoneal carcinomatosis was determined using receiver operating characteristic curve analysis. The value of aCEA for predicting the occurrence of peritoneal carcinomatosis was evaluated using a logistic regression model. The optimal cut-off value of aCEA to diagnose CRC with peritoneal carcinomatosis was 3.89 ng/mL, and the area under the curve for aCEA was 0.996 (sensitivity 96.3%, specificity 100%, positive predictive value 100%, negative predictive value 98.3%). Multivariate logistic regression analysis showed that aCEA was an independent factor predicting the occurrence of peritoneal carcinomatosis. In this study, we showed that aCEA may be a useful parameter for diagnosing CRC with peritoneal carcinomatosis, and we propose an optimal aCEA cut-off value of 3.89 ng/mL. Further study that includes patients with other malignant ascites may be necessary to validate these findings.

Postoperative CEA is a better prognostic marker than CA19-9, hCGβ or TATI after resection of colorectal liver metastases.

Liver metastases of colorectal cancer can be operated with a curative intent in selected cases. However, more than half of the patients have a recurrence. The aim of this study was to evaluate the prognostic and predictive value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), human chorionic gonadotropin β (hCGβ) and tumour-associated trypsin-inhibitor (TATI) in colorectal cancer patients before and 3 months after resection of liver metastases. Marker concentrations were determined in blood samples from 168 colorectal cancer patients, who underwent liver resection between the years 1998 and 2007 at Helsinki University Hospital, Finland. The samples were taken before and 3 months after curative resection. Increased concentrations of CEA (>5 µg/L) and hCGβ (>1 pmol/L) 3 months after liver resection correlated with recurrence and impaired overall survival and increased CA19-9 (>26 kU/L) with impaired overall survival, but postoperative TATI was not prognostic. Preoperatively elevated CEA and CA19-9 correlated with impaired overall survival, but not with recurrence. Neither preoperative hCGβ nor TATI was prognostic. In conclusion, CEA is a useful prognostic marker, when measured 3 months after resection of colorectal liver metastases. CA19-9 also has prognostic significance and may have additional value.

Correction: Kinetic change of serum carcinoembryonic antigen can early predict progression in patients with metastatic non-small cell lung cancer during maintenance therapy with bevacizumab plus pemetrexed.

[This corrects the article DOI: 10.18632/oncotarget.20456.].

Diagnostic accuracy of tumor markers for malignant pleural effusion: a derivation and validation study.

The utility of tumor markers (TMs) for differentiating malignant pleural effusion (MPE) from benign pleural effusion (BPE) has been a subject of controversy. The majority of published studies are single center designed and lack validation. We performed a derivation and validation study in China to evaluate the diagnostic value of carcinoembryonic antigen (CEA) as well as carbohydrate antigen (CA) 15-3, CA 19-9 and CA 125 to differentiate between MPE and BPE. Three hundred and twenty seven pleural effusion (PE) and paired serum samples were collected from consecutive patients with MPE or BPE in Beijing (174 patients, derivation) and Wuhan (153 patients, validation) during the same period. The concentrations of four TMs were tested using chemiluminescent microparticle immunoassay technology. The performance of the TMs was analyzed by standard receiver operating characteristic (ROC) curves. The levels of four TMs were significantly higher in MPE than in BPE and the corresponding serum. The concentrations of CEA and CA 15-3 were more stable than the concentrations of CA 125 and CA 19-9. CEA was the best single marker for discriminating MPE from BPE. With a specificity of 100% in the total population, the highest sensitivity (37.8%) using serum was found in CEA. In addition, CEA presented 19.8% sensitivity in PE and 18.0% sensitivity in the Δ(PE-serum). For CA 15-3, the sensitivity was 32.4% in PE, 15.3% in the PE/serum ratio and 25.2% in the Δ(PE-serum). CEA and CA 15-3 rather than CA 125 and CA 19-9 are more reliable to differentiate between MPE and BPE. The use of the Δ(PE-serum) value in TMs, such as CEA and CA 15-3, may improve the sensitivity and specificity of the diagnosis etiology of PE.

Diagnostic and prognostic value of CEA, CA19\u20139, AFP and CA125 for early gastric cancer

BackgroundThe diagnostic and prognostic significance of carcinoembryonic antigen (CEA), carbohydrate associated antigen 19–9 (CA19–9), alpha-fetoprotein (AFP) and cancer antigen 125 (CA125) in early gastric cancer have not been investigated yet. Thus, the present study aimed to explore the diagnostic and prognostic significance of the four tumor markers for early gastric cancer.MethodsFrom September 2008 to March 2015, 587 early gastric cancer patients were given radical gastrectomy in our center. The clinicopathological characteristics were recorded. The association between levels of CEA and CA19–9 and clinicopathological characteristics and prognosis of patients were analyzed.ResultsThere were 444 men (75.6%) and 143 women (24.4%). The median age was 57 years (ranged 21–85). The 1-, 3- and 5-year overall survival rate was 99.1%, 96.8% and 93.1%, respectively. The positive rate of CEA, CA19–9, AFP and CA125 was 4.3%, 4.8%, 1.5% and 1.9%, respectively. The positive rate of all markers combined was 10.4%. The associations between the clinicopathological features and levels of CEA and CA19–9 were analyzed. No significant association was found between CEA level and clinicopathological features. However, elevated CA19–9 level was correlated with female gender and presence of lymph node metastasis. Age > 60 years old, presence of lymph node metastasis and elevation of CEA level were independent risk factors for poor prognosis of early gastric cancer.ConclusionsThe positive rates of CEA, CA19–9, APF and CA125 were relatively low for early gastric cancer. Elevation of CA19–9 level was associated with female gender and presence of lymph node metastasis. Elevation of CEA level was an independent risk factor for the poor prognosis of early gastric cancer.

Tumor Marker Kinetics as Prognosticators in Patients with Unresectable Gallbladder Adenocarcinoma Undergoing Palliative Chemotherapy.

Background/AimsTo determine the prognostic value of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 in gallbladder cancer (GBC) during palliative chemotherapy.MethodsOne hundred and twenty-three patients with pathologically confirmed unresectable GBC were included. Differences in serum CEA and CA 19-9 levels before and after chemotherapy were measured. Receiver operating characteristic curve analysis, Kaplan-Meier analyses of CEA, CA 19-9, and combined changes were performed to assess the optimal cutoff values and survival rates.ResultsPatients with decreased tumor markers had significantly better progression-free survival (PFS) and overall survival (OS) than patients with increased tumor markers. The pre- and postchemotherapy CA 19-9 ratio had the highest area-under-the-curve values for predicting 3-month PFS and 1-year OS. In the multivariate analysis, increases in serum CA 19-9 during palliative chemotherapy in patients with unresectable GBC was an independent prognosticator of poor PFS and OS, with hazard ratios of 2.20 (p=0.001) and 1.67 (p=0.020), respectively. Patients with increases >10-fold were considered to have progressive disease, whereas individuals with increases >3-fold were likely to benefit from early imaging follow-up.ConclusionsCA 19-9 kinetics was a reliable prognosticator of PFS and OS in patients with unresectable GBC who underwent palliative chemotherapy.

CEA Response and Depth of Response (DpR) to Predict Clinical Outcomes of First-Line Cetuximab Treatment for Metastatic Colorectal Cancer.

The decrease in carcinoembryonic antigen (CEA) level is faster and greater during cetuximab treatment than bevacizumab treatment and correlates with prolonged survival in patients with metastatic colorectal cancer (mCRC) who receive cetuximab. We investigated if the degree of change in the CEA value can serve as a diagnostic tool for predicting survival, as well as tumor regression in mCRC patients treated with cetuximab combined regimen as first-line treatment. Associations among the CEA decrease, depth of response (DpR), and clinical outcomes were evaluated in 113 patients with mCRC from two phase II trials of first-line therapy: the JACCRO CC-05 trial of cetuximab plus FOLFOX and the CC-06 trial of cetuximab plus SOX. Analysis was performed using Spearman's rank correlation coefficient. A 75% decrease in the CEA was used as the cut-off value to define the CEA response and discriminate CEA responders on the basis of the results of a previous study. Ninety-two patients were eligible for analyses of both CEA and DpR. The median CEA decrease was 67.4%, and the median time to CEA nadir was 2.8months, which was similar to the median time to DpR of 3.0months. The DpR was associated with PFS and OS (rs=0.56, P<0.0001; rs=0.39, P=0.0090, respectively); moreover, the CEA decrease correlated with PFS (rs=0.56, P<0.0001), as well as OS (rs=0.35, P=0.019). CEA responders had significantly longer PFS (11.8 vs. 5.5months, hazard ratio [HR] 0.46, P=0.0009) and slightly, but not significantly longer OS (36.2 vs. 23.5months; HR 0.57; P=0.072) than CEA non-responders. The CEA decrease was statistically significantly associated with the DpR (rs=0.44, P<0.0001). Our study demonstrates that both DpR and CEA response correlate with clinical outcomes of first-line treatment with cetuximab. The CEA decrease may serve as a surrogate for DpR in patients who receive first-line cetuximab treatment (UMIN000004197, UMIN000007022).

Application of circulating tumor cell counting in diagnosis of patients with colorectal cancer

Objective To explore the application value of circulating tumor cell (CTC) counting in the diagnosis of patients with colorectal cancer. Methods From July to October in 2015, a total of 61 patients firstly diagnosed with colorectal cancer, at stage Ⅰ to Ⅳ were enrolled. At the same period, 20 individuals (healthy volunteers or patients with benign colorectal diseases) were selected as controls. Peripheral blood (7.5 mL) was taken before therapy. Peripheral blood CTC were counted by immunomagnetic beads enrichment combined with fluorescent staining method in two hours. The positive detection rate of CTC for colorectal cancer, especially early colorectal cancer was analyzed. And the priority of combination it with carcino-embryonic antigen (CEA) was also investigated. Chi-square test, t test and rank-sum test were used for statistical analysis. Results Two patients could not be pathological staged, due to the lack of whole body imaging evaluation.There were 30 patients with colorectal cancer at early stage (stage Ⅰto Ⅱ) and 29 patients at advanced stage (stage Ⅲ to Ⅳ). The difference in CEA level between patients at early stage and advanced stage ((3.3±1.1) μg/L vs (20.4±3.3) μg/L) was statistically significant (t=-2.74, P=0.008). The median cell number of CTC of colorectal cancer group and control group was 1 (interquartile range=4) and 0, respectively, and the difference was statistically significant (Z=2.721, P=0.007). Taken 0/7.5 mL and 5 μg/L as the cut-off value of CTC and CEA, the detection rates of CTC for colorectal cancer and early colorectal cancer were 65.6%(40/61) and 63.3%(19/30), respectively; the detection rates of CEA for colorectal cancer and early colorectal cancer were 29.5%(18/61) and 13.3%(4/30). When CTC combined with CEA, the detection rates for colorectal cancer and early colorectal cancer were 73.8%(45/61) and 66.7%(20/30), respectively. Conclusions CTC has certain detection value in colorectal cancer especially early colorectal cancer. If it combined with CEA, the detection rate is much higher. Key words: Colorectal neoplasms; Circulating tumor cell; Diagnosis

Submitted, Not Presented: Biliary/Pancreas.

Introduction: Estimating malignant potential of cystic lesions of the pancreas poses a significant clinical challenge. Mucinous cysts, characterized by elevated carcinoembryonic antigen (CEA), are thought to have high malignant potential. Many physician rely upon a threshold CEA level of 192 ng/mL in assessing malignant potential of these lesion and whether invasive surgical resection should be recommended. This approach, however, is controversial, with some recent studies calling the usefulness and reliability of CEA testing into question. Herein, we review our experience with patients who have undergone endoscopic sampling of pancreatic cystic lesions via endoscopic ultrasound with fine needle aspiration (EUS-FNA) and opted for surgical. Methods: We conducted a retrospective study at our tertiary care institution of patients who underwent EUS-FNA of a pancreatic cystic lesion followed by surgical resection of the same lesion between 2009-2017. This cohort of patients was divided into patients whose surgical resection revealed benign surgical pathology and those whose resection revealed malignant surgical pathology. Our primary outcome was a comparison of CEA levels between these two groups. Secondary analysis included assessment of differences in patient or lesion characteristics including patient age, patient gender, cyst size, cyst location and other cyst molecular markers. Results: Our study identified 53 patients who met our inclusion criteria. Of these, 15 had benign surgical pathology and 38 had malignant surgical pathology. The group of patients found to have malignant surgical pathology was noted to have a significantly higher CEA level on their pre-operative EUS-FNA. In addition, we noted a trend toward a lower amylase in the group found to have malignant pathology. The two groups were similar in terms of patient age, patient gender, and lesion size. (Table 1) In assessing the CEA threshold of 192ng/mL, our data indicate a sensitivity of 63% and specificity of 60%.Table: Table. Comparison of pancreatic cyst characteristics in patients with benign or malignant surgical pathology after pancreatic surgical resectionConclusion: Our findings support the notion that higher CEA levels, in general, will correlate with higher malignant potential, however the relatively low sensitivity and specificity of the commonly used CEA threshold indicates that management decisions should not be solely based on the CEA value. Further study is needed to fully define indications for invasive surgical interventions in these complex cases.

The value of serum human tumor protein P53 in colorectal cancer combined diagnosis and postoperative monitoring

Objective: The aim of this paper is to investigate the application value of serum human tumor protein P53 (TP53) in the diagnosis and postoperative monitoring of colorectal cancer. Methods: One hundred and fifteen patients with colorectal cancer diagnosed without colorectal cancer and without surgery, radiotherapy and chemotherapy and total of 158 patients with colorectal benign disease and 182 healthy subjects were enrolled in this study. The levels of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA199) were detected by electrochemiluminescence assay. The expression of TP53 was analyzed by ELISA. Fourth-one patients with colorectal cancer were detected with one day before operation and the first seven days after operation. The expression of CEA, CA199 and TP53 was analyzed by ROC curve. The results were compared with those of CEA and CA199 diagnostic value. Results: The medians of the levels of TP53 in patients with colorectal cancer patients, colorectal benign, and healthy subjects are 316.0(24.6, 940.8 ) , 9.8(3.7, 30.1 ) and 1.9(1.4, 2.5 ) μg/L (H=260.161, P<0.01), respectively. The level of TP53 in patients with colorectal cancer was significantly higher than that in colorectal benign and healthy subjects. The levels of serum TP53 in patients with colorectal cancer show great discrepancies in different TNM stages, different tumor location, depth of invasion and lymph node metastasis (P<0.05) , but no difference in sex, age, and tumor growth type. The levels of TP53 in the same patient is 711.5(354.9, 1 068.0) μg/L in the first seven days after operation, significantly decreased when compared to it in the one day before the operation with the value of 952.6 (419.7, 1485.4) μg/L (Z=-1.989, P<0.05). The difference was statistically significant, and CEA, CA199 were not statistically significant. And the sensitivity (79.1%) and specificity (81.8%) of TP 53 were significantly higher than those of CEA (39.1%, 70.3%) and CA199 (47.8%, 69.1%). If TP53 was combined with CEA and CA199, sensitivity (86.1%) and specificity (87.9%) can be significantly improved, in which the area of Receiver Operating Characteristic (ROC) curve was 0.924. Conclusions: Serum TP53 has a certain positive significance for the diagnosis, postoperative monitoring of colorectal cancer. Combined detection with CEA and CA199 can improve the sensitivity and specificity, implicating good clinical application value.

Suspicious brush cytology is an indication for liver transplantation evaluation in primary sclerosing cholangitis.

AIMTo investigate markers for high-grade dysplasia for the optimal timing of liver transplantation in patients with primary sclerosing cholangitis (PSC).METHODSEarlier data support a dysplasia-carcinoma sequence, even low- to high-grade dysplasia, in PSC-associated cholangiocarcinoma (CCA). Surveillance using endoscopic retrograde cholangiography (ERC) and brush cytology aims to detect cases of biliary dysplasia, and liver transplantation is an option in cases with suspicion of malignancy in brushing. This study investigated markers to identify patients with high-grade biliary dysplasia for optimal timing in early liver transplantation. Patients undergoing surveillance using ERC and brush cytology during 2008-2014 and who were diagnosed with biliary dysplasia in explanted liver or CCA until February 2016 were included in the study. Demographic data, cholangiography findings, laboratory values, cytological morphology and DNA ploidy were analysed.RESULTSThirty PSC patients had biliary neoplasia in the explanted liver during the study period. Sixteen of these patients had low-grade dysplasia, 10 patients had high-grade dysplasia, and 4 patients had CCA. Fifteen PSC patients diagnosed with CCA were not transplanted. Patients with low-grade dysplasia were younger. Alkaline phosphatase or carcinoembryonic antigen values did not differ between groups during surveillance, but carbohydrate antigen 19-9 was higher in CCA patients. No difference in PSC duration, ERC scores, suspicious cytology, or ploidy analysis was found between groups. No difference was observed between fibrosis stage in explanted livers. Low- and high-grade dysplasia could not be differentiated before liver transplantation based on liver enzymes, tumour markers, ERC scores, brush cytology or DNA ploidy.CONCLUSIONRepeated suspicion of neoplasia in brush cytology should be an indication for evaluations of liver transplantation prior to the development of CCA.