Elevated Serum CA Research Articles

Clinical Features of Borderline Ovarian Seromucinous Tumor.

Ovarian seromucinous tumor is a histological type of ovarian neoplasm. Although seromucinous borderline tumors (BSMT) are associated with endometriosis, the frequency of their occurrence is low, and many aspects of their behavior remain unclear. In this study, we aimed to clarify the clinicopathological factors of BSMT. We retrospectively reviewed 32 patients with pathologically diagnosed BSMT who underwent surgery at Jikei University Hospital. The survey items were patient characteristics, such as age, initial symptoms, preoperative tumor markers, surgical procedure and stage of surgery, presence of endometriosis, and recurrence. The median age was 45 years. Lower abdominal pain was the most common chief complaint, about one-third of patients were asymptomatic; one-sixth were discovered during follow-up for endometriosis. The majority had a high serum CA19-9 level. Twenty-five patients (78.1%) had unilateral masses, whereas seven patients (21.9%) had bilateral masses. More than 90% of the cases had coexisting endometriosis histologically. Thirty cases (93.8%) were stage I, only two were stage II, and none were stage III or IV. Recurrence was observed in two cases: one was borderline malignant and the other was a carcinoma. BSMT is a rare form of borderline malignancy. Its preoperative diagnosis is often difficult because of various clinical findings, but a history of endometriosis and an elevated serum CA19-9 level may aid in some cases.

The Effects of Claw Health and Bone Mineral Density on Lameness in Duroc Boars.

To investigate the effects of claw lesion types and bone mineral density on lameness in boars, the data of claw lesion score, gait score, and bone mineral density, measured by a Miniomin ultrasound bone densitometer, were collected from a total of 739 Duroc boars. Firstly, we discovered that the prevalence of claw lesions was as high as 95.26% in boars. The percentage of lameness of boars with SWE was higher than those with other claw lesions. Meanwhile, the results showed that the probability of lameness was higher in boars with lower bone mineral density (p < 0.05). Logistic regression models, including variables of boar age, body weight, serum mineral level, and housing type, were used to identify the influencing factors of bone mineral density in this study. The results found that bone mineral density increases with age before reaching a maximum value at 43 months of age, and begins to decrease after 43 months of age. Elevated serum Ca levels were significantly associated with an increase in bone mineral density (p < 0.05). Aside from the above findings, we also made an interesting discovery that boars in the individual pen model significantly increased bone mineral density compared to those in the individual stall model. In conclusion, claw lesions and bone mineral density were significantly associated with lameness. Age, serum Ca, and housing type are the potential influencing factors for bone mineral density in boars.

Yield of Staging Laparoscopy for Pancreatic Cancer in the Modern Era: Analysis of More than 1,000 Consecutive Patients.

Accurate staging prior to resection of pancreatic ductal adenocarcinoma (PDAC) is imperative to avoid unnecessary operative morbidity and oncologic futility in patients with occult intra-abdominal distant metastases. We aimed to determine the diagnostic yield of staging laparoscopy (SL) and to identify factors associated with increased risk of positive laparoscopy (PL) in the modern era. Patients with radiographically localized PDAC who underwent SL from 2017 to 2021 were retrospectively reviewed. The yield of SL was defined as the proportion of patients with PL, including gross metastases and/or positive peritoneal cytology. Factors associated with PL were assessed using univariate analysis and multivariable logistic regression. Of 1,004 patients who underwent SL, 180 (18%) had PL due to gross metastases (n = 140) and/or positive cytology (n = 96). Patients who had neoadjuvant chemotherapy prior to laparoscopy had lower rates of PL (14% vs 22%, p = 0.002). When the analysis was restricted to chemo-naive patients who had concurrent peritoneal lavage performed, 95 of 419 patients (23%) had PL. In multivariable analysis, PL was associated with younger (<60) age, indeterminate extrapancreatic lesions on preoperative imaging, body/tail tumor location, larger tumor size, and elevated serum CA 19-9 (all p < 0.05). Among patients with no indeterminate extrapancreatic lesions on preoperative imaging, the rate of PL ranged from 1.6% in patients with no risk factors to 42% in young patients with large body/tail tumors and elevated serum CA 19-9. The rate of PL in patients with PDAC remains high in the modern era. SL with peritoneal lavage should be considered for the majority of patients prior to resection, specifically those with high-risk features, and ideally prior to neoadjuvant chemotherapy.

The value of [18F]FDG PET/CT examination in the detection and differentiation of recurrent ovarian cancer.

The exact role of positron emission tomography with fluorine-18-deoxyglucose ([18F]FDG PET/CT) in an early diagnosis of relapsed ovarian cancer is not clearly defined. The aim of the study was to assess the value of [18F]FDG PET/CT in the detection and differentiation of recurrent ovarian cancer. Eighty-four patients with suspected recurrent ovarian cancer underwent [18F]FDG PET/CT examination. Results of PET/CT were analyzed taking into account clinical data of the patients, histological diagnosis, and 6-month follow-up. The [18F]FDG PET/CT examinations showed abnormal findings in 67 patients (79.76%). There were 63 true positive results (75.00%), 14 true negative (16.67%), 4 false positive (4.76%), and 3 false negative (3.57%) results. Sensitivity, specificity, positive and negative predictive values of [18F]FDG PET/CT were 95%, 78%, 94%, and 82%, respectively. In patients with elevated serum Ca 125 concentration (n = 43), sensitivity and specificity of [18F]FDG PET/CT was 95.00% and 66.67%, respectively. Recurrence was confirmed in 22 (88.00%) of 25 patients referred for [18F]FDG PET/CT due to suspected relapse in imaging tests. A high frequency of recurrent ovarian cancer detected in the [18F]FDG PET/CT examinations due to increased Ca 125 concentration in patients without clinical symptoms and without changes in other imaging tests confirmed the usefulness of [18F]FDG PET/CT in such cases. In patients with suspected recurrent ovarian cancer implied in radiological findings, [18F]FDG PET/CT results in most cases differed from the original results of imaging examination. Our results showed high accuracy of [18F]FDG PET/CT in the evaluation of recurrent ovarian cancer and presented this diagnostic method as a useful tool in detecting and differentiating suspected lesions in this group of patients.

Prognostic significance of serum CA125 in the overall management for patients with gastrointestinal stromal tumors

BackgroundCarbohydrate antigen 125 (CA125) is elevated as a tumor marker in many carcinomas, but its association with gastrointestinal stromal tumor (GIST) has received less attention. This study intends to evaluate whether CA125 level can predict tumor progression and overall survival (OS) of GIST patients.MethodsWe retrospectively analyzed the clinical data and follow-up records of GIST patients who underwent surgical resection in Nanjing Drum Tower Hospital from August 2010 to December 2020. All patients were classified according to serum CA125 level. The relationship between CA125 and clinical outcomes was then examined.ResultsA total of 406 GIST patients were enrolled in this study, among which 46 patients had preoperative elevated serum CA125 level and 13 patients with high CA125 level both preoperative and postoperative were observed. Preoperative CA125 concentration was significantly related to rupture status, resection style, tumor site, tumor size, mitotic index, NIH risk grade and c-kit exons. According to Kaplan–Meier curve analysis, high expression of postoperative CA125 was significantly correlated with worse progression-free survival (PFS) and OS among patients with preoperative elevated CA125 level. Ultimately, Cox proportional regression model analysis revealed that increase of preoperative and concurrent postoperative CA125 concentration was an independent predictive factor for PFS.ConclusionsThe concurrent abnormality of serum CA125 before and after operation was an independent risk factor for GIST progression, suggesting its significance as a serum biomarker in the overall management of GIST patients.

Serum CA 19-9 and risk of high-grade dysplasia/invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas: an overlooked high-risk feature?

Background: Intraductal papillary mucinous neoplasms (IPMN) are premalignant cystic tumors with variable behavior. Elevated serum CA 19-9 was incorporated as a worrisome feature in the International Association of Pancreatology 2017 guidelines, and may be associated with an increased risk of high-grade dysplasia and invasive carcinoma (HGD/IC). We aimed to compare the independent predictive value of CA 19-9 with other worrisome and high-risk features to better delineate its utility and importance.

Syndrome similar to Familial Hypocalciuric Hypercalcemia (FHH) produced in mice deleted of the gene encoding transient receptor potential canonical channel 1 (TRPC1)

We recently found that global deletion of TRPC1 produces phenotypes similar to FHH [1]. These TRPC1 null mice have mildly elevated serum Ca in both fasted and unfasted conditions from 3.5 through 21.5 months of age, and inappropriately elevated parathyroid hormone (PTH) levels.

The presence of clear cell glands around the ovarian endometrioid cyst has an association with clear cell carcinoma.

We found some clear cell glands appeared in the endometrioid cysts (ECs) of the ovary (EC-CCG). To explore the clinicopathological features, molecular biological changes, and prognosis in EC-CCG and analyze the association with ovarian clear cell borderline tumors (CCBT) and clear cell carcinoma (CCC). We retrospectively examined 35 cases of EC-CCG, compared them to 13 cases of clear cell cystadenomas, 14 cases of CCBT, and 49 cases of CCC. We analyzed the differences in clinicopathological features and prognosis between the four groups. Data on clinicopathology and survival were gathered. Immunohistochemistry (IHC) was performed in all cases, and we analyzed the molecular changes of 2 cases of EC-CCG and 1 case of CCC by whole-exome sequencing (WES). EC-CCG shared some common clinicopathological features with CCBT: they occurred before menopause, had an elevated serum CA125 level in some cases, had an ovarian cystic mass on B-ultrasound, and had a risk of recurrence. Microscopically, both diseases were based on typical EC, and clear cell glands in the EC cyst wall were seen in varying numbers. Some cases of EC-CCG had IHC results similar to those of CCBT and CCC, with positive expression of HNF1β and NapsinA; decreased expression of ER, PR, and ARID1A; and increased expression of Ki67 (> 5%). WES results revealed that EC-CCG had mutations in TP53BP1, ZNF462, FN1, and FTL (which was also mutated in CCC). In summary, we found that clear cell glands appearing around EC in the ovary have an association with CCC.

Distinct clinicopathological features of ovarian endometriosis after long-term exposure to mifepristone.

Mifepristone has been used to treat endometriosis, but it can cause a constellation of endometrial alterations. Our study investigated the effects of long-term mifepristone on ovarian endometriosis. We retrospectively analyzed the clinicopathological changes of ovarian endometriosis in 11 Chinese patients after long-term low-dose mifepristone therapy and compared these alterations with those observed in eutopic endometrium and adenomyosis side-by-side. Immunohistochemistry was applied to investigate estrogen receptor (ER), progesterone receptor (PR), and Ki67 expression in eutopic and ectopic endometrium. Nearly all patients had a pelvic mass and elevated serum CA125 levels. The ovarian lesions were grossly solid, cystic-solid, or cystic. They had a grayish-reddish appearance and a fleshy, honeycomb-like cut surface. The ovarian lesions shared morphological features with the uterine endometrium, and they were characterized by dilated, crowding endometrial glands with non-physiological changes. Immunostaining revealed consistent staining for ER and PR and a low Ki67 index in both eutopic and ectopic endometrium. Our findings suggest that ovarian endometriosis can mimic an endometrioid borderline tumor after long-term mifepristone administration. Careful histological assessment and related clinical information are critical for the correct interpretation of these rare entities.

S29 Dilated Main Pancreatic Duct Without a Visible Pancreatic Mass: Long-Term Follow-Up and Predictors of Future Pancreatic Ductal Adenocarcinoma

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease frequently diagnosed at an advanced stage when therapeutic options are limited. Pancreatic imaging abnormalities that predate diagnosis of PDAC may serve as an early detection tool. Dilation of the main pancreatic duct (D-MPD) has been shown to occur up to a year before PDAC diagnosis. However, while D-MPD in the absence of a visible pancreatic mass raises concern for occult neoplasm, the natural history of D-MPD remains poorly understood. From a large cohort of patients with D-MPD and no pancreatic mass, we aimed to assess long-term outcomes and compare patients who were subsequently diagnosed with PDAC to those who did not develop PDAC. Methods: We identified all subjects ≥18 years old at our institution with D-MPD (MPD >3mm) on either abdomen/pelvis CT or MRI scans between 1/1/2012 and 12/31/2017. Patients with prior PDAC, pancreatic surgery, definite pancreas mass or other visible cause of D-MPD were excluded after expert review by study radiologist. Pertinent clinical, demographic, and imaging data were summarized. A stratified univariate Cox proportional hazards model was utilized to evaluate risk factors for PDAC development. Results: Among 2307 patients (baseline CT:1615, MRI: 692) who met our study criteria, 63.7% were female, median age was 71 (IQR 59.5 -80.1), and median follow-up was 1466 days (IQR 1426-1509). The 1-year and 3-year event rates for PDAC were 2.70 and 2.99 per 100-patient years respectively. Out of sixty-three (2.7%) patients who developed PDAC within 3 years of the baseline scan, the majority (58/63) were within 1 year (Figure). Factors associated with a significantly increased 3-year risk of PDAC included male gender, BMI >25, diabetes mellitus, non-O blood type, elevated serum CA 19-9, focal narrowing of MPD, equivocal pancreatic mass and suboptimal baseline scan quality (Table). Conclusion: D-MPD may predate the diagnosis PDAC and raises concern for neoplasm. However, in our study only a small subset of D-MPD patients without an overt pancreatic mass developed PDAC on follow-up. The risk is highest in the first year with rare events after one year of PDAC-free follow-up. Risk factors identified in this study may enrich assessment and guide surveillance of patients with D-MPD. Future studies exploring machine learning tools can further enhance the identification of those at risk of future PDAC and facilitate early detection.Figure 1.: Kaplan-Meier curve estimate of PDAC event rates over the 3-year followup duration Table 1. - Univariate Survival Analysis (w/ strata) assessing the risk of developing PDAC within 3 years from baseline CT/MRI in 2307 patients with D-MPD Characteristics Reference Hazard Ratio 95% HR CI p-value Age (years) ≥50 < 50 7.109 0.987 51.192 0.0515 Body Mass Index (kg/m2) ≥25 < 25 1.972 1.172 3.319 0.0105 Maximum MPD diameter (mm) ≥5-< 10 ≥3-< 5 3.773 1.987 7.167 < .0001 ≥10 ≥3-< 5 20.081 8.455 47.691 < .0001 CA19-9 ≥35 < 35 4.819 2.678 8.670 < .0001 Gender Male Female 1.937 1.181 3.176 0.0088 ABO Blood type Type Non- O Type O 2.238 1.162 4.310 0.0161 Alcohol Ever Use Never Use 1.029 0.612 1.731 0.9137 Aspirin Ever Use Never Use 0.936 0.534 1.640 0.8177 Diabetes mellitus Yes No 2.596 1.554 4.338 0.0003 Chronic Pancreatitis Yes No 0.386 0.094 1.576 0.1847 Acute Pancreatitis Yes No 1.116 0.551 2.260 0.7609 Family History of PDAC Yes No 1.952 0.930 4.097 0.0772 Pancreas Cyst on imaging Yes No 1.444 0.856 2.439 0.1688 Equivocal Mass on imaging Yes No 12.524 7.248 21.640 < .0001 Image Quality Suboptimal but diagnostic Optimal 2.241 1.309 3.839 0.0033 Dilation Pattern Segmental/Multifocal Diffuse 1.175 0.717 1.926 0.5214 Focal Narrowing of the MPD Present Absent 40.800 9.732 171.038 < .0001

Analysis of 55 patients with multiple endocrine neoplasia type 1-associated insulinoma from a single center in China

ObjectiveTo investigate the clinical characteristics of patients with multiple endocrine neoplasia type 1 (MEN1)-related insulinoma and their relationship with specific biochemical changes and to summarize the features of treatment options for the Chinese population with this disease and the impact on long-term prognosis.Methods“MEN1” and “insulinoma” were used when searching the Peking Union Medical College Hospital (PUMCH) medical record retrieval system to obtain clinical information about patients. We identified patients diagnosed with MEN1-associated insulinoma based on endocrinological, radiological, and pathological examinations, and subsequently analyzed their clinical data.ResultsA total of 55 patients with MEN1-associated insulinoma were included, including 29 (52.7%) men and 26 (47.3%) women. The parathyroid gland was the most commonly affected (78.2%), followed by the pituitary gland (69.1%) and adrenal gland (16.4%). Insulinoma was the first manifestation of MEN1 in at least 23.6% (13/55) of patients. Nineteen (34.5%) patients presented with initial symptoms of hypoglycemia before the age of 22 years. Among the 24 Patients with high serum calcium (Ca) had significantly lower serum insulin levels than those with normal serum Ca levels (p < 0.001) during hypoglycemic episodes. However, serum C-peptide level at 0.5 h and serum insulin level at 1 h was higher in patients with hypercalcemia than in patients with normal serum Ca levels in the oral glucose tolerance test (OGTT), although the differences were not statistically significant. Multifocal pancreatic neuroendocrine tumors (pNETs) were present in 38 (69.1%) patients; most of them (55.6%, 20/36) underwent multiple enucleations, and 45% (9/20) had a postoperative recurrence. Five patients (10%) who underwent distal pancreatectomy developed pancreatic insufficiency after an average of seven years. patients who underwent genetic testing, 23 (95.8%) were positive for MEN1 mutation, with mutations most commonly found in exons 2 (21.7%) and 3 (13%).ConclusionsIn our study, the rates of postoperative recurrence and long-term complications in patients with MEN1 with multifocal pNETs were significantly different from those in other international centers and might be related to the choice of surgical method. In addition, elevated serum Ca levels in patients with primary hyperparathyroidism may affect insulin secretion.

A diagnostic dilemma of a pulmonary nodule of a patient who suffered advanced ovarian cancer: A case report and a hypothesis.

IntroductionThis report presents a case of lung cancer which can be easily misdiagnosed as distant metastasis. Along with a literature review on the morphological, pathological and prognostic characteristics of lung cancer associated with cystic airspaces (LCCA), it would help to improve our understanding of the dynamic evolution of LCCA, to avoid its delayed diagnosis and treatment. We also propose here a hypothesis on the etiology of LCCA.Case presentationA patient with advanced ovarian cancer who presented with elevated serum CA125 at time of admission and had undergone TAHBSO at first, and second operation of sigmoid colon resection was performed due to her locoregional recurrence of ovarian cancer. After her second operation, patient showed further increment of serum CA125 and CECT scan indicated an airspace-related pulmonary nodule in the right middle lobe of her lungs. It was suspected that distant metastases of ovarian cancer had reoccurred postoperatively.Clinical discussionAfter comparing the characteristic of metastatic ovarian cancer with LCCA, we diagnosed the pulmonary nodule as primary lung cancer. Surgery eventually confirmed the pulmonary nodule as second primary lung cancer associated with cystic airspaces.ConclusionThe rare occurrence of LCCA should merit special attention from clinicians and radiologists so as to avoid missed or delayed diagnosis. We propose here a hypothesis that LCCA is related to spreading of tumour cells during surgical procedures in lung cancer surgery. Should our hypothesis be substantiated in further studies, this would affect the operation procedures for surgeons in the future.

Pseudo-pseudo Meig's syndrome presenting as an acute surgical abdomen: A rare entity and review of the literature.

Pseudo-pseudo Meigs' syndrome is a rare entity of systemic lupus erythematosus, which is defined with the combination of pleural effusion, elevated serum CA-125 levels, and ascites. It has similar clinical aspects with gynecological malignancies which may lead gynecologists to perform unnecessary surgeries and lab workouts. This review seeks to point out the importance of diagnosing pseudo-pseudo Meig's syndrome (PPMS) and endeavors to inform gynecologists about the differential diagnoses. This article includes a review of the literature on different cases of PPMS. We searched the PubMed database using the search terms in various combinations "Pseudo-pseudo Meig's syndrome," "Tjalma syndrome," and "SLE." According to the current literature, a majority of internal medicine specialists recognized this clinical condition in the past few years and discussed PPMS as a new onset of systemic lupus erythematosus. PPMS is one of the disregarding entities where gynecologists do not consider it as a differential diagnosis in case of less awareness. When a gynecologist evaluates ascites manifesting as acute abdomen; ectopic pregnancy, ovarian hyperstimulation syndrome, cyst rupture, and malignancy come to mind first. Four-thirds of those patients evaluated by gynecologists were performed hysterectomy leading to unnecessary interventions and economic burden on the health system. Although the mechanism is unrevealed and remains unclear, PPMS has been noticed in the literature for the past few years. In order to prevent unnecessary interventions, this syndrome should be considered as a differential diagnosis.

Para-aortic lymph node dissection in left-sided colorectal cancer: Risk factors, prognostic impact, and therapeutic value.

This study aimed to clarify risk factors, prognostic impact, and the therapeutic value of para-aortic lymph node (PALN) dissection in left-sided colorectal cancer. One hundred and fifty-four patients who underwent primary tumor resection and PALN dissection for left-sided colorectal cancer were included. Logistic regression analysis was used to identify risk factors for PALN metastasis. Cox regression analysis was performed to identify risk factors for overall survival (OS). PALN metastasis was pathologically confirmed in 47 patients (30.5%). Postoperative complications occurred in 42 patients (27.3%). Pathological N stage (OR = 4.661, p = 0.034) and inferior mesenteric artery LNs metastasis (OR = 6.048, p = 0.003) remained to be independently associated with PALN metastasis, the 5-year OS rate and median survival in patients with PALN metastasis was 37.7% and 24 months. Elevated preoperative serum CA19-9 level (HR = 1.006, p = 0.007), number of positive LNs > 7 (HR = 7.263, p = 0.001), and mucinous adenocarcinoma or signet ring cell carcinoma (HR = 6.511, p = 0.001) were independently associated with OS in patients with PALN metastasis. PALN dissection in addition to primary tumor resection have acceptable postoperative complications and may be oncologically beneficial in selected left-sided colorectal cancer patients with clinically suspicious PALN metastasis.

Prognostic significance of serum CA 19-9 response and dynamics in patients with intrahepatic cholangiocarcinoma undergoing surgical resection.

479 Background: Pre and post-operative elevation of serum CA 19-9 have been associated with poor outcomes and increased risk of recurrence in patients with resected intrahepatic cholangiocarcinoma (ICC). We sought to investigate the impact of CA 19-9 response and dynamics on survival for patients with ICC undergoing surgical resection. Methods: Clinicopathologic characteristics were abstracted from a prospectively maintained database at a tertiary cancer care center for patients with ICC undergoing surgical resection from 2003 to 2020. Exclusion criteria included CA 19-9 non-producers (≤ 1 U/mL at baseline), missing baseline/pre-operative or postoperative CA 19-9 value, or total bilirubin &gt; 2 mg/dL. Overall (OS) and recurrence-free survival (RFS) was compared among patients when categorized by baseline (neoadjuvant)/pre-operative (upfront surgery) and post-operative CA 19-9 values: normal (&gt; 1 to 37 U/mL), intermediate (&gt; 37 to 200 U/mL), and elevated (&gt; 200 U/mL). Patients were then stratified by perioperative CA 19-9 response (responder [non-normal to normal CA 19-9 OR 50% reduction in CA 19-9; normal to normal CA 19-9], non-responder [non-normal to non-normal CA 19-9 OR &lt; 50% reduction in CA 19-9; normal to non-normal CA 19-9]) and CA 19-9 dynamics (normal to normal, non-normal to normal, non-normal to non-normal, normal to non-normal CA 19-9 values). Results: A total of 112 patients were identified including 67 (59.8%) who underwent upfront surgery and 45 (40.2%) who received neoadjuvant therapy. Patients with a normal CA 19-9 at diagnosis had median RFS and OS durations of 61 and 163 months, followed by intermediate CA 19-9 (20 and 98 months) and elevated CA 19-9 (18 and 46 months, p = 0.308 RFS; p = 0.295 OS). Those who had a normal CA 19-9 post-operatively had the best median RFS and OS (46 and 163 months), followed by intermediate CA 19-9 (13 and 58 months) and elevated CA 19-9 (5 and 8 months, p = 0.059 RFS; p = 0.005 OS). When stratified by perioperative CA 19-9 response, responders had a median RFS of 36 vs. 13 months in non-responders (p = 0.143), and a median OS of 98 months vs. 88 months in non-responders (p = 0.077). Patients with normal CA 19-9 post-operatively had longer RFS/OS (normal to normal, 48/98 months; non-normal to normal, 30/not estimable months) than those who had non-normal CA 19-9 both pre- and post-operatively (non-normal to non-normal, 7/34 months, p = 0.018 RFS; p = 0.007 OS). Conclusions: Patients with normal CA 19-9 levels post-operatively, who had either normal or elevated CA 19-9 pre-operatively, had the greatest RFS and OS durations. A normal (or normalized) post-operative CA 19-9 may inform patient-centered decisions on adjuvant therapy and/or surveillance intensity.

Predicting pathologic venous invasion before pancreatectomy with venous resection: When does radiology tell the truth?

BackgroundPatients factors in addition to radiological characteristics could predict the presence of pathologic venous invasion in patients undergoing pancreatectomy with venous resection. MethodsWe tested the predictive value of 6 radiological classification methods for predicting pathologic venous invasion—the Nakao, Ishikawa, MD Anderson, Lu, Raptopoulos, and National Comprehensive Cancer Network methods—on a cohort of 198 pancreatectomies (160 pancreaticoduodenectomies and 38 total pancreatectomies) with venous resection for pancreatic adenocarcinomas. Radiological and clinical factors determining pathologic venous invasion were identified by multivariable logistic analysis. ResultsPathologic venous invasion was detected in 124 patients (63.2%). The multivariable logistic regression analysis identified Lu classification (odds ratio = 1.77, 95% confidence interval =1.34–2.35; P < .0001), elevated serum CA19-9 values (odds ratio = 1.97, 95% confidence interval = 1.00–3.90; P = .04), and preoperative neoadjuvant chemotherapy (odds ratio = 0.38, 95% confidence interval = 0.18–0.79; P = .009) as independent factors associated with pathologic venous invasion. Radiological tumor-vessel contact greater than 50% of the circumference or venous wall deformity was associated with a significantly higher rate of pathological venous invasion (80% vs 52%; P < .0001), deeper (media-intima) venous invasion (47% vs 25%; P < .0001), R1 resection (58% vs 41%; P = .03), higher transfusions (84% vs 66%; P = .005), and arterial resection rates (43% vs 27%; P < .0001). Tumor-vein circumference contact of >50% and/or venous wall deformity was still associated with significantly higher rates of pathologic venous invasion, regardless of whether neoadjuvant chemotherapy was used or not and CA19-9 normalized or not under preoperative treatment. ConclusionPreoperative radiological detection of tumor-vein circumference contact >50% and/or venous wall deformity is associated with up to 80% of cases of pathological venous invasion. The combination of radiologic features with biological (CA19-9) and clinical (presence of preoperative chemotherapy) factors could better refine preoperatively the need for venous resection.

Establishment of an optimized CTC detection model consisting of EpCAM, MUC1 and WT1 in epithelial ovarian cancer and its correlation with clinical characteristics.

ObjectiveEmerging studies have demonstrated the promising clinical value of circulating tumor cells (CTCs) for diagnosis, disease assessment, treatment monitoring and prognosis in epithelial ovarian cancer. However, the clinical application of CTC remains restricted due to diverse detection techniques with variable sensitivity and specificity and a lack of common standards.MethodsWe enrolled 160 patients with epithelial ovarian cancer as the experimental group, and 90 patients including 50 patients with benign ovarian tumor and 40 healthy females as the control group. We enriched CTCs with immunomagnetic beads targeting two epithelial cell surface antigens (EpCAM and MUC1), and used multiple reverse transcription-polymerase chain reaction (RT-PCR) detecting three markers (EpCAM, MUC1 and WT1) for quantification. And then we used a binary logistic regression analysis and focused on EpCAM, MUC1 and WT1 to establish an optimized CTC detection model.ResultsThe sensitivity and specificity of the optimized model is 79.4% and 92.2%, respectively. The specificity of the CTC detection model is significantly higher than CA125 (92.2% vs. 82.2%, P=0.044), and the detection rate of CTCs was higher than the positive rate of CA125 (74.5% vs. 58.2%, P=0.069) in early-stage patients (stage I and II). The detection rate of CTCs was significantly higher in patients with ascitic volume ≥500 mL, suboptimal cytoreductive surgery and elevated serum CA125 level after 2 courses of chemotherapy (P<0.05). The detection rate of CTCEpCAM+ and CTCMUC1+ was significantly higher in chemo-resistant patients (26.3% vs. 11.9%; 26.4% vs. 13.4%, P<0.05). The median progression-free survival time for CTCMUC1+ patients trended to be longer than CTCMUC1− patients, and overall survival was shorter in CTCMUC1+ patients (P=0.043). ConclusionsOur study presents an optimized detection model for CTCs, which consists of the expression levels of three markers (EpCAM, MUC1 and WT1). In comparison with CA125, our model has high specificity and demonstrates better diagnostic values, especially for early-stage ovarian cancer. Detection of CTCEpCAM+ and CTCMUC1+ had predictive value for chemotherapy resistance, and the detection of CTCMUC1+ suggested poor prognosis.

Elevated serum CA19-9 indicates severe liver inflammation and worse survival after curative resection in hepatitis B-related hepatocellular carcinoma.

We explored the prognostic value of preoperative CA19-9 in α-fetoprotein (AFP)-positive and -negative HCC with hepatitis B virus (HBV) background (HBV-HCC), and explored the underlying mechanism. Recurrence-free survival (RFS) and overall survival (OS) were assessed in HBV-HCC patients who underwent curative resection (Cohort 1). Immunohistochemical staining of CA19-9 in HCC and liver parenchyma were quantified in another cohort of 216 patients with resected HCC (Cohort 2). Immunohistochemical staining of CA19-9 and serum CA19-9 level was also compared between patients with HCC and intrahepatic cholangiocarcinoma (ICC) (Cohort 3). In Cohort 1, CA19-9 ≥ 39 U/mL was an independent risk factor for RFS (HR = 1.507, 95% CI = 1.087-2.091, p = 0.014) and OS (HR = 1.646, 95% CI = 1.146-2.366, p = 0.007). CA19-9 ≥ 39 U/mL was also associated with significantly higher incidence of macrovascular invasion (MaVI) compared with CA19-9 < 39 U/mL (23.0% vs. 7.2%, p = 0.002), and elevated aminotransferase and aspartate aminotransferase to platelet ratio index (APRI), and lower albumin. Immunohistochemical staining of CA19-9 revealed that CA19-9 expression was found exclusively in the background liver but not in HCC tumor cells. In contrast, tumor tissue was the main source of CA19-9 in ICC patients. CA19-9 ≥ 39 U/mL was associated with worse OS and RFS in both AFP-positive and negative HCC patients. CA19-9 indicated more severe inflammation and cirrhosis in the liver of HCC patients.

Correlation of CA 19-9 with HbA1c in prediabetic and diabetic groups

Introduction and Aim: Carbohydrate antigen19-9 (CA 19-9) is a marker of pancreatic cancer. In diabetics, pancreatic beta cell dysfunction can lead to elevated serum CA19-9 level. This study was designed for estimation of CA19-9 in diabetes and its correlation with glucose levels and glycosylated hemoglobin. Materials and Methods: The includes diabetic, pre diabetic with no history of malignancies and healthy normal subjects (n=50 each). Ca19-9 was estimated using ELISA, HbA1c by D10-Biorad variant turbo and the Lipid profile in Roche COBAs 6000 auto analyzer. Statistical analysis was done by Statistical Package for Social Sciences software version17 (SPSS 17). P &lt;0.05 was considered significant. Results: Serum CA19-9 level was high in diabetics compared to normal, (p=0.38) however it was decreased in pre diabetic group (P=0.06). There was significant difference in comparison of CA19-9 levels between pre diabetic and diabetics(p=0.001). A significant increase in triglycerides was observed both in diabetics (p&lt;0.01) and pre-diabetics(p=0.04). There was a significant positive correlation of CA19-9 with TC/HDL (p=0.022) and non-HDL(p) in control group. Conclusion: CA19-9 levels can be influenced by glycemic status, hence assessment of pancreatic cancer in diabetic patients must be interpreted carefully in consideration with CA19-9 levels. CA19-9 level was decreased in prediabetics when compared to normal and diabetics. This is a novel finding, the cause for which must ascertained, and this will open further avenues for research.

P-P19 Incidentally detected Double Duct Sign (InDDuS): a study on the long-term outcomes

Abstract Background The long-term outcomes of patients with biliary and pancreatic ductal dilatation (double duct sign-DDS), without a detectable underlying cause, is unclear in the current literature. This study aims to review the five-year outcomes of patients with incidentally detected double duct sign. Methods This is a retrospective study of patients that were found to have DDS between January 2010 to December 2015 at a tertiary referral Hepato-Pancreatico-Biliary unit. Patients were identified from the departmental performance team and cross-checked with the Radiology department. Patients who had malignancy and benign causes of DDS (such as pancreatitis and gallstones) were excluded. Five-year patient outcomes were collected from subsequent MDT outcomes and clinic letters. Results Initial screen identified 108 patients with DDS. Of these, 37 patients (81% female, median age 69 years, range 26-94 years) had no identifiable cause and were analysed. Main presenting complaints were abdominal pain (n = 22), weight loss (n = 9), and asymptomatic (n = 3). Twelve had anaemia, 14 had derange LFTs and 2 patients had elevated serum CA19-9. A median of two (range 0-9) further investigations were performed to determine the underlying cause of DDS (US = 6, CT = 24, MRCP=17, endoscopy=16). Median follow up of 7.2 (range 5-11) years detected no pancreatic or ampullary cancer amongst all patients. Conclusions Results from this study suggests DDS without evidence of malignancy on Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) have minimal risk of developing pancreatic or ampullary cancer in the next five years. Thus, they can be safely discharged from follow up.