Preoperative Serum Tumor Markers Research Articles

The Prognostic Value of Preoperative Serum Tumor Markers in Non-Small Cell Lung Cancer Varies With Radiological Features and Histological Types.

ObjectivesTo assess the association between common-used serum tumor markers and recurrence of lung adenocarcinoma and squamous cell carcinoma separately and determine the prognostic value of serum tumor markers in lung adenocarcinoma featured as ground glass opacities.MethodsA total of 2,654 non-small cell lung cancer patients undergoing surgical resection between January 2008 and September 2014 were analyzed. The serum levels of carcinoma embryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), neuron-specific enolase (NSE), carbohydrate antigen 125 (CA125), carbohydrate antigen 153 (CA153) and carbohydrate antigen 199 (CA199) were tested preoperatively. Survival analyses were performed with COX proportional hazard regression.ResultsAmong patients with lung adenocarcinoma, elevated preoperative serum CEA(HR=1.246, 95%CI:1.043-1.488, P=0.015), CYFRA21-1(HR=1.209, 95%CI:1.015-1.441, P=0.034) and CA125(HR=1.361, 95%CI:1.053-1.757, P=0.018) were significantly associated with poorer recurrence free survival (RFS). Elevated preoperative serum CA199 predicted worse RFS in patients diagnosed with lung squamous cell carcinoma (HR=1.833, 95%CI: 1.216-2.762, P=0.004). Preoperative serum CYFRA21-1(HR=1.256, 95%CI:1.044-1.512, P=0.016) and CA125(HR=1.373, 95%CI: 1.050-1.795, P=0.020) were independent prognostic factors for patients with adenocarcinoma presenting as solid nodules while serum CEA (HR=2.160,95%CI:1.311-3.558, P=0.003) and CA125(HR=2.475,95%CI:1.163-5.266, P=0.019) were independent prognostic factors for patients with adenocarcinoma featured as ground glass opacities.ConclusionsThe prognostic significances of preoperative serum tumor markers in non-small cell lung cancer were associated with radiological features and histological types.

Comparison of the diagnostic performances of circulating tumor cells and the serum tumor markers CEA, CA125, and CA15-3 for breast cancer: a retrospective case-control study

Objective: Serum tumor markers are seldom considered as diagnostic biomarkers for breast cancer because they lack good sensitivity or specificity. This study aimed to evaluate whether a combination of circulating tumor cells (CTCs) and the serum tumor markers carcinoembryonic antigen (CEA), cancer antigen (CA)125, and CA15-3 might improve their diagnostic performance. Methods: We performed a retrospective case-control study of patients with breast cancer or benign breast diseases (BBD) and healthy female donors (HDs) who underwent preoperative CTC detection and serum tumor marker tests between December 2017 and November 2018. CTC detection and serum tumor marker test results were collected from 177 breast cancer patients, 64 patients with BBD, and 20 HDs. Correlations between CTC, CEA, CA125, or CA15-3 and participants’ clinical characteristics were then analyzed. The diagnostic performances of CTC, CEA, CA125, and CA15-3 were estimated using the area under the receiver operating characteristic curve (AUC). This study was approved by the Institutional Review Board of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, China (approval No. [2018] kuaishendi(75)) on May 24, 2018. Results: CTC, CEA, and CA15-3 were able to distinguish breast cancer patients from controls (BBD+HDs) ( P <0.0001, P =0.0006, and P =0.0086, respectively). CTCs were associated with tumor size ( P =0.0275) and lymph node involvement ( P =0.0373), while CA15-3 was correlated with cancer stage ( P =0.01) and lymph node involvement ( P =0.001). The AUCs of CTCs, CEA, CA125, and CA15-3 were 0.845, 0.623, 0.477, and 0.58, respectively. CA125, with AUC<0.5, was not considered a biomarker for breast cancer. CEA and CA15-3 had low sensitivities (<10%) but high specificities (>98%). Combination with CTC improved the diagnostic performances of CEA and CA15-3 for breast cancer. CTC_CA15-3 had better diagnostic performance than CTC_CEA, with an AUC of 0.874, a sensitivity of 0.757, and a specificity of 0.905. Conclusion: CTCs, CEA, and CA15-3 are potential diagnostic biomarkers for breast cancer. The diagnostic performance of CEA and CA15-3 may be improved by combination with CTCs.

Clinicopathological Evaluation of Gastric Signet Ring Cell Carcinoma: Our Experience.

AimGastric cancer is one of the most common cancers worldwide. In Turkey, stomach cancer is ranked 5th among men and 8th among women in all cancers and is located in the forefront in cancer-related deaths. Signet ring cell adenocarcinoma, which is the histopathological subtype of gastric cancer, has a poor prognosis. The incidence of signet ring cell adenocarcinoma is rising. In the present study, we aimed to describe the clinicopathologic features of signet ring cell adenocarcinoma.Materials and MethodsA total of 79 patients with 30 being female (38%) and 49 male (62%) who were diagnosed with gastric signet ring cell adenocarcinoma in the Medical Oncology Department of Ankara Numune Training and Research Hospital between January 2004 and October 2015 were retrospectively evaluated.ResultsThe baseline demographic characteristics of the patients, such as tumor localization, tumor stage, preoperative serum tumor markers, and treatment type (surgery and chemotherapy regimen), and the effects of these variables on survival and mortality were evaluated. Total surgery, stage III disease, moderate to poor grade, preoperative serum CA 19-9 and CEA levels were found as independent predictors of progression risk (p < 0.05). Each 1 ng/mL increase in preoperative serum CEA level was found to increase the risk of progression by 1.20 folds. Again, each 1 U/mL in preoperative serum CA 19-9 level was found to increase the risk of progression and mortality by 1.06 folds.ConclusionThe clinicopathologic features of signet ring cell stomach cancer were described. Tumor localization and disease, CA 19-9 and CEA levels, and treatment type (surgery and chemotherapy regimen) were effective on survival and mortality. However, further studies with larger patient groups are needed on this issue.How to cite this articleAltay SB, Akkurt G, Yılmaz N, et al. Clinicopathological Evaluation of Gastric Signet Ring Cell Carcinoma: Our Experience. Euroasian J Hepato-Gastroenterol 2020;10(2):76–84.

Impact of Preoperative Serum Tumor Markers in Patients with Lung Squamous Cell Carcinoma

Background: Several previous researchers have investigated the prognostic value of serum tumor markers, especially carcinoembryonic antigen (CEA). Only a limited number of studies reported the usefulness of serum tumor markers for lung squamous cell carcinoma (SQ). We aimed to examine the significance of serum tumor markers for lung SQ. Methods: Eighty-five lung SQ patients who underwent surgery and followed more than 5-year were included. The ratios of 5-year survivors to all patients in groups with several clinicopathologic factors, including tumor markers, were compared. We also compared the clinicopathologic factors between central type and peripheral type SQ. Results: The majority of patients were male gender and current/ former smokers. Age, pN status, cytokeratin-19 fragment (CYFRA 21-1), squamous cell carcinoma antigen (SCC), and comorbid interstitial pneumonia (IP) were associated with the ratio of 5-year survivors significantly. When patients were compared based on tumor location, high p-stage and CYFRA 21-1 were related to central type SQ. Conclusion: Both SCC and CYFRA 21-1 appeared to be useful prognostic markers for patients with lung SQ. Furthermore, CYFRA 21-1 was related to central type SQ.

PD19-05 DOES PERCENTAGE OF SEMINOMA AT ORCHIECTOMY IMPACT PATIENT MORBIDITY AND PATHOLOGIC OUTCOMES AT POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR MIXED GERM CELL TUMOR?

INTRODUCTION AND OBJECTIVE: Post-chemotherapy retroperitoneal lymph node dissections (PC-RPLND) for pure seminoma are widely considered to have an increased potential for surgical complexity and morbidity secondary to increased post-chemotherapy desmoplastic changes. This places patients at increased risk, often with pathologic findings only revealing necrosis. We sought to determine if the percentage of seminoma in the orchiectomy specimen predicts necrosis on PC-RPLND for non-seminomatous germ cell tumors (NSGCT) and the associated impact on patient morbidity. METHODS: Patients with seminoma in the orchiectomy specimen who underwent PC-RPLND for NSGCT at Indiana University from 2009-2019 were identified to assess pathologic findings, required ancillary procedures at the time of PC-RPLND, and post-operative outcomes. Patients were categorized into quartiles to assess if increasing percentage of seminoma predicted necrosis. RESULTS: Of the 109 patients identified, pathologic analysis revealed necrosis in 30/109 (27.5%), malignancy 17/109 (15.6%), and teratoma 62/109 (56.9%). As percent seminoma increased by quartile, necrosis was more prevalent (23.7%, 25%, 33.3%, 41.7%), as was the radiographic size decrease in post-chemotherapy retroperitoneal masses. For patients with greater than 90% seminoma, necrosis was found 50% of the time. The incidence of concurrent nephrectomy, need for intra-operative vascular repair, and estimated blood loss during PC-RPLND was greatest in the 4th quartile. There was no significant difference in pre-operative serum tumor markers, patient age, body mass index, pre-operative comorbidities, length of stay, or post-operative Clavien-Dindo classification outcomes. CONCLUSIONS: As percent seminoma in the orchiectomy specimen increased, the incidence of necrosis, surgical complexity, and the need for concurrent ancillary procedures increased. However, it did not seem to change the hospital course or post-operative morbidity. Unfortunately, these results show that PC-RPLND cannot be eliminated even in patients with very high orchiectomy seminoma percentages as over half of these patients had teratoma or viable malignant elements in the retroperitoneum. Source of Funding: None

A panel of protein kinase high expression is associated with postoperative recurrence in cholangiocarcinoma

BackgroundCancer recurrence is one of the most concerning clinical problems of cholangiocarcinoma (CCA) patients after treatment. However, an identification of predictive factor on Opisthorchis viverrini (OV)-associated CCA recurrence is not well elucidated. In the present study, we aimed to investigate the correlation of twelve targeted protein kinases with CCA recurrence.MethodsTwelve protein kinases, epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2, 3, 4 (HER2, HER3, HER4), vascular endothelial growth factor receptor 3 (VEGFR3), vascular endothelial growth factor-C (VEGF-C), erythropoietin-producing hepatocellular carcinoma receptor type-A3 (EphA3), EphrinA1, phosphor-serine/threonine kinase 1 (p-Akt1), serine/threonine kinase 1 (Akt1), beta-catenin and protein Wnt5a (Wnt5a) were examined using immunohistochemistry. Pre-operative serum tumor markers, CA19–9 and CEA were also investigated.ResultsAmong twelve protein kinases, EGFR, HER4, and EphA3 were associated with tumor recurrence status, recurrence-free survival (RFS) and overall survival (OS). Multivariate cox regression demonstrated that EGFR, HER4, EphA3 or the panel of high expression of these proteins was an independent prognostic factor for tumor recurrence. The combination of high expression of these proteins with a high level of CA19–9 could improve the predictive ability on tumor recurrence. Moreover, the patients were stratified more accurately when analyzed using the combination of high expression of these proteins with primary tumor (T) or lymph node metastasis (N) status.ConclusionEGFR, HER4, EphA3 or the panel of high expression of these proteins is an independent prognostic factor for post-operative CCA recurrence.

The relationship of neutrophil to lymphocyte ratio with testicular cancer.

ABSTRACTPurpose:To assess the relationship between testicular germ cell tumors (TGCT) and neutrophil to lymphocyte ratio (NLR) and to determine whether this ratio can be used as a serum tumor marker.Material and Methods:Sixty-one patients with testicular germ cell tumors were included into the study. Patients were grouped as localized and non-localized. Histologically patients were categorized as seminoma and nonseminomatous germ cell tumors. Complete blood cell count was measured the day before surgery and at the postoperative 1st month. Preoperative and postoperative mean NLR values were compared.Results:Thirty-six patients (59%) had seminomas and 25 patients (41%) had nonseminomatous testicular cancer. Forty-five patients (73.8%) had localized and 16 patients (26.2%) had non-localized testicular cancer. There was a statistically significant difference between preoperative and postoperative mean NLR of the localized patients (p=0.001) but no such difference was detected for non-localized patients (p=0.576). Nineteen patients with localized seminomas had normal preoperative serum tumor markers. There was a significant difference between preoperative and postoperative mean NLR in this group of patients (p=0.010). Twenty-six patients with localized tumors had preoperative increased serum tumor markers which normalized after orchiectomy. Mean NLR of these patients significantly decreased from 3.10±2.13 to 1.62±0.59 postoperatively (p=0.010).Conclusions:NLR appears to be a useful marker for TGCT. It is successful in predicting localized and non-localized disease in early postoperative period.

Outcomes After Multidisciplinary Management of Primary Mediastinal Germ Cell Tumors.

We examined management strategies, overall survival (OS), and progression-free survival (PFS) among patients with PMNSGCTs undergoing resection and multidisciplinary management at a high-volume institution. Outcomes after resection of PMNSGCTs are not well-characterized, with limited data on factors associated with survival. We reviewed patients with PMNSGCT who underwent resection between 1980 and 2019. Median follow-up was 3.4 years. Preoperative therapy (including use of bleomycin), surgical management, recurrence, and survival were examined. Factors associated with survival were analyzed using Cox regression. In total, 113 patients were included [median age, 28 years (range, 16-65)]. Preoperative serum tumor markers (STMs) normalized/decreased in 74% of patients. Pathology included necrosis only (25%), teratoma +/- necrosis (20%), viable nonteratomatous germ cell tumor +/- teratoma (41%), and secondary somatic-type malignancy +/- teratoma (20%). Bleomycin chemotherapy was not associated with pulmonary complications or 90-day mortality. Patients receiving second-line chemotherapy followed by resection had significantly worse OS and PFS than patients receiving first-line chemotherapy followed by resection. On multivariable analysis, R1/R2 resection (HR, 3.92; P < 0.001) and increasing postoperative STMs (HR, 4.98; P < 0.001) were associated with shorter PFS; necrosis on pathology (HR, 0.42, P = 0.043) was associated with longer PFS. In patients with PMNSGCT undergoing resection, completeness of resection, postoperative pathology, and postoperative STMs were associated with PFS. Induction bleomycin was not associated with pulmonary complications or mortality in patients undergoing resection. Patients undergoing second-line chemotherapy followed by resection have a poor prognosis, with long-term survival of 22%.

P-174 - Proposal of optimal cut-off of preoperative serum tumor marker levels to predict postoperative recurrences of gastric cancer

P-174 - Proposal of optimal cut-off of preoperative serum tumor marker levels to predict postoperative recurrences of gastric cancer

The association of five preoperative serum tumor markers and pathological features in patients with breast cancer.

BackgroundThe utility of frequently used serum tumor markers in breast cancer remains controversial. The study aimed to investigate the role of preoperative carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 153 (CA153), cancer antigen 724 (CA724), and ferritin (FER) in the management of breast cancer and their relationships with pathological features.MethodsA total of 804 patients with breast mass who underwent breast surgery and 305 healthy volunteers were enrolled. Preoperative serum levels of CEA, CA125, CA153, CA724, and FER were measured. And the pathological features of all the patients were recorded. The association of preoperative serum tumor markers and pathological features was analyzed.ResultsAmong the 804 patients, 355 were identified as malignant cases and 449 as benign cases. CEA, CA153, and FER of patients with breast cancer were higher than those of healthy volunteer group and patients with benign breast diseases. The area under curve (AUC) of CEA, CA153, and FER for distinguishing patients with breast cancer and subjects with non‐breast cancer was 0.688 (95% CI: 0.656‐0.721), 0.609 (95% CI: 0.574‐0.645), and 0.623 (95% CI: 0.586‐0.660), respectively. CA153 correlated with tumor size, node status, and TNM stage, whereas CA125 with node status. No statistic differences of the five markers were observed among the four molecular subtypes.ConclusionPreoperative levels of CEA, CA153, and FER exhibit low diagnostic accuracy for breast cancer (stage I‐III). CA153 correlates with tumor burden, suggesting its prognostic value. The five serum markers do not correlate with molecular subtypes.

The difference in prognosis of stage II and III colorectal cancer based on preoperative serum tumor markers.

Background: Preoperative serum tumor markers have been widely used to predict prognosis in stage II and III colorectal cancer (CRC). However, few previous studies addressed the effect of increased preoperative numbers of tumor markers.Methods: Patients with stage II and III CRC who underwent curative resection were included from January 2009 to October 2015. The relationship between serum tumor markers and clinicopathological parameters was analyzed. DFS and OS were compared in stage II and III CRC.Results: The median follow-up was 45 months. In this study, 735 enrolled patients were assessed based on the numbers of increased tumor markers. We found that these increased tumor markers were closely associated with clinical stage, T stage, N stage, tumor location, pathology type, differentiation, lymphatic invasion and vascular invasion (all p values < 0.05). Furthermore, the number of increased tumor markers directly affected the survival of patients with CRC after curative surgery. The 3-year DFS and OS of patients with a score of 0 were 84.0% and 91.0%, respectively, which are much higher than those of patients with a score of 4 (42.9% and 37.8%, respectively) (p < 0.05). The 5-year DFS and OS of patients with a score of 0 were 75.9% and 77.9%, respectively, which are much higher than those of patients with a score of 4 (31.7% and 23.6%, respectively). Interestingly, our results suggested that stage III CRC patients with a score of 0 had longer DFS and OS times than stage II patients with scores of 3 and 4. Further analysis revealed statistically significant differences in OS (p < 0.05) but not in DFS.Conclusions: The number of increased tumor markers could significantly predict prognosis in stage II and III CRC. In addition, these increased tumor markers had direct impacts on metastasis as well as the recurrence status and survival time of stage II and III CRC patients.

Prognostic value of combining preoperative serum tumor markers and peripheral blood routine indexes in patients with colorectal cancer

To investigate the prognostic value of preoperative serum tumor markers combined with peripheral blood routine indexes in colorectal cancer patients. From January 2010 to March 2013, clinicopathological data of colorectal cancer patients receiving surgery treatment at the Third Affiliated Hospital of Sun Yat-sen University were collected. (1) histologically confirmed adenocarcinoma; (2) primary cancer resected; (3) intact clinical data; (4) no signs of clinical infection. Patients with intestinal perforation or obstruction, hematological diseases or other malignant tumors were excluded. Informations were recorded containing sex, age, tumor location, degree of differentiation, tumor size, vascular tumor thrombus, nerve invasion, depth of infiltration, lymph node metastasis, distant metastasis, TNM stage, peripheral serum CEA, CA199, number of neutrophil, monocyte, platelet and lymphocyte. Positive CEA was defined as ≥5 μg/L, CA199 as ≥35 U/L; while NLR (neutrophil-to-lymphocyte ratio), MLR (monocyte-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio) greater than their cut-off values were defined as positive. ROC curve was used to determine the cut-off values (with greatest area under curve) of NLR, MLR and PLR. The prognostic values of these indexes were analyzed using Kaplan-Meier regression and log-rank test. COX regression was used to perform risk factor analysis. A total of 312 colorectal cancer patients were enrolled, including 192 males and 120 females with median age of 61 (15-85) years. Till March 11, 2018, during median follow-up period of 65 months(2-96), the follow-up rate was 90.4% with loss of 30 cases and the mortality was 37.2% with 116 death. Univariate analysis found that colorectal cancer patients with positive CEA, CA199, NLR (>2.32), MLR (>0.24) and PLR (>164.1) had poor prognosis (all P<0.01). When combining CEA, CA199 with NLR, MLR, PLR, the survival analysis showed that patients with both negative indexes had the best prognosis, one positive the worse and both positive were the worst (all P<0.01). COX regression revealed that CEA(HR= 1.702,95%CI:1.148-2.522, P<0.01), combination of CA199 and MLR (HR=2.292, 95%CI:1.426-3.683, P<0.01) were independent risk factors for colorectal cancer. Combination of preoperative serum tumor markers and peripheral blood routine indexes can provide prognostic information for the patients with colorectal cancer.

The Morphologic Spectrum of Sertoliform Cystadenoma of the Rete Testis: A Series of 15 Cases.

Sertoliform cystadenoma of the rete testis (SCRT) is rare with only 9 cases reported to date in the literature, none with follow-up. Four large genitourinary pathology consult services were searched. We identified 15 cases of SCRT. Men were 21 to 84 years old (mean, 46 y) and had testicular discomfort or mass. Other findings were seminoma (n=1), spermatocele (n=2), hydrocele (n=1), varicocele (n=1), and scrotal hematoma (n=1). Eight had preoperative serum tumor markers, which were normal. Tumors ranged from 0.3 to 4 cm (mean, 1.5 cm). All of them were well circumscribed with solid and cystic features and occupied on average, 73% of the rete (20% to 100%). The tumors were mostly confined within dilated channels of the rete testis and showed classic features consisting of: (1) tubules with well-formed lumina in 87% of cases; (2) well-formed tubules with no lumina in 87% of cases; and (3) cords/nests in hyalinized or myxoid stroma in 73% of cases. Other patterns included: (1) solid/sheet growth in 26% of cases; (2) individual cells in 13% of cases; (3) festoons in 13% of cases; (4) branching tubules in 7% of cases; and (5) papillary in 7% of cases. Cells were cuboidal with round to oval nuclei with small nucleoli, except at the periphery where projections into rete tubules had a more columnar appearance. In the festooning pattern, nuclei were pseudostratified and columnar with prominent nucleoli and nuclear grooves. In 4 cases, tumor extended into adjacent seminiferous tubules surrounded by dense peritubular fibrosis, with in some cases small cysts lined by flattened epithelium containing pale lightly granular material. All cases lacked necrosis and significant atypia. Mitoses ranged from 0 to 2 per 10 high-power field. Follow-up ranged from 4 to 170 months with mean of 97 months. For the 13 cases with information, all patients were alive, except for 3 who died of either unrelated causes (9.2 and 10 y) or of unknown cause (4.8 y at age 89 y). We performed immunohistochemistry for steroidogenic factor 1 and inhibin in 4 of our cases, where 3 (75%) were positive for both markers. We also describe 2 additional cases which morphologically resembled SCRT but had more atypical features. This study highlights that SCRT has variable morphology. We also verify the benign nature of the lesion and its lack of association with any syndromes.

P3.16-051 Implications of Preoperative Serum Tumor Levels on Pathological Characteristics in Patients with Lung Adenocarcinoma

Although preoperative serum tumor marker levels, such as carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC) are often evaluated in non-small cell lung cancer patients, the implication of these levels are still unknown. This study examined the predictive effect of preoperative tumor marker levels on pathological characteristics of lung adenocarcinoma. We retrospectively reviewed patients with lung adenocarcinoma who underwent macroscopic complete resection. The pathological metastasis and/or involvement was defined that positive pleural effusion or lavage cytology, pleural involvement, pulmonary metastasis, lymph node metastasis, and/or lymphovascular involvement were identified on pathological examination. To identify predictors for the pathological metastasis and/or involvement, tumor markers (CEA, SCC, Sialyl Lewisx-1 [SLX], cytokeratin-19 fragments [CYFRA], neuron-specific enolase [NSE], and pro-gastrin-releasing peptide [ProGRP]), and demographic and clinical factors were analyzed by a univariate analysis and multivariate logistic regression analysis. For the significant tumor markers, optimal cutoff points were determined with a receiver operating characteristic analysis. Of the 263 eligible patients, 138 were male and 125 were female. The median age was 70 years. The median preoperative CEA, SCC, SLX, CYFRA, NSE, and ProGRP levels were 3.7 ng/ml, 0.8 ng/ml, 28 U/ml, 1.8 ng/ml, 8.4 ng/ml, and 46.9 pg/ml, respectively. According to the 7th edition of the TNM classification, 186 patients (71%) had c-stage IA disease, 48 (18%) had c-stage IB disease, 26 (10%) had c-stage II disease, and 3 (1%) had c-stage III disease. Positive pleural effusion, positive pleural lavage cytology, pleural involvement, pulmonary metastasis, lymph node metastasis, lymphatic permeation, and vascular invasion were identified in 3 (1%), 4 (2%), 48 (18%), 9 (3%), 28 (11%), 20 (8%), and 35 patients (13%), respectively, and in total, 83 patients (32%) developed the pathological metastasis and/or involvement. The univariate analysis identified CEA, smoking index, size, solid size, and c-stage as significant predictors. A multivariate analysis revealed CEA (OR: 1.113, p=0.005) and solid size (OR: 1.052, p<0.001) as significant predictors. The optimal cutoff point was determined as 6.0 ng/ml for the preoperative CEA, and 35 of the 63 patients (56%) with ≥6.0 ng/ml of CEA developed the pathological metastasis and/or involvement whereas 48 of the 200 patients (24%) with <6.0 ng/ml of CEA developed pathological metastasis and/or involvement. Our results suggested the predictive effect of the high preoperative CEA level on pathological metastasis and involvement in patients with lung adenocarcinoma, and thus, we may consider preoperative CEA to decide surgical procedure for these patients, such as the extent of pulmonary resection and lymphadenectomy.

The clinicopathological features and risk factors of recurrence in patients with mucinous borderline ovarian tumors

Objective: To investigate the clinicopathological features and risk factors in patients with mucinous borderline ovarian tumors (MBOT). Methods: From 1999 to 2006, 66 MBOT patients in our hospital with more than ten-year follow-up were enrolled retrospectively. They were re-classified according to the literature. The clinicopathological features of different subgroups, including age, preoperative serum tumor markers, surgical methods, pathological features, surgical pathology staging, as well as the risk factors of recurrence and survival were analyzed. Results: Median age was 39 years in 66 patients. Before the surgery, 33.3% (20/60) patients had elevated CA125 and 51.7% (30/58) had elevated CA199. The accurate rate for fast frozen pathology of resected specimen was 73.4%. 21 patients underwent conservative surgery and 45 patients underwent extensive surgery. 57 patients underwent comprehensive operation and 43 cases (75.4%) resulted in stage Ⅰ. 48 of the 66 patients (72.7%) had intestinal-type tumors (IMBT) and 18 patients (27.3%) had endocervical-like tumors (EMBT). The median follow-up was 150 months. Eight recurrences (12.1%) were identified. The mean time between surgery to the initial recurrence was 26.4 months (13 to 50 months). Recurrence rate of IMBT was higher than that of EMBT (14.6% versus 5.6%) with no significance (P>0.05). All patients with pseudomyxoma had disease recurrence. Recurrence rate of stage Ⅲ patients was significantly higher than that of stage Ⅰ patients (33.3% versus 9.3%, P<0.05). During the follow-up period, tumor-related death occurred in 2 cases with a 10-year survival rate of 95.4%. Kaplan-Meier method and Log Rank analysis showed that clinical staging and peritonealmyxoma were adverse prognostic factors (P<0.05). Although the recurrence rate of patients undergoing conservative surgery was higher than that of patients with extensive surgery (23.8% versus 6.7%, P=0.047), the overall survival was almost the same between these two groups (P>0.05). Conclusions: MBOT patients have relatively good prognosis. IMBT are more common than EMBT subtypes, but recurrence rate and patient survival were almost the same between these two groups. Patients with pseudomyxoma was more likely to have disease recurrence. Patients who underwent conservative surgery resulted in higher recurrence rate but did not affect the overall survival of patient. Pseudomyxoma and clinical staging were adverse prognostic factors in MBOT patients.

Serum CA125 is a predictive marker for breast cancer outcomes and correlates with molecular subtypes.

Detection of serum tumor markers has been developed as a non-invasive tool to assess treatment efficiency in different types of cancer. This study aims to investigate the role of preoperative serum tumor markers (CEA, CA125 and CA15-3) in the management of breast cancer, and their relationships with patients’ clinicopathological parameters as well as different molecular subtypes. Altogether, 151 patients with invasive breast cancer and 180 control subjects with benign breast diseases were enrolled in this study. In the present study, preoperative serum levels of CEA, CA125 and CA15-3 were significantly higher in patients with breast cancer than controls subjects. Moreover, late-stage cancer patients exhibited significantly higher levels of CEA, CA125 and CA15-3 compared with early-stage ones. Statistical analysis indicated that elevated CA125 and CA15-3 levels were obviously related to patients with larger tumor diameter (>5cm) and lymph node metastasis. Furthermore, our results showed that the preoperative serum levels of CA125 exhibited statistical differences among various molecular subtypes, with the most frequent elevations occurring in the triple-negative tumors. In summary, our study indicated that the preoperative serum levels of CEA, CA125 and CA15-3 might be more efficient for monitoring advanced tumors than early diagnosis. High preoperative CA125 levels may reflect tumor burden and are associated with aggressive molecular subtype, suggesting that it can be used to predict poor outcome and prognosis of breast cancer patients.

Serum tumor markers to predict cancer-related venous thromboembolism in gastric cancer.

e15526 Background: To investigate the relationship between the preoperative level of serum tumor markers and cancer-related venous thromboembolism in patients with gastric cancer. Methods: 1005 patients with gastric cancer who underwent curative resection were finally enrolled in this study. Serum tumor markers including CEA, CA19-9, CA242, CA72-4, CA125 were tested within one week before curative surgery. Measurement data between groups were compared with t test. The sensitivity, specificity, positive predictive values, and negative predictive values of five biomarkers and the combination group were calculated, respectively. The odds ratios were calculated via both univariate and multivariate logistic regression models. Results: Cancer-related venous thromboembolism was found in 540 (53.73%) patients. The increase of each cancer marker is remarkably related with cancer-related venous thromboembolism. The more abnormal serum tumor markers come out, the high the risk of positive cancer-related venous thromboembolism can be. The possibility of positive cancer-related venous thromboembolism would be 2.9 times as much as a normal patient as any of the tumor markers increases. With the increase of any 4 of the tumor markers can make the risk 16.4 times Conclusions: The status of postoperative cancer-related venous thromboembolism can be predicted from preoperative serum tumor markers. For those patients with a high risk of positive cancer-related venous thromboembolism, more aggressive treatment should be arranged.

Serum tumor markers predict cancer-related venous thromboembolism in gastric cancer

Background: To investigate the relationship between the preoperative level of serum tumor markers and cancer-related venous thromboembolism (CVT) in patients with gastric cancer. Methods: A total of 1,005 patients with gastric cancer who underwent curative resection were finally enrolled in this study. Serum tumor markers including carcinoembryonic antigen (CEA), cancer antigen (CA)19-9, CA242, CA72-4, CA125 were tested within 1 week before curative surgery. Measurement data between groups were compared with t -test. The sensitivity (SEN), specificity (SPN), positive predictive values (PPV), and negative predictive values (NPV) of five biomarkers and the combination group were calculated, respectively. The odds ratios (ORs) were calculated via both univariate and multivariate logistic regression models. Results: CVT was found in 540 (53.73%) patients. The increase of each cancer marker is remarkably related with CVT. The more abnormal serum tumor markers come out, the high the risk of positive CVT can be. The possibility of positive CVT would be 2.9 times as much as a normal patient as any of the tumor markers increases. With the increase of any 4 of the tumor markers can make the risk 16.4 times. Conclusions: The status of postoperative CVT can be predicted from preoperative serum tumor markers. For those patients with a high risk of positive CVT, more aggressive treatment should be arranged.

Predictive Value of Preoperative Serum Tumor Marker Levels for Pathological Characteristics of Resected Lung Adenocarcinoma

SESSION TITLE: Lung Cancer I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The aim of this study was to investigate the association between preoperative serum tumor marker levels and pathological characteristics of resected lung adenocarcinoma. METHODS: We retrospectively reviewed patients with lung adenocarcinoma who had undergone macroscopic complete resection from 2013 to 2015. Patients with multiple lung cancer other than adenocarcinoma, previous treatment history of lung cancer, or active other malignancies were excluded. Preoperative serum tumor marker levels (CEA, SCC, SLX, CYFRA, ProGRP, and NSE) and preoperative clinical factors (age, sex, smoking index, and tumor size) were analyzed with univariate analysis (Fisher’s exact test or the chi-square test) and multivariate logistic regression analysis to identify predictors for the pathological involvement (positive pleural effusion or lavage cytology, pleural involvement, pulmonary metastasis, lymph node involvement, lymphovascular involvement, and/or upstaging) or the poor prognostic subtypes (solid or micropapillary predominant adenocarcinoma). For the significant factors, optimal cutoff points were determined with a receiver operating characteristic (ROC) analysis. RESULTS: Of a total of consecutive 183 patients, 100 were male and 83 were female, and the median age was 70 years. On pathologic diagnosis, 4 (2%) patients had positive pleural effusion or lavage cytology, 36 (20%) had pleural involvement, 6 (3%) had pulmonary metastasis, 20 (11%) had lymph node involvement, 39 (21%) had lymphovascular involvement, and 43 (23%) showed upstaging. In total, 72 patients (39%) had the pathological involvement. In the subtypes of adenocarcinoma, 17 (9%) patients had solid or micropapillary predominant adenocarcinoma, 129 (71%) had invasive adenocarcinoma other than these 2 subtypes, and 37 (20%) had AIS or MIA. Both univariate and multivariate analysis identified CEA and tumor size for the pathological involvement and smoking index and SLX for the poor prognostic subtypes as significant predictors. Of patients with CEA ≥5.3 ng/ml or SLX ≥34 U/ml which were determined by the ROC analysis, 33 of 57 (58%) and 9 of 39 (23%) patients had the pathological involvement or the poor prognostic subtypes, respectively. CONCLUSIONS: Preoperative higher CEA and SLX may predict pathological characteristics of lung adenocarcinoma, such as presence of pathological involvement and poor prognostic subtypes. CLINICAL IMPLICATIONS: Preoperative serum tumor marker levels should be considered for deciding surgical treatment strategy of lung adenocarcinoma. DISCLOSURE: The following authors have nothing to disclose: Terumoto Koike, Akihiko Kitahara, Seijiro Sato, Takehisa Hashimoto, Shin-ichi Toyabe, Masanori Tsuchida No Product/Research Disclosure Information

Predictive and prognostic value of preoperative serum tumor markers in resectable adenosqamous lung carcinoma.

BackgroundAdenosquamous carcinoma is a rare and aggressive form of lung cancer. The prognostic and predictive value of preoperative serum tumor markers and frequency of EGFR mutations in adenosquamous lung carcinoma are unclear.MethodsWe retrospectively analyzed data and samples collected from 106 radically resected adenosquamous lung carcinoma patients with pathological stage I-IIIA between 2008 and 2013. Correlations between serum tumor marker levels and EGFR mutations as well as survival parameters were analyzed and prognostic factors were identified.ResultsOf the 106 adenosquamous lung carcinoma patients, 29 (27.4%) harbored EGFR mutations. By univariate analysis, advanced clinical stage (P = 0.009 for disease-free survival [DFS]; P = 0.046 for overall survival [OS]), larger tumor size (P = 0.001 for DFS; P = 0.002 for OS), regional lymph node metastasis (P = 0.024 for DFS; P = 0.030 for OS), higher NSE level (P = 0.002 for DFS; P < 0.001 for OS), and higher TMI (tumor marker index) (P = 0.009 for OS) were significantly correlated with a worse prognosis. By multivariate analysis, NSE (P = 0.014) was confirmed as independent predictor for DFS, while NSE (P = 0.001) and TMI (P = 0.038) were independent prognostic factors for OS.ConclusionAdenosquamous lung carcinoma is an aggressive malignancy with relatively high EGFR mutation frequency. Elevated preoperative NSE level and TMI are adverse predictive and prognostic indicators.