Serum Levels Of Carbohydrate Antigen Research Articles

Cellular Senescence, Represented by Expression of Caveolin-1, in Cancer-Associated Fibroblasts Promotes Tumor Invasion in Pancreatic Cancer.

The role of senescence of cancer-associated fibroblasts (CAFs) in the development of cancer is controversial. In this study, we investigated whether cellular senescence of CAFs, represented by CAV1 expression, affects tumor progression in pancreatic cancers (PC). Because CAV1 plays a major role in cellular senescence, we used CAV1 expression to monitor cellular senescence. A total of 157 consecutive patients with PC who underwent curative resection were enrolled in the study. Patients were divided into two groups according to CAV1 expression in CAFs by immunohistochemistry. We investigated the relationship between the CAV1 expression in CAFs and the patients' clinicopathological characteristics, including survival. We also established ten CAFs cell lines using PC clinical samples and chose one of them to knock down CAV1 expression. Finally, we cultured a PC cell line (MIAPaCa-2) in CAF-conditioned medium (CM). Regarding patients' clinicopathological characteristics, the serum levels of carbohydrate antigen 19-9 and the rate of advanced tumor stage (pT2, 3, and 4) were significantly higher in the high-CAV1 group. The high-CAV1 group had significantly worse outcomes in both overall and disease-free survival (p < 0.01). Additionally, in co-culture assays using CAFs-CM and MIAPaCa-2 cells, we found that knockdown of CAV1 in CAFs negatively affected the invasion of PC cells. In PC, CAV1 expression in CAFs is associated with patients' poor prognosis and the downregulation of CAV1 in CAFs reduces the invasiveness of PC cells. Therefore, CAV1 of CAFs might be a new target for the treatment of PC.

Clinical Significance of Serum CEA and CA19-9 Levels before Surgery and during Postoperative Follow-up in Colorectal Cancer

Background: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most common colorectal cancer markers. We aimed to identify the appropriate clinical conditions for measuring serum CEA and CA19-9 levels before surgery and during follow-up.

Prognostic significance of perioperative tumor marker levels in stage II/III gastric cancer.

AIMTo evaluate the prognostic significance of perioperative carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels in stage II/III gastric cancer.METHODSFrom a multi-institutional retrospective database compiled by integrating clinical data from nine institutions, data of 998 patients who underwent curative resection for stage II/III gastric cancer between 2010 and 2014 were retrieved and analyzed. The prognostic impact of the preoperative and postoperative levels and chronological changes in CEA, CA19-9 and their combination were evaluated. To test whether postoperative adjuvant chemotherapy alters the prognostic impact of perioperative CEA and CA19-9 levels, the hazard ratios for mortality were compared between patients who underwent surgery alone and patients who underwent surgery followed by adjuvant chemotherapy.RESULTSThe prognostic impact of postoperative CEA and CA19-9 was superior to that of the preoperative levels. Multivariable analysis identified high postoperative CEA and CA19-9 levels as independent prognostic factors for overall survival. Disease-free survival rates clearly decreased in a stepwise manner in association with postoperative CEA and CA19-9 levels, and patients with high levels of both markers showed significantly poorer prognosis than other patient groups. When we analyzed perioperative changes in serum CEA and CA19-9 levels, patients with high levels before and after surgery had the worst disease-free survival rates among all patient groups. Patients with normalized CEA levels after surgery had a significantly lower disease-free survival rate than those with normal perioperative levels, whereas patients with normalized CA19-9 levels after surgery had equivalent survival to those with normal perioperative levels. The prognostic impact of high CEA levels was observably smaller in patients who underwent adjuvant chemotherapy than in patients who underwent surgery alone, whereas that of high CA19-9 was greater in patients who underwent adjuvant chemotherapy. High postoperative CEA levels were significantly associated with an increased prevalence of liver, lung and bone recurrences, and high postoperative CA19-9 levels were significantly associated with increased frequencies of lymph node and liver recurrences.CONCLUSIONThe evaluation of serum CEA and CA 19-9 levels both before and after surgery provides useful information for precise risk stratification after curative gastrectomy.

Clinical significance of serum EGFR gene mutation and serum tumor markers in predicting tyrosine kinase inhibitor efficacy in lung adenocarcinoma.

To study the clinical significance of serum epidermal growth factor receptor (EGFR) gene mutation and serum tumor markers in the prediction of tyrosine kinase inhibitor (TKI) efficacy in patients with lung adenocarcinoma. Ninety patients with pathologically diagnosed lung adenocarcinoma were enrolled. Further, 51 out of 90 patients received the EGFR-TKI therapy, oral gefitinib. The correlations among serum EGFR gene mutations in exons 18-21, serum tumor markers such as carcinoembryonic antigen (CEA), carbohydrate antigen 24-2 (CA24-2), carbohydrate antigen 125, carbohydrate antigen 15-3 as well as carbohydrate antigen 19-9 (CA19-9) levels, and EGFR-TKI efficacy were determined. There was a high consistency of EGFR gene mutation rate between serum and tissue samples. The serum EGFR gene mutation rate in female patients or non-smokers was significantly higher than that in male patients or smokers, respectively. Serum CA19-9, CA24-2, and CEA levels were significantly correlated with serum EGFR mutation. After receiving gefitinib, the progression-free survivals (PFSs) of patients with high serum CEA level, high serum CA19-9 level, or serum EGFR gene mutation were significantly higher than those of normal patients, respectively. The PFSs were significantly prolonged in patients with EGFR gene mutation and high serum CEA level or patients with EGFR gene mutation and high serum CA19-9 level compared with those in patients with one abnormal biomarker and normal patients. Combined detection of EGFR gene mutations as well as CA19-9 and CEA levels in peripheral blood can predict the efficacy of EGFR-TKI in the treatment of patients with lung adenocarcinoma.

High pretreatment serum CA19-9 level predicts a poor prognosis for patients with stage III colon cancer after curative resection and adjuvant chemotherapy.

Carbohydrate antigen 19-9 (CA19-9) is one of the most widely used tumor markers in gastrointestinal cancer. However, serum CA19-9 is not a recommended routine measurement in colon cancer. In this study, we evaluated the value of the preoperative serum CA19-9 level for the prediction of postoperative prognosis in stage III colon cancer. The medical records of 367 consecutive patients with stage III colon cancer who underwent curative resection followed by adjuvant chemotherapy with oxaliplatin and capecitabine between December 2007 and April 2015 were retrospectively reviewed. We determined the optimal cutoff value of CA19-9 for 3-year recurrence using the receiver operating characteristic (ROC) method. Differences in disease-free survival (DFS) and overall survival (OS) rates stratified by CA19-9 level were compared by using Kaplan-Meier and log-rank tests. A Cox proportional hazards model was used to identify prognostic variables for DFS and OS. The statistically determined best cutoff value for CA19-9 was 24 U/ml. High CA19-9 levels (> 24 U/ml) were significantly associated with poorly differentiated tumors, abnormal carcinoembryonic antigen (CEA) levels, and a high cumulative incidence of lung metastasis. Additionally, compared with low CA19-9 levels, high preoperative CA19-9 levels were associated with inferior 3-year DFS and OS rates, especially for high-risk patients (T4Nany or TanyN2). Multivariate analyses revealed that CA19-9 was an independent factor associated with both DFS (hazard ratio [HR], 2.248; 95% confidence interval [CI], 1.393-3.628; P = 0.001) and OS (HR: 2.081; 95% CI: 1.137-3.808; P = 0.017). The results of this study showed that high levels of preoperative serum CA19-9 indicated a worse prognostic outcome for stage III colon cancer patients. An early follow-up protocol to assess lung metastasis and a full course of adjuvant chemotherapy should be used for these patients.

Serum levels of carbohydrate antigen 125 in combination with N-terminal pro-brain natriuretic peptide in patients with acute decompensated heart failure.

Background/AimsCarbohydrate antigen 125 (CA-125) is an emerging prognostic biomarker for heart failure. We aimed to test the long-term prognostic value of CA-125 in combination with N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute decompensated heart failure (ADHF).MethodsThis observational study included a total of 413 patients (64.1 ± 15.6 yearold, 214 men) with ADHF. All-cause mortality during the 2-year follow-up was investigated for the prognosis.ResultsDuring the follow-up (mean follow-up, 591 ± 233 days), 109 deaths (26.0%) were recorded. In the multivariable analysis model, CA-125 was an independent factor associated with all-cause mortality (log CA-125: hazard ratio, 1.23; 95% confidence interval, 1.02 to 1.48; p = 0.030) together with age, sex, New York Heart Association class, β-blocker, and NT-proBNP. The Kaplan-Meier survival analysis demonstrated that the group with both low marker levels showed the best 2-year survival (87.9%) followed by the group with low NT-proBNP and high CA-125 (76.1%), high NT-proBNP and low CA-125 (64.7%) and high NT-proBNP and high CA-125 levels (54.3%) (p < 0.001). Addition of CA-125 in combination with NT-proBNP and established risk factors further increased the predictive power for mortality in patients with ADHF.ConclusionsCA-125 was an independent factor associated with all-cause mortality in patients with ADHF. Combination of CA-125 with NT-proBNP significantly improved the prediction of mortality in patients with ADHF.

Study of oxidative stress in ovarian cancer

Background: Ovarian cancer is the fifth most common form of cancer in the world and is often asymptomatic in its early stages. Development of ovarian cancer-specific biomarkers for the early detection of disease could improve the current dismal survival rate. Evaluation of serum carbohydrate antigen 125 (CA125), alkaline phosphatase (ALP) and oxidative stress in ovarian carcinoma patients may improve the prognosis of the disease through earlier detection. Aim of the study: The aim of this study was to find the relative risk of ovarian cancer in patients screened for CA125, ALP, Nitric oxide (NO) and Malondialdehyde (MDA) as a marker for lipid peroxidation. Material and methods: 451 subjects with ovarian cancer were screened for serum CA125 levels using a chemiluminescence analyser, out of which 164 showed values above 21 U/ml. 80 subjects with higher values were further analysed for MDA and NO using spectrophotometry and ALP by fully automated chemistry analyser. Results: The selected 80 subjects with CA125 values above 74 U/ml had increased ALP, NO and MDA, also showing positive correlation amongst these parameters. Conclusions: Benefits of CA125 screening vary with age group according to blood CA125 levels. Enzyme ALP levels are elevated with higher values of CA125. MDA and NO indicate oxidative stress and increase as the ovarian marker values increase. Positive correlation amongst the parameters indicates a significant increase in oxidative stress in ovarian cancer. For women with various CA125 levels in different age groups, screening and treatment depends upon individual decision and clinical examination.

Changes of serum MG7-Ag and CA125 levels before and after chemotherapy in patients with advanced cervical cancer and their relationships with the curative effect

Objective To discuss the changes of serum gastric cancer associated antigen MG7 (MG7-Ag), carbohydrate antigen 125 (CA125) levels before and after chemotherapy in patients with advanced cervical cancer and their relationships with the curative effect. Methods A total of 150 advanced cervical cancer patients with paclitaxel combined with cisplatin treatment were selected from June 2014 to June 2017 in our hospital, and 150 cases of healthy persons were selected at the same time. The serum MG7-Ag and CA125 levels of all persons were detected. The differences of MG7-Ag and CA125 levels between healthy persons and advanced cervical cancer patients were analyzed. And the changes of MG7-Ag, CA125 levels before and after chemotherapy and the relationships between the MG7-Ag, CA125 levels and the curative effect of chemotherapy were analyzed. Results The serum MG7-Ag and CA125 levels in the patients with advanced cervical cancer were significantly higher than those in the healthy persons [(15.36±2.23) U/ml vs. (2.42±0.31) U/ml, (275.42±30.52) U/ml vs. (11.89±1.77) U/ml], and the differences were statistically significant (t=26.215, P 25% as the critical value were 82.54%, 82.76%, 82.67%, CA125 decline percentage with >18% as the critical value were 85.71%, 86.21%, 86.00%, and the combination of the two were 96.83%, 97.70%, 97.33%. The combination of the two were significantly higher than that of the two alone, and the differences were statistically signi-ficant (χ2=6.948, P=0.008; χ2=11.018, P=0.001; χ2=17.926, P<0.001; χ2=4.881, P=0.027; χ2=7.768, P=0.005; χ2=12.611, P<0.001). Conclusion The serum MG7-Ag and CA125 levels in patients with advanced cervical cancer are higher than those in healthy persons. The MG7-Ag and CA125 levels of patients with CR and PR are decreased after chemotherapy, and their changes of serum levels can be used as the important indexes for evaluating the efficacy of chemotherapy. The combined detection of them has the better evaluation efficiency, and it is worth for further clinical promotion. Key words: Uterine cervical neoplasms; Drug therapy; Treatment outcome; CA-125 antigen; Gastric cancer associated antigen MG7

Dissected peripancreatic tissue margin is a critical prognostic factor and is associated with a K-ras gene mutation in pancreatic ductal adenocarcinoma.

We previously reported that the dissected pancreatic tissue margin (DPM) and the preoperative serum level of carbohydrate antigen 19-9 (preCA19-9) were independent prognostic factors in pancreatic ductal adenocarcinoma (PDAC). In the current study, the prognostic relevance of these factors, including their molecular associations, were validated. A total of 161 patients with PDAC underwent a pancreatectomy between 1986 and 2013, and a multivariate Cox proportional hazards model and a propensity score-based model validated the prognostic importance of DPM. The prognostic factors were compared with the mutation profiles of the K-ras and TP53 genes. Univariate prognostic analysis of disease-specific survival (DSS) demonstrated that DPM (P<0.0001), preCA19-9 (P<0.0001) and Union for International Cancer Control (UICC) stage (P<0.0001), were all significantly associated with poor outcome in PDAC. A multivariate Cox proportional hazards model confirmed that preCA19-9 (P=0.0002) and DPM (P=0.0002) remained as prognostic factors independent of UICC stage (P=0.0015). The combination of preCA19-9 and DPM to predict prognosis could accurately identify the long-term survivors of PDAC (70% 5-year DSS), and a multivariate logistic regression model identified that DPM was the most effective predictor of mortality. The prognostic relevance of DPM was also confirmed (P=0.0008) through propensity score-based background adjustment of patient bias. K-ras gene mutation was significantly associated with DPM (P=0.0002), and DPM-positive patients demonstrated recurrence of distant metastasis in 67% of cases. Therefore, DPM is a critical prognostic indicator in PDAC. In combination with preCA19-9, DPM may be useful to identify long-term survivors of PDAC. Furthermore, to the best of our knowledge, the current study was the first to discover that DPM can represent a poor prognosis based putatively on its association with the K-ras gene mutation.

Diagnostic value of serum human epididymis protein 4 and carbohydrate antigen 125 combined with risk of ovarian malignancy algorithm index for ovarian cancer

Objective To investigate the clinical value of serum human epididymis protein 4 (HE4), carbohydrate antigen 125 (CA125) combined with risk of ovarian malignancy algorithm (ROMA) index in the diagnosis of ovarian cancer. Methods A total of 541 patients in the Department of Gynaecology in Baoji Central Hospital from August 2016 to February 2018 were collected. The serum HE4 and CA125 levels were measured by using electrochemiluminescence immunoassay in 226 cases of ovarian cancer (ovarian cancer group), 315 cases of ovarian benign disease (ovarian benign disease group) and 100 female healthy people (the control group). ROMA index was calculated according to ROMA model and the results were analyzed statistically. Results The levels of serum HE4, CA125 and ROMA index were significantly different in premenopausal and postmenopausal ovarian cancer group, ovarian benign disease group and the control group (all P < 0.05). The sensitivity and Yonden's index of the three combined diagnosis of serum HE4, CA125 and ROMA for premenopausal ovarian cancer were 97.01% and 77.01% respectively, which were higher than those of a single detection (HE4: 79.37%, 69.11%; CA125: 76.06%, 66.38%; ROMA index: 89.55%, 72.41%; χ2sensitivity=12.35, P=0.000; χ2Yonden's index=6.460, P=0.013. The sensitivity and Yonden's index of the three combined diagnosis of serum HE4, CA125 and ROMA for postmenopausal ovarian cancer were 98.99% and 82.99% respectively, which were higher than those of a single detection (HE4: 86.90%, 79.40%; CA125: 82.98%, 76.31%; ROMA index: 93.54%, 80.64%; χ2sensitivity=14.25, P=0.000; χ2Yonden's index=4.822, P=0.031). The area under the curve of the combined detection of three indicators was higher than that of a single detection (premenopausal group: 0.871 vs. 0.682, 0.626, 0.708; postmenopausal group: 0.981 vs. 0.724, 0.705, 0.833), and there were significant differences (premenopausal group: χ2= 11.24, P= 0.000; postmenopausal group: χ2= 16.38, P= 0.000). Conclusion The combined detection of serum HE4, CA125 and ROMA index can increase the sensitivity and accuracy for diagnosing ovarian cancer, which can provide a more reliable basis for diagnosis and screening of ovarian cancer. Key words: Ovarian neoplasms; Human epididymis protein 4; Carbohydrate antigen 125; Risk of ovarian malignancy algorithm; Diagnosis

Sustained Elevation of Postoperative Serum Level of Carbohydrate Antigen 19-9 is High-Risk Stigmata for Primary Hepatic Recurrence in Patients with Curatively Resected Pancreatic Adenocarcinoma.

Survival after surgery for pancreatic adenocarcinoma (PA) is poor and heterogeneous, even for curative (R0) resection. Serum carbohydrate antigen (CA) 19-9 levels are important prognostic markers for resected PA. However, sustained elevation of CA19-9 in association with the patterns of recurrence has been rarely investigated. Patients who underwent R0 resection (n = 539) were grouped according to postoperative serum CA19-9 levels (Group E: sustained elevation; Group N: no elevation). Clinicopathological factors, patterns of recurrence, and survival were compared between the groups. Group E (n = 159) had significantly shorter median overall survival (17.1 vs. 35.4months, p < 0.0001) than Group N (n = 380). Postoperative CA19-9 elevation was a significant independent predictor of poor survival in multivariate analysis (hazard ratio 1.98, p < 0.0001). The rate of hepatic recurrence in Group E was 2.6-fold higher than in Group N (45% vs. 17%, p < 0.0001). Postoperative CA19-9 elevation was a strongest independent predictor of primary hepatic recurrence (p < 0.0001) by a multiple regression model. Loco-regional, peritoneal, and other distant recurrence did not differ between the groups. The extent of preoperative CA19-9 elevation was correlated sustained elevation of CA19-9 after surgery (p < 0.0001) and primary hepatic recurrence (p = 0.0019). Sustained CA19-9 elevation was strong predictor of primary hepatic recurrence and short survival in cases of R0 resection for PA.

Diagnostic value of elevated serum carbohydrate antigen 199 level in acute cholangitis secondary to choledocholithiasis.

AIMTo investigate the diagnostic value of abnormal serum carbohydrate antigen 199 (CA199) level in acute cholangitis secondary to choledocholithiasis.METHODSIn this retrospective cohort study, the clinical data of 727 patients with choledocholithiasis admitted to the Third Affiliated Hospital of Zunyi Medical College from June 2011 to June 2017 were collected. Among these patients, 258 patients had secondary acute cholangitis and served as observation group, and the remaining 569 choledocholithiasis patients served as the control group. Serum liver function indexes and tumor markers were detected in both groups, and the receiver operating characteristic (ROC) curves were constructed for markers showing statistical significances. The cutoff value, sensitivity, and specificity of each marker were calculated according to the ROC curves.RESULTSThe results of liver function tests showed no significant differences between the two groups (P > 0.05). Tumor markers including serum CA125, CA153, carcinoembryonic antigen, and alpha fetoprotein levels were also not significantly different (P > 0.05); however, the serum CA199 level was significantly higher in the observation group than in the control group (P < 0.05). The ROC curve analysis showed that the area under the curve was 0.885 (95%CI: 0.841-0.929) for CA199, and the cutoff value of 52.5 kU/L had the highest diagnostic accuracy, with a sensitivity of 86.8% and a specificity of 81.6%.CONCLUSIONAbnormally elevated serum CA199 level has an important value in the diagnosis of acute cholangitis secondary to choledocholithiasis. It may be a specific inflammatory marker for acute cholangitis.

Effect of MRI combined with serum levels of CA153, CEA and CYFRA21-1 on the diagnostic efficacy of breast cancer patients

Objective To investigate the effect of color magnetic resonance imaging (MRI) combined with serum levels of carbohydrate antigen 153 (CA153), carcinoembryonic antigen (CEA) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) on the diagnostic efficacy of breast cancer patients. Methods From December 2015 to December 2017, 80 cases of breast cancer in our hospital were selected as the observation group. Another 98 patients with benign breast diseases as control group A, and 94 healthy women as control group B. The serum levels of CA153, CEA and CYFRA21-1in the three groups were measured by electrochemiluminescence and the level of the above serum indexes in patients with different disease stages (stage Ⅰ to Ⅱ, Ⅲ to Ⅳ) in the observation group were compared. The 3 groups were examined by color Doppler high frequency ultrasound. The specificity, sensitivity and accuracy of color Doppler ultrasound combined with serum CA153, CEA and CYFRA21-1 or detecting alone in the diagnosis of breast cancer analyzed. Results There were significant differences in the levels of serum CA153, CEA and CYFRA21-1 in the 3 groups (P<0.05), and the level of serum CA153, CEA and CYFRA21-1 in the observation group was higher than that in the control group A and the control group B (P<0.05). The levels of serum CA153, CEA and CYFRA21-1 in patients in stage Ⅲ to Ⅳ of the observation group were higher than those in patients in stage Ⅰ to Ⅱ (P<0.05). The sensitivity and accuracy of color Doppler ultrasound combined with serum CA153, CEA and CYFRA21-1 in the diagnosis of breast cancer were 96.25% (77/80) and 84.93% (231/272), respectively, which were all higher than those of serum CA153, CEA and CYFRA21-1 alone (P<0.05). And the sensitivity of combined diagnosis was higher than that of color Doppler high frequency ultrasound alone (P<0.05). Conclusions Color Doppler ultrasound combined with serum levels of CA153, CEA and CYFRA21-1 can significantly improve the sensitivity and accuracy of breast cancer diagnosis, reduce the risk of missed diagnosis, and provide a strong basis for diagnosis and treatment of breast cancer. Key words: Breast neoplasms/DI; Magnetic resonance imaging; CA-15-3 Antigen/BL; Carcinoembryonic antigen/BL; Keratin-19/BL; Antigens, neoplasm

The Combination of Neutrophil-to-lymphocyte Ratio and Serum Carbohydrate Antigen 19-9 Level as a Prognostic Indicator in Patients with Recurrent Pancreatic Cancer.

We retrospectively investigated the relationship between prognosis and combined neutrophil-to-lymphocyte ratio (NLR) and serum carbohydrate antigen 19-9 (CA19-9) levels in patients with recurrent pancreatic cancer. We enrolled 66 patients whose pancreatic cancer recurred. Based on ROC analysis results, the patients were divided into NLRHigh (NLR ≥1.69) or NLRLow (NLR <1.69), and into CA19-9High (CA19-9 ≥107.95 U/ml) or CA19-9Low (CA19-9 <107.95 U/ml). When the patients were grouped by combined NLR and CA19-9, their 2-year survival rates were NLRLow/CA19-9Low: 58.7%; NLRLow/CA19-9High or NLRHigh/CA19-9Low (grouped together): 11.2%; and NLRHigh/CA19-9High: 0% (p<0.0001). Finally, in multivariate analysis, the combination of NLR and serum CA19-9 level was an independent prognostic factor in patients with recurrent pancreatic cancer. The combination of NLR and serum CA19-9 level is a useful prognostic indicator for recurrent pancreatic cancer.

The value of serum carcinoembryonic antigen and carbohydrate antigen19-9 levels in the diagnosis of gastric cancer in elderly patients

Objective To assess the value of serum carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)levels in the diagnosis of gastric cancer in elderly patients. Methods This prospective study included 104 elderly patients with gastric cancer at our hospital from March 2015 to December 2016 to serve as an experimental group.Moreover, 104 elderly patients with benign gastric lesions were enrolled to serve as a control group.Serum CEA and CA19-9 levels were compared between the two groups.The diagnostic specificity, sensitivity, and validity for gastric cancer were calculated by using CEA or CA19-9 alone or the two in combination. Results Serum CEA and CA19-9 levels in the experimental group were significantly higher than in the control group(t=3.001 and 5.110, P=0.039 and 0.016, respectively); The specificity, sensitivity, and validity of CEA and CA19-9 in combination were significantly higher than when each of the measures was used alone(χ2=2.101 and 2.109, P=0.031 and 0.019, respectively). Serum CEA levels showed good predictive power for both lymph node metastasis of gastric cancer(Z=5.109, P=0.002)and liver metastasis of gastric cancer(Z=3.910, P=0.026); Serum CA19-9 levels could predict lymph node metastasis of gastric cancer(Z=4.189, P=0.003). Conclusions Serum CEA and CA19-9 in combination have high sensitivity and validity for gastric cancer detection; Elevated CEA can predict gastric cancer metastasis and elevated CA19-9 may predict lymph node metastasis. Key words: Stomach neoplasms; Antigens, tunor-associated, carbohydrate

Clinical Significance of Serum Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 Levels Before Surgery and During Postoperative Follow-Up in Colorectal Cancer

Objective: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most common colorectal cancer markers. We aimed to identify the appropriate clinical conditions for measuring serum CEA and CA19-9 levels before surgery and during follow-up. Methods: This study included 1275 colorectal cancer patients who were divided into 3 groups according to preoperative CEA levels (group A, ≤5 ng/mL; group B, &amp;gt;5–≤11 ng/mL; group C, &amp;gt;11 ng/mL). Each group was subdivided into 2 groups according to preoperative CA19-9 levels (cutoff level: ≤37 U/mL). Recurrence and survival rates were analyzed. Results: Recurrence rate, disease-free survival after curative surgery, and prognosis were significantly worse in group A and B patients with high CA19-9 levels. At recurrence, CEA levels showed a greater increase in group B and C patients; CA19-9 levels increased in group A patients with high CA19-9 levels. At recurrence, high serum CA19-9 levels were observed in group A patients with high preoperative serum CA19-9 levels, even if the serum CEA level did not increase. Preoperative CA19-9 levels could predict recurrence and prognosis in groups A and B. Conclusion: Periodic CA19-9 determination is useful for monitoring recurrence among group A patients with high CA19-9 levels.

Clinical significance of chromodomain helicase/ATPase DNA binding protein 1-like and human mutL homolog 1 gene expression in cholangiocarcinoma.

Cholangiocarcinoma is a highly malignant form of gastrointestinal cancer with an unfavorable prognosis. The novel oncogene chromodomain helicase/ATPase DNA binding protein 1-like (CHD1L) has been confirmed to serve a vital role in numerous types of cancer, including liver cancer. Mismatch repair (MMR) is a common DNA repair process that contributes to the preservation of the integrity and stability of genetic substances. Human mutL homolog 1 gene (hMLH1) is an important MMR protein family member. The present study aimed to evaluate the pathological and clinical features of cholangiocarcinoma, and to investigate the clinical significance of CHD1L and hMLH1 expression in cholangiocarcinoma. A total of 108 samples from cholangiocarcinoma tumor tissues and 60 samples from normal bile duct tissue were obtained from patients admitted to The Second Affiliated Hospital of Nanchang University between May 2005 and May 2014. All cholangiocarcinoma cases were pathologically confirmed. The expression of CHD1L and hMLH1 was examined by immunohistochemistry analysis. The expression of CHD1L in cholangiocarcinoma (94.44%) was significantly higher than in normal bile duct tissues (40.00%). CHD1L expression was associated with gallstone history, serum carbohydrate antigen 19-9 (CA19-9) level and Tumor-Node-Metastasis (TNM) stage (P<0.05). hMLH1 expression in cholangiocarcinoma (77.78%) was significantly lower than in normal bile duct tissues (96.67%), and was associated with gender, age, serum CA19-9 level, the presence of hepatitis B virus surface antigen, TNM stage and tumor diameter (P<0.05). Kaplan-Meier survival curve analysis indicated that the 3-year accumulative survival rates for CHD1L-positive and -negative patients differed significantly (P<0.05; 17.90 and 83.33%, respectively). There was no statistically significant difference (P>0.05) between the 3-year accumulate survival rates for hMLH1-positive and -negative patients (38.90 and 33.30%, respectively). High CHD1L expression and low hMLH1 expression levels were observed in patients with cholangiocarcinoma, and their abnormal expression patterns were associated with the progression of malignancy and an unfavorable disease prognosis. Therefore, CHD1L and hMLH1 may be potential prognostic biomarkers for cholangiocarcinoma.

The value of PET/CT imaging for detecting primary malignant tumor to patients with elevated serum CA19-9

Objective To investigate the diagnostic accuracy of malignant tumor of 18F-fluorodeoxyglucose positron emission tomography/computed tomograprhy (18F-FDG PET/CT) imaging in the patients of elevated serum carbohydrate antigen 19-9 (CA19-9) and its correlation with maximum standardized uptake value (SUVmax) and serum CA19-9 level. Methods Whole-body 18F-FDG PET/CT scan was performed in 149 patients with elevated serum CA19-9 level without the history of malignancy. Blood sample was drawn in each case for CA19-9 assay two weeks or less before the performing PET/CT. Final diagnoses were confirmed by operation/biopsy pathological results and clinical follow-ups. Results Among the 149 patients, 64 cases were finally diagnosed as malignancies and 85 cases of non-malignancy diseases. The true positive of the diagnoses by 18F-FDG PET/CT was 60 cases, the false positive 13 cases, the true negative 72 cases, the false negative 4 cases. The accuracy of diagnosis of malignant tumor with elevated serum CA19-9 was 43.0%, while elevated serum CA19-9 combined with 18F-FDG PET/CT imaging was 88.6%, with statistically significant difference (χ2=59.882, P 1 000 U/ml. The diagnostic accuracy of each group of PET/CT was 94.5%, 84.9%, 81.3% and 88.0%, respectively. There was no statistically significant difference between each group (χ2=3.503, P>0.05). The area under the curve (AUC) of the serum CA19-9 for the diagnosis of malignant tumor (ROC) was 0.726, and the sensitivity and specificity of the diagnostic boundary value of 152.75 U/ml were 70.3% and 68.2%, respectively. The AUC of SUVmax in diagnosis of malignant tumor was 0.742, the best cutoff value was 6.95, and the sensitivity and specificity were 73.3%, 69.2% respectively. Conclusions 18F-FDG PET/CT is useful for detecting malignant tumors combined with serum tumor marker CA19-9. The patients with elevated serum CA19-9 are necessary to do PET/CT imaging, especially serum CA19-9>152.75 U/ml. And it should be considered malignant tumor when SUVmax>6.95. Key words: Neoplasms/DI; CA-19-9 antigen/BL; Tomography, emission-computed; Tomography, X-ray computed; Fluorodeoxyglucose F18

Liver Transplant for Perihilar Cholangiocarcinoma (Klatskin Tumor): The Essential Role of Patient Selection

Perihilar cholangiocarcinoma (Klatskin tumor) is a rare tumor entity, which is diagnosed late due to uncharacteristic symptoms. The therapeutic strategy for cure is still liver resection. Liver transplant in cases of locally irresectable tumors represents an alternative potential curative therapy for a select group of patients. We present our data of 22 patients with irresectable Klatskin tumors who received transplants between 1996 and 2015. We analyzed relevant prognostic factors for the selection of patients to be transplanted to ensure an acceptable overall survival and reviewed known and established selection criteria. Four factors (age, tumor size, serum level of carbohydrate antigen 19-9, percutaneous transhepatic cholangiodrainage) could be detected for possible patient selection. Positive lymph node status and advanced tumor stage according to the Union for International Cancer Control were confirmed as negative prognostic factors for survival after transplant. Liver transplant is a curative therapy for selected patients with irresectable Klatskin tumors, but further prospective studies are urgently needed.

Clinical analysis of four serum tumor markers in 458 patients with ovarian tumors: diagnostic value of the combined use of HE4, CA125, CA19-9, and CEA in ovarian tumors.

PurposeTo investigate the diagnostic values of human epididymis protein 4 (HE4), carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) for ovarian tumors.MethodsThe participants were divided into three groups: 386 healthy women (control group), 262 patients with benign ovarian tumors (the benign group), and 196 patients with malignant pelvic tumors (the malignant group). The serum levels of HE4, CA125, CA19-9, and CEA were analyzed by electrochemiluminescent immunoassay.ResultsIt showed that serum levels of HE4, CA125, CA19-9, and CEA of patients with malignant ovarian tumors were significantly higher than those in the control group and benign group (P<0.01). HE4 had a high specificity (96.56%) in malignant ovarian tumors. The tumor markers HE4, CA125, CA19-9, and CEA had a sensitivity of 63.78%, 62.75%, 35.71%, and 38.78%, respectively. The combined use of two or more tumor markers (parallel test) had a higher diagnostic sensitivity but lower specificity than a single tumor marker. The combined efficiency of HE4 and CA125 was the highest, with a sensitivity and specificity of 80.10% and 69.08%, respectively. HE4 and CA125 combined with the Risk of Ovarian Malignancy Algorithm provided an efficient means of screening and diagnosis of ovarian malignancies. The diagnostic sensitivity increased to 88.52% when three or four tumor markers were used but showed no significant difference compared with the combination of HE4 and CA125 (P>0.05).ConclusionThe combination of three or four tumor markers did not improve the diagnostic efficacy when compared with the combination of HE4 and CA125.