CEA Values Research Articles

Potential Diagnostic Value of Plasma Long-Chain Non-Coding RNA HIT in Breast Cancer

The current study aims to investigate the expression of HOXA transcript induced by transforming growth factor-β (TGF-β) (HIT) in plasma of women with breast cancer and its potential diagnostic value for breast cancer. qRT-PCR was used to detect the expression of HIT in breast cancer tissues and the plasma of patients with breast cancer. The correlation between the expression of HIT in plasma and clinicopathological parameters of breast cancer was analyzed. The levels of CAl53 and CEA in plasma were also detected. Operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy of plasma HIT for breast cancer. Compared with the adjacent tissues, the expression of HIT in breast cancer tissues was significantly increased. Meanwhile, the level of plasma HIT in the breast cancer group was significantly higher than that in the benign lesion group and healthy control group. The level of plasma HIT expression in breast cancer patients was correlated with estrogen receptor (ER) erbB-2 and lymph node metastasis (p < 0.05); the area under ROC curve (AUC) of plasma HIT in diagnosis of breast cancer alone was 0.827 with the sensitivity and specificity of 57.7% and 86.4%. The diagnostic efficacy of HIT, was significantly higher than that of CAl53 and CEA, and the combined diagnostic value of HIT, CAl53 and CEA was also higher than that of any single detection. High expression of HIT in plasma may be a potential biomarker for the diagnosis of breast cancer.

Primary Tumor Resection for Stage IV Colorectal Cancer in the Era of Targeted Chemotherapy

BackgroundIn the current era of targeted therapies, the benefits of resection of primary tumors in patients with unresectable stage IV colorectal cancer, specifically with regard to overall survival, are unknown. MethodsOur study population comprised 208 consecutive patients with unresectable stage IV colorectal cancer who received chemotherapy containing at least one molecular target agent, bevacizumab, cetuximab, and panitumumab, at the National Cancer Center Hospital from 2006 to 2013. To lessen the effects of confounding factors between two treatment groups (resection versus non-resection) such as performance status, presence of severe symptoms, M subcategories (M1a versus M1b, M1c) according to the TNM classification, primary tumor site, and CEA value, we conducted three different propensity score analyses (regression adjustment, stratification, and matching). ResultsOf the 208 patients, 108 (52%) underwent resection of the primary tumor, while 100 (48%) did not. Regression adjustment revealed that resection was not associated with longer overall survival (hazard ratio of 0.70 (95% CI [0.49–1.00]; p = 0.051)). Stratification analysis of five strata revealed inconsistent results (hazard ratios ranged from 0.50 to 1.58); specifically, resection was associated with longer overall survival in four strata, but with shorter survival in one stratum. The propensity score-matched cohort (64 matched pairs) yielded a hazard ratio of 0.76 (95% CI [0.51–1.15]; p = 0.197). ConclusionsAll three analyses revealed that, in the current era of chemotherapy with target agents, primary tumor resection was only marginally influential and did not significantly improve overall survival over chemotherapy alone.

Decision Tree Analysis of Pancreatic Cyst Fluid Data for the Detection of Mucinous Cysts

Introduction: Though cyst fluid glucose levels have been shown to be a reliable marker for differentiating Mucinous and Non-Mucinous pancreatic cysts, a number of cysts have a more complex association with CEA and amylase enzyme values. Our project aimed to utilize machine learning to develop a decision tree that will provide clinicians with a practical tool to optimally determine the mucinous character of the lesion from lab results alone. Methods: This is a retrospective study conducted at a high-volume advanced endoscopy center. Clinical and lab data was abstracted from the electronic medical records of all patients who underwent pancreatic cyst aspiration between June 2015 and November 2017. Statistical analysis was done using STATA v 15.1. A decision tree was built using the J48 classifier algorithm in Weka 3.8.0. Factors used for data modelling were age, gender, diabetic status, and levels of glucose, CEA and amylase. The decision tree thus generated was validated using 10-fold cross validation. Results: A total of 57 lesions were included in the analysis. The average age of the cohort was 62.6 years (SD ±16.4). The most common diagnosis was pseudocyst (n=21, 36.8%), followed by 20 IPMNs (14 branch ducts (24.6%), 3 main duct (5.3%), and 3 mixed duct cysts (5.3%)), 11 mucinous Cystadenomas (19.3%), 4 lymphoepithelial cysts (7.0%), and 1 ciliated foregut cyst (1.6%). Thus, there were 31 Mucinous and 26 Non-Mucinous pancreatic cysts in our cohort. Mucinous cysts had higher CEA levels compared to Non-Mucinous cysts (Median 56.4 ng/mL vs 3.1 ng/mL, Mann-Whitney-U, pvalue=0.0018). However, Glucose and Amylase levels were lower in Mucinous cysts compared to Non-mucinous cysts (Both Mann-Whitney-U, p-value= 0.0002 and 0.0107 respectively). The decision tree algorithm revealed that pancreatic cysts will be non-mucinous if the glucose level is greater than 16 mg/dL. Additionally, cysts will non-mucinous if their CEA < 3.1 ng/mL and undetectable glucose levels. This model thus correctly classified 77.2% of all cysts, and, had a kappa statistic of 0.5473. Its ROC was 0.757 and r2-statistic was 0.85. Conclusion: Our decision tree analysis reveals that in addition to the expected non-mucinous cysts with high glucose values, there exists a small group of zero-glucose low-CEA cysts with CEA < 3.1 ng/mL and undetectable glucose levels. Our decision tree can be used by endoscopists in clinical practice as a simple and easy tool to predict the mucinous/non-mucinous character of pancreatic cysts.73_A Figure 1. Pancreatic Cysts Descriptive Statistics73_B Figure 2. Pancreatic Cyst Fluid Decision Tree Analysis - Results73_C Figure 3. Pancreatic Cyst Decision Tree Model

Intersphincteric Resection Has Similar Long-term Oncologic Outcomes Compared With Abdominoperineal Resection for Low Rectal Cancer Without Preoperative Therapy: Results of Propensity Score Analyses

Intersphincteric resection has been performed for very low rectal cancer in place of abdominoperineal resection to avoid permanent colostomy. This study aimed to evaluate long-term oncologic outcomes of intersphincteric resection compared with abdominoperineal resection. In this retrospective study, propensity score matching and stratification analyses were performed to reduce the effects of confounding factors between groups, including age, sex, BMI, CEA value, tumor height, tumor depth, lymph node enlargement, and circumferential resection margin measured by MRI. A database maintained at our institute was used to identify patients during the period between 2000 and 2014. A total of 285 patients who underwent curative intersphincteric resection (n = 112) or abdominoperineal resection (n = 173) for stage I to III low rectal cancer without preoperative chemoradiotherapy were enrolled in this study. The main outcome was recurrence-free survival. Patients in the abdominoperineal resection group were more likely to have a preoperative diagnosis of advanced cancer before case matching. After case matching, clinical outcomes were similar between intersphincteric resection and abdominoperineal resection groups. Five-year relapse-free survival rates were 69.9% for the intersphincteric resection group and 67.9% for abdominoperineal resection group (p = 0.64), and were similar in the propensity score-matched cohorts (89 matched pairs). Three-year cumulative local recurrence rates were 7.3% for intersphincteric resection and 3.9% for abdominoperineal resection (p = 0.13). In the propensity score-matched model, the hazard ratio for recurrence after intersphincteric resection in comparison with abdominoperineal resection was 0.90. Stratification analysis revealed similar recurrence rates (HR, 0.75-1.68) for intersphincteric resection in comparison with abdominoperineal resection. Eight covariates were incorporated into the model, but other covariates were not included. Our findings suggest similar oncologic outcomes for intersphincteric resection and abdominoperineal resection without preoperative chemoradiotherapy in patients with low rectal cancer adjusted for background variables. See Video Abstract at http://links.lww.com/DCR/A661.

Diagnosis of Pulmonary Tuberculosis by Measurement of ADA, CEA and PCR in Bronchoalveolar Lavage and Compare with Smear and Culture of BK in the Patient with Pulmonary Infiltration

Background: Pulmonary tuberculosis ( TB) is one of the problems in diagnosis and management of patients with pneumonia and pleural effusion. Bronchoscopy and bronchoalveolar lavage (BAL) can help us in the differential diagnosis. Tumor markers are substances that are produced by cancer or other cells of the body in response to diseases. These substances can be found in the blood, urine, or body fluids, for example in bronchoalveolar lavage of some patients with pulmonary diseases. CEA is a tumor marker that can help us for diagnosis and monitoring of peripheral lung cancer. ADA has been shown to rise in the BAL of patients with TB. Because the sputum smear negative TB patients have been a diagnostic challenge for health professionals this study was designed to determine the diagnostic value of ADA & CEA & PCR in BAL fluid and then compare the relationship of these markers with sputum and clinical finding in diagnosis of pulmonary tuberculosis. Material and Method: A cross sectional study conducted in Shahrekord Hajar hospital where 100 patients were enrolled in our study (62 females, 38 males). These patients were admitted to hospital and bronchoscopy with BAL was performed, then fluid was analysed for ADA, CEA, PCR and sputum smear for TB. Result: From 100 patients who were evaluated in this study 9 patients had TB, 39 patients had pneumonia, 11 patients had primary lung malignancy, 9 patients had metastases to lung and 8 patients had bronchitis. In Patients with TB the level of ADA was not significantly elevated in BAL. ADA increased significantly in patients with pneumonia (P: 0/95). In patients with metastases to lung and primary lung cancer and a combination of both groups compared to other patients without malignancy there was no relationship between CEA. PCR was positive in TB and other patients, but significantly increased in TB. (p=0/021) Discussion: Although it was thought that CEA may be elevated in BAL of patients with malignancy and ADA in tuberculosis we did not find a correlation in these patients. This study showed that ADA and CEA levels in BAL fluid does not help us in diagnosis of TB or cancer. It may have afalse positive in pneumonia, COPD and other diseases, but PCR for TB may assist in TB diagnosis but not alone.

Tu1408 EVALUATING THE UTILITY OF PANCREATIC CYST GLUCOSE LEVELS AS A MARKER OF MUCINOUS CHARACTER OF PANCREATIC CYST LESIONS

Pancreatic cysts are a frequent incidental finding on abdominal imaging studies such as CT or MRI. Imaging characteristics alone lack adequate accuracy to differentiate between benign, pre-malignant and malignant lesions. EUS guided FNA and cyst fluid analysis, especially CEA value, is helpful in distinguishing between mucinous and non-mucinous cysts. Few studies have evaluated the utility of cyst fluid glucose levels. Data were collected on patients (age, gender, presence or absence of diabetes) and their pancreatic cyst fluid (CEA, amylase, glucose, cytopathology) who underwent EUS-FNA at our institution over 2 years. Cysts were classified into mucinous or non-mucinous cysts based on surgical pathology results or clinical characterization and follow up. In total, 57 patients’ pancreatic cysts were aspirated. There were 28 males (49%) and 29 females (52%). The average age of patient was 62.6 (±16.4) years. There were 31 mucinous cysts (50%) including 14 side branch IPMNs (24.6%), 3 mixed IPMNs (5.3%), 3 main duct IPMNs (5.3%) and 11 mucinous cystic neoplasms (19.3%). There were 26 non-mucinous cysts (50%) including 4 lymphoepithelial cysts (7%), 21 pseudocysts (36.8%) and 1 foregut cyst (1.8%). Comparing patients with mucinous v. non-mucinous cysts, there was no statistically significant difference in the number of diabetics or gender. The average age of patients with mucinous cysts was 67.3±12.7 years, which was significantly higher than patients with non-mucinous cysts (57±18.6 years), p=0.0081. The median glucose value of patients with mucinous cysts was 1 (IQR 1-7) and for non-mucinous cysts was 64.5 (IQR 54-103) with p=0.0002. The median CEA value was 56.4 (IQR 6.1-741.9) for mucinous cysts v. 3.1 (IQR 0.5-21.5) for non-mucinous cysts, p=0.0018). ROC analysis revelaed that cut off of Glucose >36 mg/dL has a sensitivity of 84.62% and specificity 79.31%, and correctly classifies 81.82% of cysts. Evaluation of glucose levels may aid in diagnosis of cystic lesions when the distinction is unclear based on CEA values.Tabled 1Pancreatic Cysts Fluids Statistics AnalysisSummary StatisticsMucinousNon-MucinousTestP-Valuen3126Average Age (SD)67.3(12.7)57.0(18.6)0.0081Gender12 M and 19 F10 M and 16 FChi-square0.086DM13 (41%)13 (50%)Chi-square0.543GlucoseMean (SD)22.0 (46.1)76.3 (52.4)Median(IQR)1 (1-7)64.5 (54-103)Mann - Whitney U0.0002CEAMean (SD)1387.8 (2973.4)284.7 (1232.8)Median(IQR)56.4 (6.1 - 741.9)3.1 (0.5 - 21.5)Mann - Whitney U0.0018AmylaseMean (SD)4515.8 (5596.2)8666.1 (6189.5)Median(IQR)898 (72 - 11644.5)13000 (942 - 13000)Mann - Whitney U0.0107ROC StatisticsNAUCSE95% CIGlucose550.78710.06790.649900.88186CEA560.74390.06680.616280.85607Amylase530.69710.07160.556570.81660 Open table in a new tab

Clinical Relevance of Postoperative Neutrophil-Lymphocyte Ratio (NLR) to Recurrence After Adjuvant Chemotherapy of S-1 for Gastric Cancer.

The clinical significance of postoperative neutrophil lymphocyte ratio (NLR) remains unclear. The aim of this study was to examine the impact of postoperative NLR on prediction for postoperative recurrence of gastric cancer. A retrospective analysis was performed on data from 170 patients with Stage II/III gastric cancer who underwent surgery followed by adjuvant chemotherapy using S-1 between 2006 and 2015. Postoperative NLR was calculated every 6 months and the data at the time of recurrence or last survival were used for analysis. Postoperative NLR was associated with Prognostic nutritional index (PNI) and modified Glasgow Prognostic Score (mGPS). In multivariate analysis, we found that elevated CA19-9, CEA and NLR were independent predictive markers. The patients with low values of both NLR and CEA after surgery had the most favorable prognosis. The postoperative NLR might be one of the surrogate markers for recurrence after curative surgery for patients with Stage II/III gastric cancer.

Serological TK1 predict pre-cancer in routine health screenings of 56,178 people.

People with biomarkers above cut-off values normally have higher risk to develop pre-malignancies and malignancies. Here we investigate if serological TK1 protein (STK1p), AFP, CEA and PSA below cut-off values predict development of pre-cancer. The mean values and the concentration distribution of STK1p, AFP, CEA and PSA were determined in a cohort of 56,178persons participating a health screening group, consist of people with non-tumor diseases, pre-malignancy and diseases associated with the risk process of malignancy. A health disease-free group (n= 428) was selected among the 56,178participants and used as controls. The STK1p below cut-off value (⩽ 2pM) showed partly (51.6%) an almost normal concentration distribution and partly (43.9%) an extensive tail in the health screening group, which was not found in the disease-free group. Due to the extensive tail in the distribution, the mean value of STK1p increased significantly (p= 0.0001) from 0.38 ± 0.30pM in the health disease-free group to 0.69 ± 0.55pM in the group below the cut-off value. No significantly differences in the concentration distribution and the mean values among gender and ages were observed. On the other hand, there were no difference in the concentration distributions and the mean values of AFP, CEA and PSA between the health disease- free group and the group below cut-off values, as well as between gender and ages. Of interest, the elevated mean value of STK1p of the group below the cut-off value was correlated to pre-malignancy and diseases associated with the risk process of malignancy in liver and prostate. No such correlations were found with AFP, CEA and PSA. STK1p is a potential proliferating biomarker for early discover of persons in the risk to develop or already have pre-malignancies or diseases associated with the risk process of malignancy.

Evidences for the antitumor potentiality of Hemimycale arabica and Negombata magnifica mesohyls in hepatocellular carcinoma rat model

The current study was constructed to explore the antitumor activity of Hemimycale arabica (blue sponge) and Negombata magnifica (red sponge) mesohyls in rat model of HCC. Forty adult female albino rats were distributed into: (1) negative control group, (2) HCC group, (3) Doxorubcin (DOXO)-treated group, (4) mesohyl of H. arabica-treated group, and (5) mesohyl of N. magnifica-treated group. Serum AST, ALT, GGT, α-fucosidase (AFU) activities; bilirubin, AFP and CEA levels was evaluated. Histopathological investigation of liver tissue sections was performed. The findings of this study indicated the presence of significant enhancement in serum AST, ALT, GGT, AFU, bilirubin, AFP, and CEA values in HCC-afflicted rats vs. the control counterparts. Insignificant change in serum AST, ALT, and GGT activity as well as bilirubin levels has been detected upon treatment of HCC-afflicted rats with DOXO. DOXO treatment revealed significant depletion in AFU, CEA, and AFP serum values comparing with HCC-afflicted ones. Treatment of HCC-afflicted rats with mesohyl blue (Hemimycale arabica) or red (Negombata magnifica) sponges evoked significant blunting in the measured biochemical parameters with respect to the untreated HCC-afflicted ones. The favorable impact of the natural treatments was documented by the great recovery of the structural organization of the liver of the treated rats. The current study provides an experimental evidence for the antitumor potential of Hemimycale arabica and Negombata magnifyica mesohyls in HCC rat model which may be ascribed to the strong hepatoprotective activity, the powerful free radical scavenging ability, and the highly apoptotic property of their active constitutes.

Mesothelin and osteopontin as circulating markers of diffuse malignant peritoneal mesothelioma: A preliminary study

BackgroundThe differential diagnosis between diffuse malignant peritoneal mesothelioma (DMPM) and other peritoneal surface malignancies (PSM) is still challenging. Serum mesothelin and osteopontin are increasingly used as markers of pleural mesothelioma, but their role in DMPM is unclear. We assessed the diagnostic and prognostic values of mesothelin, osteopontin, CEA, CA19.9, CA125, and CA15.3 in DMPM patients. MethodsMarkers were dosed before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) by enzyme-linked immunosorbent assay (ELISA) in 30 DMPM patients and 14 controls with other PSMs. Receiver-operating characteristics (ROC) curve were plotted. The performance of each marker was assessed by the area under the ROC curve (AUC-ROC). ResultsMean mesothelin levels were 7.84 ng/dl (SD = 5.14) in DMPM group and 3.00 ng/dl (SD = 1.25) in controls (P = 0.001). Mean CEA levels were 5.3 ng/dl (SD = 4.7), and 61.96 ng/dl (SD = 112.5) in the two groups (P = 0.008). No statistical difference was seen for osteopontin (P = 0.738), CA19.9 (P = 0.081), CA125 (P = 0.600), and CA15.3 (P = 0.365). AUC-ROC was 0.836 for CA19.9, 0.812 for mesothelin, 0.793 for CEA, and lower for CA125 (0.652), osteopontin (0.531), and CA15.3 (0.481). Using diagnostic cut-offs selected by ROC methodology, sensitivity, specificity, positive and negative predictive values were 70.0%, 100.0%, 100.0%, and 60.9% for mesothelin >5.21 ng/dl, and 90.0%, 85.7%, 93.1%, and 80.0% for CA19.9 < 8.8 U/dl. At multivariate analysis, osteopontin correlated with survival (hazard rate 6.46; 95%CI 1.81–23.05; P = 0.004). ConclusionWhen assessing PSMs of unknown origin, elevated mesothelin with low CA19.9 may increase the suspicion index for DMPM. Ospeopontin warrants further investigations as a prognostic marker for DMPM.

Long-term high air pollution exposure induced metabolic adaptations in traffic policemen

ObjectiveTo assess the adverse physiological changes induced by long-term exposure to PM2.5. MethodsTotally 183 traffic policemen and 88 office policemen as the control group, were enrolled in this study. The concentrations of PM2.5 in both the working places of traffic and office policemen were obtained. Detailed personal questionnaires and conventional laboratory tests including hematology, fasting blood glucose, blood lipids, liver, kidney, immunity and tumor-related markers were conducted on all participants of this study. ResultsA dose-response relationship between the FBG, HDL-c and CEA values and the PM2.5 exposure duration was observed. Multivariate analysis confirmed that one hour on duty outdoor per day for one year was associated with an increase in FBG of 0.005% (95% CI: 0.0004% to 0.009%), CEA of 0.012% (95% CI: 0.006% to 0.017%), and a decrease in HDL-C of 0.001% (95% CI: 0.00034% to 0.002%). ConclusionLong-term high air pollution exposure may lead to metabolism adaptation and it is likely involved in the development of cardiovascular disease and diabetes mellitus.

Prognostic Value of CEA and Ca 19.9/Tumor Markers in Gastric Cancer to Identify Patients with Poor Prognosis after Radical Surgery

Introduction: Although gastric cancer incidence has decreased worldwide, it’ s still the fifth most frequent malignancy and the third leading cause of cancer related mortality. Many prognostic factors have been identified as indicators of gastric cancer prognosis including tumour size, depth, lymph nodes metastasis and microvascular involvement. To date the clinical significance of tumoral markers remains unclear. In our study we would like to investigate the prognostic survival significance of preoperative CEA and CA19.9.Material and Methods: From January 2004 to September 2016, a total of 326 gastric cancer patients were analysed. Of these 260 were enrolled in the study. The two serum tumour markers CEA and CA19.9 were detected within 7 days before surgery. The normal cut off value for serum CEA was 5 ng/ml whereas for CA19.9 was 35 U/ ml. Patients were also dichotomized according to CEA and CA19.9 median value (respectively 2 ng/ml and 9 U/ml).Results: Our results suggest that the optimal application of these common tumour markers could promote the clinical screening and staging of gastric cancer patients. Their evaluation is cheap and easy, allowing a routinely use to identify patients at high risk of death or post-surgical recurrences. Also, we could utilize the optimal cut-off value of CA19.9 for individualizing patients with an early stage but a very bad prognosis.Discussion and Conclusion: We conclude that the combined assessment of CA19.9 and CEA levels could have prognostic value in gastric cancer in particular to identify patients with a poor prognosis after radical surgery, who need an aggressive follow-up and medical treatment.

Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip.

Our objective was to find the best predictor of late residual acetabular dysplasia in developmental dysplasia of the hip (DDH) after closed reduction (CR) and discuss the indications for secondary surgery. We retrospectively reviewed the records of 89 patients with DDH (mean age 16.1 ± 4.6months; 99 hips) who were treated by CR. Hips were divided into three groups according to final outcomes: satisfactory, unsatisfactory and operation. The changes in the acetabular index (AI), centre-edge angle of Wiberg (CEA), Reimer's index (RI) and centre-head distance discrepancy (CHDD) over time among groups were compared. The power of predictors for late residual acetabular dysplasia of AI, CEA, RI and CHDD at different time points was analysed by logistic regression analysis. Receiver operating characteristics (ROC) curve analysis was used to determine cutoff values and corresponding sensitivity, specificity and diagnostic accuracy for these parameters. Both AI and CEA improved in all groups of patients following CR. In the satisfactory group, AI progressively decreased until seven to eightyears, while CEA increased until nine to tenyears (P < 0.05). In the unsatisfactory group, AI and CEA ceased to improve three and twoyears after CR, respectively (P < 0.05). CEA and RI were significantly better in the satisfactory group compared with the unsatisfactory group at all time points (P < 0.05). Following CR, both RI and CHDD remained stable over time in all groups. Final outcome following CR could be predicted by AI, CEA and RI at all time points (P < 0.01). Cutoff values of AI, CEA and RI were 28.4°, 13.9° and 34.5%, respectively, at oneyear and 25°, 20° and 27%, respectively, at two to fouryears post-CR. A total of 80-88% of hips had an unsatisfactory outcome if AI > 28.4° and >25 at one and two to fouryears following CR, respectively. However, if CEA was less than or RI was larger than the cutoff values at each time point, only 40-60% of hips had an unsatisfactory outcome. Mean sensitivity (0.889), specificity (0.933) and diagnostic accuracy (92.1%) of AI to predict an unsatisfactory outcome were significantly better compared with CEA (0.731; 0.904; 78.2%) and RI (0.8; 0.655; 70.8%) (P < 0.05). Satisfactory and unsatisfactory hips show different patterns of acetabular development after reduction. AI, CEA and RI are all predictors of final radiographic outcomes in DDH treated by CR, although AI showed the best results. AI continues to improve until seven years after CR in hips with satisfactory outcomes, while it ceases to improve three to fouryears after CR in hips with unsatisfactory outcomes. According to our results, surgery is indicated if AI >28° 1year following CR or AI >25° two to fouryears after CR. CEA and RI should be used as a secondary index to aid in the selection of patients requiring surgery.

Using circulating tumor cells to evaluate the efficacy of irreversible electroporation for unresectasble pancreatic cancer.

We used circulating tumor cells (CTCs) as biomarkers to evaluate the efficacy of pre-irreversible electroporation (IRE) and post-IRE for unresectable pancreatic cancer (PC). Real-time qPCR was used to detect potential biomarker genes in CTCs, and magnetic-activated cell sorting (MACS) and fluorescence-activated cell sorting (FACS) were performed on 43 patients with PC who underwent IRE. Some patients experienced adverse reactions within 30days of the operation, including arrhythmia (6.9%), intraoperative transient change of blood pressure (25.5%), cough (11.6%), nausea and vomiting (23.3%), ascites (25.6%), fever (9.3%), and pain of puncture point (60.5%). The number of CTCs decreased significantly with postoperative time (P<0.01). Delta cycle threshold values for the CTC-related genes CEA, Ep-CAM, and CK19 increased significantly after IRE. Furthermore, the expression of CEA, Ep-CAM, and CK19 decreased significantly with time after IRE (P<0.01). Detecting CTCs by RT-qPCR and FACS combined with MACS has significant diagnostic and prognostic value for evaluating the efficacy of IRE in patients with unresectable PC.

Development of a novel biomarker model for predicting preoperative lymph node metastatic extent in esophageal squamous cell carcinoma1

The number and range of lymph node metastasis (LNM) are critical prognostic factors in esophageal squamous cell carcinoma (ESCC). Preoperative serum biomarkers are reported to be associated with LNM. However, whether these markers can precisely predict the extent of LNM is not known. The aim of this study was to evaluate the predictive value of preoperative serum SCC-Ag, Cyfra21-1, CEA, CA19-9 and CA72-4 for LNM number and range by retrospectively investigating 577 ESCC patients undergone esophagectomy from 2007-2010. In this study, the positive rate of SCC-Ag and CA19-9 were associated with pN stage. Significant differences were found in CEA and CA19-9 between pN0-1 stage patients and pN2-3 stage patients. However, in subgroup analysis (patients with pN0-1), significant difference was found only in SCC-Ag between pN0 and pN1 stage patients (P=0.003). Middle thoracic ESCC patients were Chosen to analyze the correlation between the range of LNM and biomarkers. SCC-Ag was correlated with paraesophageal and paracardial lymph nodes, but not correlated with subcarinal and left gastric artery lymph nodes. Interestingly, the results of CEA were opposite to that of SCC-Ag. CA19-9 was associated with subcarinal and paracardial LNM (P=0.000, P=0.038). Based on the results, a model incorporated SCC-Ag, CEA and CA19-9 was constructed. The rate of patients with pN2-3 stage was 15.4% and 54.4% in group 1 and 4 of our model.In summary, SCC-Ag was associated with early lymph node metastatic stage, and CEA and CA19-9 have a close relationship with advanced lymph node metastatic stage. The model combining SCC-Ag, CEA and CA19-9 might help identify the preoperative extent of LNM for a subgroup of ESCC patients that can be benefited from neoadjuvant therapy.

P2.06-006 Screening Values of CEA and Cyfra 21-1 for Lung Cancer in Combination with Low Dose CT (LDCT) in High-Risk Populations

Lung cancer screening with low-dose CT (LDCT) decreased lung cancer mortality. However, its major limitation for high false positive rate was concerned. Tumor markers in combination with LDCT may increase its screening value for lung cancer.

Circulating tumor cell as a biomarker for evaluating allogenic NK cell immunotherapy on stage IV non-small cell lung cancer

In this study, we determined the number of peripheral blood circulating tumor cells (CTCs) pre- and post-NK in patients with stage IV non- small cell lung cancer (NSCLC) as a reference for understanding the relevance of any changes to the efficacy of NK cells therapy. The patients were given one to three courses of immunotherapy. CTC numbers and CTC-related gene expression were measured in the peripheral blood of 31 patients with stage IV NSCLC at 1day before and 7 and 30d after NK cells therapy using magnetic activated cell sorting (MACS) and fluorescence activated cell sorting (FACS) combined with real-time quantitative PCR (RT-qPCR). Throughout the research, fever was the most common reaction (34.6%). The number of CTCs was 18.11±5.813, 15.13±5.984 and 10.32±5.623, respectively, and this decreased significantly over time. ΔCt values for the CTC-related genes CEA, MAGE-3 and CK18 increased significantly after NK cells infusion. The expression of CEA, CK18 and MAGE-3 decreased significantly with time after NK. CTC was a useful biomarker for evaluating the efficacy of NK cells therapy on stage IV NSCLC.

Diagnostic and prognostic value of carcinoembryonic antigen in pancreatic cancer: a systematic review and meta-analysis.

BackgroundCarcinoembryonic antigen (CEA) is one of the most widely used tumor markers and is increased in 30%–60% of patients with pancreatic cancer. Although carbohydrate antigen 19-9 (CA19-9) is the most important serum biomarker in pancreatic cancer, the diagnostic and prognostic value of CEA is gradually being recognized.Materials and methodsThe MEDLINE, EMBASE, and Web of Science databases were searched for related literature published until January 2017. Diagnostic accuracy variables were pooled using the Meta-Disc software. The pooled hazard ratios (HRs) for prognostic data were calculated and analyzed using Stata software.ResultsA total of 3,650 participants enrolled in 19 studies met our inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of a CEA-based panel were 0.45 (95% confidence interval [CI], 0.41–0.50), 0.89 (95% CI, 0.86–0.91), 5.39 (95% CI, 3.16–9.18), and 0.55 (95% CI, 0.41–0.72), respectively. The area under the curve (AUC, 0.90) and Q-value (0.84) of the CEA-based panel indicated a significantly higher diagnostic accuracy compared with CEA or CA19-9 alone. Moreover, there was also a significant association between high levels of CEA and worse overall survival (HR, 1.43; 95% CI, 1.31–1.56).ConclusionOur meta-analysis indicated that elevated serum CEA level, as a vital supplementary to CA19-9, can play an important role in the clinical diagnosis of pancreatic cancer patients and predict poor prognosis.

The Evaluation of Analytical Performance of Immunoassay Tests by using Six-sigma Method.

SummaryBackgroundThe Six-Sigma Methodology is a quality measurement method in order to evaluate the performance of the laboratory. In the present study, it is aimed to evaluate the analytical performance of our laboratory by using the internal quality control data of immunoassay tests and by calculating process sigma values.MethodsBiological variation database (BVD) are used for Total Allowable Error (TEa). Sigma values were determined from coefficient of variation (CV) and bias resulting from Internal Quality Control (IQC) results for 3 subsequent months. If the sigma values are ≥6, between 3 and 6, and <3, they are classified as »world-class«, »good« or »un - acceptable«, respectively.ResultsA sigma value >6 was found for TPSA and TSH for the both levels of IQC for 3 months. When the sigma values were analyzed by calculating the mean of 3 months, folate, LH, PRL, TPSA, TSH and vitamin B12 were found >6. The mean sigma values of CA125, CA15-3, CA19-9, CEA, cortisol, ferritin, FSH, FT3, PTH and testosteron were >3 for 3-months. However, AFP, CA125 and FT4 produced sigma values <3 for varied months.ConclusionWhen the analytical performance was evaluated according to Six-Sigma levels, it was generally found as good. It is possible to determine the test with high error probability by evaluating the fine sigma levels and the tests that must be quarded by a stringent quality control regime. In clinical chemistry laboratories, an appropriate quality control scheduling should be done for each test by using Six-Sigma Methodology.

Impact of nutritional status in the era of FOLFOX/FIRI-based chemotherapy

BackgroundThe nutritional status plays a pivotal role during anticancer therapy. This study analyzed whether nutritional status influences the outcomes in the era of FOLFOX/FIRI therapy.MethodsThe patients were divided into two groups according to whether the nutritional status was well (serum albumin level ≥ 3.8 g/dL or a ≥ 1.0 g/dL increase as compared with the value before chemotherapy) or not before and 2 and 6 months after the start of chemotherapy. Chemotherapy-related adverse events (AE), treatment effect, and compliance were evaluated according to the nutritional status. The progression-free survival (PFS) and overall survival (OS) were assessed based on the nutritional status at 6 months.ResultsBetween 2010 and 2013, data on 108 consecutive patients were analyzed. At 2 months after chemotherapy, the hematotoxicic AE and the value of tumor markers did not differ significantly. The non-hematotoxic AE were less frequent in patients in the well-nourished group (grade 2, 15.9 vs. 38.5%, p < 0.01). Based on the nutritional status at 6 months after chemotherapy, the hematotoxicic AE (grade 3, 9 vs. 19.5%, p = 0.03) and non-hematotoxic AE (grade 2, 31.3 vs. 51.2%, p = 0.04; grade 3, 6.0 vs. 24.4%, p < 0.01) were less frequent, and the median CEA value (5.3 vs. 27.75 mg/L, p < 0.01) was significantly lower in the well-nourished group. The median PFS (364 vs. 233 days, p < 0.01) and 5-year OS (26.5 vs. 11.1%, p = 0.01) are significantly better in the well-nourished group.ConclusionsThe well-nourished at initial 6 months may predict a better treatment response and fewer adverse events in FOLFOX/FIRI chemotherapy.