Cholestasis is the Main Determinant of Abnormal CA 19–9 Levels in Patients with Liver Cirrhosis

Giannini, Edoardo G.; Borro, Paolo; Botta, Federica; Chiarbonello, Bruno; Fasoli, Alberto; Malfatti, Federica; Romagnoli, Paola; Testa, Emanuela; Risso, Domenico; Lantieri, P. B.; Antonucci, Adelmo; Boccato, M; Milone, Stephen D.; Testa, Roberto

doi:10.1177/172460080001500304

Cited by 31 publications

(20 citation statements)

References 17 publications

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“…Cholestasis may enhance expression and/or passage of the marker from bile to blood. In fact, even intrahepatic cholestasis has been associated with increased expression of CA 19-9 in cirrhotics (21) and that may explain the significant correlations found between CA 19-9 and alkaline phosphatase as well as total and direct bilirubin in the present study.…”

Section: Discussionmentioning

confidence: 61%

The Value of Serum CA 19-9 in Predicting Cholangiocarcinomas in Patients with Primary Sclerosing Cholangitis

et al. 2005

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CA 19-9 has been used with questionable accuracy to aid diagnosis of cholangiocarcinoma complicating primary sclerosing cholangitis. We aimed to characterize the test properties of CA 19-9 and of a change in CA 19-9 over time in predicting cholangiocarcinoma. Charts of 208 patients were reviewed. Fourteen patients had cholangiocarcinoma. Median CA 19-9 was higher with cholangiocarcinoma (15 vs. 290 U/ml, p < 0.0001). A cutoff of 129 U/ml provided: sensitivity 78.6%, specificity 98.5%, adjusted positive predictive value 56.6% and negative predictive value 99.4%. The median change over time was 664 U/ml in cholangiocarcinoma compared to 6.7 U/ml in primary sclerosing cholangitis alone (p < 0.0001). A cutoff of 63.2 U/ml for change in CA 19-9 provided: sensitivity 90%, specificity 98% and positive predictive value 42%. Only 2 patients with cholangiocarcinoma were the candidates for curative therapy. In conclusion, the positive predictive value of an elevated CA 19-9 was 56.6%; only advanced cases were detected by this method.

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Section: Discussionmentioning

confidence: 61%

The Value of Serum CA 19-9 in Predicting Cholangiocarcinomas in Patients with Primary Sclerosing Cholangitis

et al. 2005

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“…Serum levels of CA199, CA242, CA125, CEA and TNF-a showed a significant correlation with tumor size, tumor differentiation, clinical stage and metastasis to lymph nodes and liver (P \ 0.05), implying that CA199, CA242, CA125, CEA and TNF-a play important roles in tumor progression and are significant predictors of PC invasion and metastasis (Tables 1, 2). This may be related to the function of CA199, CA242, CA125 and CEA in cellular adhesion, an important factor in proliferation, migration and differentiation of tumor cells (Giannini et al 2001;Jiang et al 2004). Therefore, these proteins may facilitate PC tumor progression and metastasis.…”

Section: Resultsmentioning

confidence: 97%

Changes in the expression of serum markers CA242, CA199, CA125, CEA, TNF-α and TSGF after cryosurgery in pancreatic cancer patients

Zhou¹,

Niu²,

Chiu³

et al. 2012

Biotechnol Lett

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The presence of serum tumor markers, carbohydrate antigen 242 (CA242), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA), tumor-supplied group of factors (TSGF) and tumor necrosis factor-α (TNF-α), is closely associated with invasion and metastasis of many malignancies. The expression of these markers were measured in serum taken from 37 pancreatic cancer patients prior to treatment. Levels of CA242, CA199, CA125, CEA and TNF-α expression correlated with tumor size, clinical stage, tumor differentiation, lymph node and liver metastasis (P < 0.05). One month after cryosurgery, serum levels of these markers were significantly reduced compared with levels prior to cryosurgery (P < 0.05), whereas there was no significant difference was found between serum levels before and after chemotherapy (P > 0.05). Thus, cryosurgery is more effective than chemotherapy for decreasing CA242, CA199, CA125, CEA, TSGF and TNF-α serum levels in these patients.

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“…Elevation of those tumor markers has been associated with the presence of ascites (12,19) or cholestasis (25,26) in liver disease patients. In our patient group elevated CA 125 did not accurately predict the presence of ascites: although all patients with ascites had elevated CA 125 levels, 50% of those with increased serum concentrations of CA 125 had no demonstrable ascites even when checked by ultrasound.…”

Section: Discussionmentioning

confidence: 98%

The Combined Elevation of Tumor Markers CA 19-9 and CA 125 in Liver Disease Patients Is Highly Specific for Severe Liver Fibrosis

Schöniger–Hekele

Müller

2006

Dig Dis Sci

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Increased tumor markers in patients with liver cirrhosis are often considered to be unspecific. The use of this unspecific elevation to discriminate minimal fibrosis from severe fibrosis has never been explored. We aimed to answer the question, Do tumor markers predict severe liver fibrosis? The study group consisted of 125 patients with alcoholic liver disease, hepatitis B, or hepatitis C with available liver biopsy. Tumor markers CA 19-9, CA 15-3, and CA 125 were determined using routine laboratory methods and correlated with the extent of liver fibrosis. Fibrosis stages 1 and 2 were classified as minimal fibrosis; stages 3 and 4, as severe fibrosis. Tumor markers CA 19-9, CA 125, and CA 15-3 increased with stage of fibrosis. For separating patients with mild fibrosis (F1+F2) from patients with severe fibrosis (F3+F4), CA 19-9 had a sensitivity of 70.5% and a specificity of 88.6, CA 125 had 38.1% and 89.7%, and CA 15-3 had 19.0% and 93.0%, respectively. Logistic regression of a combined score of CA19-9 and CA 125 values revealed that an increase of 1 point of the CA 19-9/CA125 score resulted in a 1.6 times increase in likelihood of the presence of severe fibrosis. The CA 19-9/CA 125 score achieved a similar specificity (97.1% vs. 100%) but a higher sensitivity (42.9% vs. 33.3%) than the widely used cirrhosis discriminant score of Bonacini. A specificity (98.5%) similar to that of the CA 19-9/CA 125 score was reached by the easier determination of the combined elevation of CA 19-9 and CA 125, which had the best positive predictive value, 92.9%. The excellent predictive ability of the combined elevation of CA 19-9 and CA 125 for severe liver fibrosis (F3+F4) was confirmed in an independent group of patients with liver disease. The combined elevation of CA 19-9 and CA 125 is useful for identifying patients with advanced fibrosis or cirrhosis with high specificity. Patients without a combined elevation of CA 19-9 and CA 125 still require histological examination to identify severe fibrosis or cirrhosis.

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Cholestasis is the Main Determinant of Abnormal CA 19–9 Levels in Patients with Liver Cirrhosis

Cited by 31 publications

References 17 publications

The Value of Serum CA 19-9 in Predicting Cholangiocarcinomas in Patients with Primary Sclerosing Cholangitis

The Value of Serum CA 19-9 in Predicting Cholangiocarcinomas in Patients with Primary Sclerosing Cholangitis

Changes in the expression of serum markers CA242, CA199, CA125, CEA, TNF-α and TSGF after cryosurgery in pancreatic cancer patients

The Combined Elevation of Tumor Markers CA 19-9 and CA 125 in Liver Disease Patients Is Highly Specific for Severe Liver Fibrosis

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