Utility of serum CA19-9 in diagnosis of cholangiocarcinoma: In comparison with CEA

Qin, Xinglei; Wang, Zhuo-Ren; Jing-sen, Shi; Lu, Min; Wang, Lin; He, Quan-Ru

doi:10.3748/wjg.v10.i3.427

Cited by 147 publications

(100 citation statements)

References 49 publications

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“…While the sensitivity of serum CEA was low (43%) and the specificity was high (90%), the sensitivity and specificity of biliary CEA were 57% and 68%, respectively. This outcome was in agreement with the majority of the previously mentioned studies (6,11). Increased levels of CEA have been reported in benign and malignant epithelium of the gall bladder, human bile (47), and in benign and malignant pancreatic duct lesions (48).…”

Section: Original Articlesupporting

confidence: 93%

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Roles of serum and biliary CEA, CA19-9, VEGFR3, and TAC in differentiating between malignant and benign biliary obstructions

İnce

Yıldız²,

Baysal³

et al. 2014

Turk J Gastroenterol

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Background/Aims: Despite the presence of many diagnostic methods, the differential diagnosis between benign and malignant biliary obstructions is still not easy. We aimed to evaluate the role of serum/biliary carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), vascular endothelial growth factor receptor-3(VEGFR-3), and total antioxidant capacity (TAC) tests in this differential diagnosis. Materials and Methods: Patients (n:225; 110♂, 115♀) with diagnosis of malignant (n:96) or benign (n:129) biliary obstruction were included in this cross-sectional study. Serum and biliary CEA, CA 19-9, VEGFR-3, and TAC tests were analyzed, statistics were obtained, and significance was defined as p<0.05. Results: Mean age was 54.9±16.4 for the benign and 54.2±19.6 for the malignant group (p=0.89). Head of pancreas cancer (18.2%), cholangiocarcinoma (11.4%) and choledochal stone (48%) were the most common etiologies. The area under the curve (AUC)s by ROC analysis of serum/biliary CA 19-9, VEGFR-3, and TAC and serum CEA were 0.701/0.616, 0.622/0.663, 0.602/0.581, and 0713, respectively. Serum TAC had higher sensitivity (61.1%) and CEA had lower sensitivity (42.7%), whereas CEA had higher specificity (89.9%) and TAC had lower specificity (60.5%). In biliary tumor markers, CA 19-9 had higher sensitivity (74%) and VEGFR-3 had lower sensitivity (56.2%); however, VEGFR-3 had higher specificity (79.1%) and CA 19-9 had lower specificity (34.1%). Additionally, combination of serum CEA (p<0.001), CA 19-9 (p<0.001), VEGFR-3 (p<0.001), and biliary CA 19-9 (p=0.028) markers achieved 95% estimation probability, and the sensitivity, specificity, and accuracy were 88.5%, 45.7%, and 64%, respectively. Conclusion: Serum and biliary CEA, CA 19-9, VEGFR-3, and TAC tests would not be useful in the differentiation between malignant and benign biliary obstructions.

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Section: Original Articlesupporting

confidence: 93%

“…Nichols et al (10) found the sensitivity and specificity of CA19-9 to be 89% and 86%, respectively. Qin et al (11) demonstrated that the sensitivity and specificity of serum CEA for diagnosing CCA were 68.6% and 81.5%, respectively. Chen et al (12) found the sensitivity of biliary CA19-9 to be less than 70%, while the specificity was 60%.…”

Section: Introductionmentioning

confidence: 99%

Roles of serum and biliary CEA, CA19-9, VEGFR3, and TAC in differentiating between malignant and benign biliary obstructions

İnce

Yıldız²,

Baysal³

et al. 2014

Turk J Gastroenterol

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“…28 In advanced pancreatic cancer treated with gemcitabine-based chemotherapy, serial measurement of CA 19-9 levels are frequently used, not only as a surrogate maker for relapse or response in clinical practice but also as a primary end point in clinical trials. 29,30 Therefore, it is also worthwhile to investigate whether the CA 19-9 response is a surrogate marker for tumor response and prognosis for BTC patients treated with a combination of gemcitabine and cisplatin.…”

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confidence: 99%

A Phase II study of gemcitabine and cisplatin in advanced biliary tract cancer

Kim

Park

Lee

et al. 2006

Cancer

100

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BACKGROUNDThe authors performed a Phase II study of combination chemotherapy with gemcitabine and cisplatin in patients with inoperable biliary tract cancer to evaluate efficacy and toxicity of this combination. In addition, the correlation between the CA 19‐9 response and clinical outcome was analyzed.METHODSThe eligibility criteria for this study were 1) histologically or cytologically confirmed inoperable biliary tract cancer in patients with metastatic or recurrent disease; 2) age between 18 and 70 years; 3) at least 1 measurable lesion according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria; 4) an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2; 5) a life expectancy of at least 3 mos; and 6) adequate bone marrow, hepatic, and renal function. The patients received gemcitabine (1250 mg/m2, Days 1 and 8) and cisplatin (60 mg/m2, Day 1) every 3 weeks. Tumor response was assessed by RECIST criteria every 2 cycles of chemotherapy. Treatment was continued until progression of disease was documented.RESULTSTwenty‐nine patients were enrolled. The median age of these patients was 52 years (range, 37 to 69 yrs), and the median ECOG performance status was 1. No complete response was observed, and 10 of 29 patients had partial responses. The overall response rate was 34.5% (95% confidence interval [CI], 17.9–54.3) for the intent‐to‐treat analysis. Stable disease was observed in 4 (13.8%) patients and progressive disease in 13 (44.8%) patients. The median follow‐up time was 10.0 months (95% CI, 7.2–12.8). The median time to progression (TTP) was 3.0 months (95% CI, 2.12–3.88), and the median overall survival was 11 months (95% CI, 5.49–16.5). Although these results showed a better response rate (57.1 % vs. 27.3%) and survival (12 vs. 10 mos) in patients with a decline in CA 19‐9 of at least 25%, these data were statistically not significant. In addition, there was a significant positive correlation between the increment in CA 19‐9 values and tumor progression as determined with RECIST criteria (r = 0.96, P < 0.01). However, there was no definite correlation between the CA 19‐9 response and the response according to RECIST criteria (P = 0.087). National Cancer Institute (NCI) common toxicity criteria (CTC) Grade 3 or 4 hematologic toxicities included neutropenia in 4 (14%) patients and anemia in 1 (3%) patient. Two of 4 patients with Grade 3 or 4 neutropenia had febrile episodes (7%) and required hospital admissions. NCI‐CTC Grade 3 or 4 nonhematologic toxicity included nausea in 1 (3%) patient. There were no treatment‐related deaths.CONCLUSIONThe combination chemotherapy with gemcitabine and cisplatin in inoperable biliary tract cancer was tolerable for most patients and showed modest response rates. The role of CA 19‐9 monitoring as a surrogate biomarker in patients with BTC treated with gemcitabine chemotherapy should be further investigated. Cancer 2006. © 2006 American Cancer Society.

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“…Además, un resultado negativo no excluye el diagnóstico de malignidad dado que el 5% de la población y por ende un 5% de los carcinomas podrían no expresar el marcador 15 . En cáncer de páncreas se han reportado sensibilidad y especificidad diagnósticas de 80-90% y 70-80%, respectivamente 14,16 , y en tumores de la vía biliar las cifras reportadas son de 68-77% y 75-85%, respectivamente 6,17 . En nuestro estudio intentamos evaluar la capacidad del CA 19-9 para distinguir patología biliopancreática benigna y maligna.…”

Section: Discussionunclassified

“…Se consideran normales las concentraciones inferiores a 37 U/ml. Numerosos estudios han documentado una sobreproducción de CA 19-9 en tumores malignos de páncreas [2][3][4] y del árbol biliar 5,6 . También se ha visto una sobreproducción en otras neoplasias malignas (estómago, hígado, colon y recto) 7,8 y patologías benignas bilio-pancreáticas, como pancreatitis, colangitis y coledocolitiasis 9,10 .…”

Section: Introductionunclassified

Rendimiento diagnóstico del marcador tumoral CA 19-9 en la diferenciación entre patología bilio-pancreática benigna y maligna

et al. 2013

Rev Chil Cir

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Utility of serum CA19-9 in diagnosis of cholangiocarcinoma: In comparison with CEA

Cited by 147 publications

References 49 publications

Roles of serum and biliary CEA, CA19-9, VEGFR3, and TAC in differentiating between malignant and benign biliary obstructions

Roles of serum and biliary CEA, CA19-9, VEGFR3, and TAC in differentiating between malignant and benign biliary obstructions

A Phase II study of gemcitabine and cisplatin in advanced biliary tract cancer

Rendimiento diagnóstico del marcador tumoral CA 19-9 en la diferenciación entre patología bilio-pancreática benigna y maligna

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