Tumor Markers in Serum and Ascites in the Diagnosis of Benign and Malignant Ascites

  • Zhu, Fang-Lai (Department of Gastroenterology, The First People's Hospital of Anqing) ;
  • Ling, An-Sheng (Department of Gastroenterology, The First People's Hospital of Anqing) ;
  • Wei, Qi (Division of Hepatobiliary Surgery, Zhejiang Provincial People's Hospital) ;
  • Ma, Jie (Department of Pathology, Zhejiang Provincial People's Hospital) ;
  • Lu, Gang (Department of Pathology, Zhejiang Provincial People's Hospital)
  • Published : 2015.02.25


Objective: To evaluate the values of 4 tumor markers in serum and ascites and their ascites/serum ratios in the identification and diagnosis of benign and malignant ascites. Materials and Methods: A total of 76 patients were selected as subjects and divided into malignant ascites group (45 cases) and benign ascites group (31 cases). Samples of ascites and serum of all hospitalized patients were collected before treatment. The levels of carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), cancer antigen 125 (CA125) and carbohydrate antigen 19-9 (CA19-9) were detected by chemiluminescence (CLIA). Results: CEA, AFP and CA19-9 in both serum and ascites as well as CA125 in ascites were evidently higher in the malignant ascites group than in the benign ascites group (P<0.01). Malignant ascites was associated with elevated ascites/serum ratios for AFP and CA125 (P<0.01). The areas under receiver operating characteristic (AUROCs) of CEA and CA125 in ascites and the ratios of ascites/serum of AFP, CEA, CA125 and CA19-9 were all >0.7, suggesting certain values, while those of ascites CA19-9 and serum CEA were 0.697 and 0.629 respectively, indicating low accuracy in the identification and diagnosis of benign and malignant ascites. However, the AUROCs of the remaining indexes were <0.5, with no value for identification and diagnosis. Compared with single index, the sensitivity of combined detection increased significantly (P<0.05), in which the combined detection of CEA, CA19-9 and CA125 in ascites as well as the ratio of ascites/serum of CEA, CA19-9, CA125 and AFP had the highest sensitivity (98.4%) but with relevantly low specificity. Both sensitivity and specificity of combined detection should be comprehensively considered so as to choose the most appropriate index. Conclusions: Compared with single index, combined detection of tumor markers in serum and ascites can significantly improve the diagnostic sensitivity and specificity.


  1. Bozkurt M, Yumru AE, Aral I (2013). Evaluation of the importance of the serum levels of CA-125, CA15-3, CA-19-9, carcinoembryonic antigen and alpha fetoprotein for distinguishing benign and malignant adnexal masses and contribution of different test combinations to diagnostic accuracy. Eur J Gynaecol Oncol, 34, 540-4.
  2. Bilen MA, Reyes A, Bhowmick D, et al (2014). Variant prostate carcinoma and elevated serum CA-125. Can J Urol, 21, 7442-8.
  3. Baser E, Gungor T, Togrul C, et al (2014). Preoperative prediction of poor prognostic parameters and adjuvant treatment in women with pure endometrioid type endometrial cancer: what is the significance of tumor markers? Eur J Gynaecol Oncol, 35, 513-8.
  4. Cheng D, Liang B, Kong H (2012). Clinical significance of vascular endothelial growth factor and endostatin levels in the differential diagnosis of malignant and benign ascites. Med Oncol, 29, 1397-402.
  5. Chen Y, Liang B, Zhao YJ, et al (2012). Transcription expression and clinical significance of vascular endothelial growth factor mRNA and endostatin mRNA in pleural effusions of patients with lung cancer. Diagn Cytopathol, 40, 287-91.
  6. Kaleta EJ, Tolan NV, Ness KA, et al (2013). CEA, AFP and CA 19-9 analysis in peritoneal fluid to differentiate causes of ascites formation. Clin Biochem, 46, 814-8.
  7. Liu F, Kong X, Dou Q, et al (2014). Evaluation of tumor markers for the differential diagnosis of benign and malignant ascites. Ann Hepatol, 13, 357-63.
  8. Liu G L, Liu X, Lv XB, et al (2014). miR-148b functions as a tumor suppressor in non-small cell lung cancer by targeting carcinoembryonic antigen (CEA). Int J Clin Exp Med, 7, 1990-9.
  9. Povolotskaya N, Das N, Dhar K, et al (2014). Utility of preoperative CA125 assay in the management planning of women diagnosed with uterine cancer. Surg Res Pract, 2014, doi:10.1155/2014/497478.
  10. Trape J, Molina R, Sant F (2004). Clinical evaluation of the simultaneous determination of tumor markers in fluid and serum and their ratio in the differential diagnosis of serous effusions. Tumor Biol, 25, 276-81.
  11. Tuzun Y, Yilmaz S, Dursun M, et al (2009). How to increase the diagnostic value of malignancy-related ascites: discriminative ability of the ascitic tumour markers. J Int Med Res, 37, 87-95.
  12. Tampellini M, Ottone A, Alabiso I, et al (2014). The prognostic role of baseline CEA and CA 19-9 values and their timedependent variations in advanced colorectal cancer patients submitted to first-line therapy. Tumour Biol, [Epub ahead of print].
  13. Wang X, Li J, Han Y (2014). Prognostic significance of preoperative serum carcinoembryonic antigen in non-small cell lung cancer: a meta-analysis. Tumor Biol, 35, 10105-10.
  14. Wang XF, Wu YH, Wang MS, et al (2014). CEA, AFP, CA125, CA153 and CA199 in malignant pleural effusions predict the cause. Asian Pac J Cancer Prev, 15, 363-8.
  15. Wu K L, Chen HW, Lin SH, et al (2014). Intractable ascites, changes in serum vascular endothelial growth factor levels and thalidomide treatment in POEMS syndrome. Am J Med Sci, 347, 510-2.
  16. Zhang H, Li F, Wei Q, et al (2011). Value of combined detection of AFU and TCH in differential diagnosis between malignant and non-tuberculous benign ascites. Med Oncol, Suppl 1, S670-4.
  17. Zhang Y, Yu LK, Xia N (2012). Evaluation of serum and pleural levels of endostatin and vascular epithelial growth factor in lung cancer patients with pleural effusion. Asian Pac J Trop Med, 5, 239-42.

Cited by

  1. Ascites modulates cancer cell behavior, contributing to tumor heterogeneity in ovarian cancer vol.107, pp.9, 2016,
  2. Role of Th9 cells and Th17 cells in the pathogenesis of malignant ascites vol.5, pp.10, 2015,
  3. 2017 Update on Ovarian Cancer Peritoneal Carcinomatosis Multimodal-Treatment Considerations vol.2018, pp.1687-630X, 2018,