• Journal of Chest Surgery
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• 제49권6호
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• pp.475-477
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• 2016

Elevated carbohydrate antigen (CA) 19-9 can indicate malignancies of the gastrointestinal, pancreatic, and biliary tracts, and be found in a pulmonary sequestration. A 30-year-old man visited Seoul National University Bundang Hospital due to elevated CA 19-9 levels, representing pulmonary sequestration of the bilateral lower lobes, which were connected with each other. We performed left lower lobectomy and division of the systemic arteries. After operation, CA 19-9 levels decreased to normal range, even though a small amount of sequestrated lung remained in the right lower lobe. It is not uncommon that presence of pulmonary sequestration might elevate serum CA 19-9 levels; however, horseshoe type bilateral pulmonary sequestration is very rare.

• Asian Pacific Journal of Cancer Prevention
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• 제16권2호
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• pp.719-722
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• 2015

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.

• Asian Pacific Journal of Cancer Prevention
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• 제15권15호
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• pp.6295-6300
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• 2014

Our aim was to investigate the value of combined detection of serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, CA 242 and CA 50 in diagnosis and assessment of prognosis in consecutive gastric cancer patients. Clinical data including preoperative serum CEA, CA 19-9, CA 242, and CA 50 values and information on clinical pathological factors were collected and analyzed retrospectively. Univariate and multivariate survival analyses were used to explore the relationship between tumor markers and survival. Positive rates of tumor markers CEA, CA 19-9, CA 242 and CA 50 in the diagnosis of gastric cancer were 17.7, 17.1, 20.4 and 13.8%, respectively, and the positive rate for all four markers combined was 36.6%. Patients with elevated preoperative serum concentrations of CEA, CA 19-9, CA 242 and CA 50, had late clinical tumor stage and significantly poorer overall survival. Five-year survival rates in patients with elevated CEA, CA 19-9, CA 242 and CA 50 were 28.1, 25.8, 27.0 and 24.1%, respectively, compared with 55.0, 55.4, 56.4 and 54.5% in patients with these markers at normal levels (p<0.01). In multivariate Cox proportional hazards analyses, an elevated CA 242 level was determined to be an independent prognostic marker in gastric cancer patients. Combined detection of four tumor markers increased the positive rate for gastric cancer diagnosis. CA 242 showed higher diagnostic value and CA 50 showed lower diagnostic value. In resectable gastric carcinoma, preoperative CA 242 level was associated with disease stage, and was found to be a significant independent prognostic marker in gastric cancer patients.

• Asian Pacific Journal of Cancer Prevention
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• 제15권13호
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• pp.5383-5387
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• 2014

Purpose: To investigate whether pretreatment serum carbohydrate antigen 19-9 (CA 19-9) levels are associated with pathological responses to preoperative chemoradiotherapy (CRT) in patients with rectal cancer. Materials and Methods: In total, 260 patients with locally advanced rectal cancer (cT3-4NanyM0) who underwent preoperative CRT and radical surgery were analyzed retrospectively. CRT consisted of 50.4 Gy pelvic radiotherapy and concurrent chemotherapy. Radical surgery was performed at a median of 7 weeks after CRT completion. Pathological CRT response criteria included downstaging (ypStage 0-I) and ypT0-1. A discrimination threshold of CA 19-9 level was determined using a receiver operating characteristics analysis. Results: The median CA 19-9 level was 8.0 (1.0-648.0) U/mL. Downstaging occurred in 94 (36.2%) patients and ypT0-1 in 50 (19.2%). The calculated optimal threshold CA 19-9 level was 10.2 U/mL for downstaging and 9.0 U/mL for ypT0-1. On multivariate analysis, CA 19-9 (${\leq}9.0U/mL$) was significantly associated with downstaging (odds ratio, 2.089; 95% confidence interval, 1.189-3.669; P=0.010) or ypT0-1 (OR, 2.207; 95%CI, 1.079-4.512; P=0.030), independent of clinical stage or carcinoembryonic antigen. Conclusions: This study firstly showed a significant association of pretreatment serum CA 19-9 levels with pathological CRT responses of rectal cancer. The CA 19-9 level is suggested to be valuable in predicting CRT responses of rectal cancer cases before treatment.

• Asian Pacific Journal of Cancer Prevention
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• 제17권10호
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• pp.4671-4675
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• 2016

Background and aim: Pancreatic cancer is the fourth leading cause of cancer-related death worldwide, with an overall 5-year survival of <5% mainly due to presence of advanced disease at time of diagnosis. Therefore development of valid biomarkers to diagnose pancreatic cancer in early stages is an urgent need. This study concerned the sensitivity and specificity of serum ICAM 1 versus CA 19-9 in differentiation between pancreatic cancer and healthy subjects and acohort of patients with chronic pancreatitis with a focus on assessing validity in diagnosis of early stages of pancreatic cancer. Methods: A cohort of 50 patients with histologically diagnosed pancreatic tumors, 27 patients with chronic pancreatitis, and 35 healthy controls were enrolled. Serum samples for measurement of CA19-9 and I-CAM 1 were obtained from all groups and analyzed for significance regarding diagnosis and disease stage. Results: At a cut off value of (878.5 u/ml) I-CAM 1 had 82% and 82.26% sensitivity and specificity for differentiation between cancer and non-cancer cases, with higher sensitivity and specificity than CA19-9 at different cut offs (CA19-9 sensitivity and specificity ranged from 64-80% and 56.4 - 61.2% respectively). The AUC was 0.851 for I-CAM and 0.754 for CA19-9. Neither of the markers demonstrated significance for distinguishing between early and late cancer stages. Conclusion: ICAM 1 is a useful marker in differentiation between malignant and benign pancreatic conditions, and superior to CA19-9 in this regard. However, neither of the markers can be recommended for use in differentiation between early and late stage pancreatic cancers.

• Asian Pacific Journal of Cancer Prevention
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• 제14권7호
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• pp.4369-4371
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• 2013

Objective: To evaluate the association of a diagnosis of lung cancer and combined detection of serum carcinoembryonic antigen (CEA), carbohydrateantigen 19-9 (CA19-9), neuron specific enolase (NSE) as well as the cytokeratin 19 fragment (CYFRA21-1). Methods: Serum CEA, CA19-9, NSE and CYFRA21-1 were assessed in 150 patients with lung cancer, 100 patients with benign lung disease and 100 normal control subjects, and differences of expression were compared in each group, and joint effects of these tumor markers in the diagnosis of lung cancer were analyzed. Results: Serum CEA, CA19-9, NSE and CYFRA21-1 in patients with lung cancer were significantly higher than those with benign lung disease and normal controls (p<0.01). It is suggested that these four tumor markers combined together could produce a positive detection rate of 90.2%, significantly higher than that of any single test. Conclusion: Combination detection of CEA, CA19-9, NSE and CYFRA21-1 could significantly improve the sensitivity and specificity in diagnosis of lung cancer, and could be important in early detection.

• Tuberculosis and Respiratory Diseases
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• 제75권1호
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• pp.25-27
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• 2013

Carbohydrate antigen 19-9 (CA 19-9) is a widely-used tumor marker in patients with pancreatic cancer. However, some patients with respiratory disease also exhibit elevated serum CA 19-9 levels. We report a case of normalization of elevated serum CA 19-9 levels after treatment of the nodular bronchiectatic form of Mycobacterium abscessus lung disease. A 40-year-old man visited our hospital because of chronic cough and sputum. A computed tomography scan revealed severe bronchiectasis in the right upper and right middle lobes. Nontuberculous mycobacteria were repeatedly isolated and identified as M. abscessus. The serum CA 19-9 level was elevated to 142.35 U/mL (normal range, <37 U/mL). Surgical resection was performed because of failure of sputum conversion after antibiotic treatment. The serum CA 19-9 level returned to the normal range after surgery. This case suggested that serum CA 19-9 levels could be elevated in patients with the nodular bronchiectatic form of M. abscessus lung disease.

• 핵의학기술
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• 제13권3호
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• pp.185-188
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• 2009

목적 : 건진센터 종양 검사가 정상범위 내에서 재검기준이 명확히 설정되어 있지 않아 검사자마다 각자의 재검기준에 따라 재검을 시행함에 따라 재검상의 편차가 크고 일괄적이지 못했다. 이를 개선하기 위해 정상치이하값에서의 재검기준을 마련하고 정상치이하인 값에서 trend 결과를 관리할 수 있는 본원 OCS QC (order communication system quality control)프로그램을 이용하여 건진 센터 종양 검사의 결과보고오류에 개선을 하고자 한다. 대상 및 방법 : 2009년 2월부터 3월까지 본원 건진 센터에서 종양 검사(AFP, CEA, CA19-9, CA125, PSA)를 실시한 환자들을 대상으로 하였다. 우선 각 검사의 정상범위에서 Inter assay CV%를 구하여 screening 기준 값을 설정하였다. OCS QC program에 진료과, 대상 검사종목, screening 기준 값을 입력하여 기준 값에 벗어난 결과는 색깔에 반전을 주었다. 1차로 5가지종양 검사를 전 결과대비 ${\pm}$ 30% 기준을 벗어난 screening 건수를 구하였고 2차로 각각의 종양 검사에 대해 전 결과 대비 AFP는 ${\pm}$ 60%, CEA와 CA19-9는 ${\pm}$50%, CA125와 PSA는 ${\pm}$40%로 기준 값을 상향조정하여 screening 건수를 구하였으며 정상치 이하에서의 재검기준도 설정하여 비교하였다. 결과 : 1차 screening 건수 백분율은 30~40%의 결과를 얻었고, 2차 screening 건수 백분율은 AFP 26.1%, CEA 18.9%, CA19-9 17.3%, CA-125 18.7%, PSA 21.0%로 평균 20%의 screening 백분율을 얻었다. 정상치 이하에서의 재검기준은 AFP 5.0이하$\leftrightarrow$10.0이상, CEA 1.0이하$\leftrightarrow$3.0이상, 2.0이하$\leftrightarrow$4.0이상, CA19-9와 CA-125 10.0이하$\leftrightarrow$30.0이상, PSA 1.0이하$\leftrightarrow$2.0이상으로 정하였으며 평균 20.4%의 screening 백분율에 재검기준을 적용시켜 실제 재검사 건수를 얻었다. 2달 동안 재검사 건수는 AFP 0건, CEA 15건, CA19-9 3건, CA-125 2건, PSA 5건이었다. 결론 : OCS QC 프로그램을 이용하여 시스템적인 재검기준을 마련함으로 검사자간 재검 실시 편차의 감소가 있었고 정상치 이하 값에서 결과보고오류에 대해 개선이 있을 것으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권5호
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• pp.2171-2174
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• 2012

Background: Pancreatic cancer is a distressing disease with a miserable prospects and early recognition remains a challenge due to ubiquitous symptomatic presentation, deep anatomical location, and aggressive etiology. False positives and problems in distinguishing pancreatitis from adenocarcinoma limit the use of CA 19-9 as both disorders can present with similar symptoms and share radiographic physiognomies. This study aimed to assess the relative increase in accuracy of diagnosing the patients with chronic pancreatitis, benign neoplasm of pancreas and adenocarcinomas with CA 19-9, haptoglobin, and serum amyloid A in comparison to CA 19-9 alone. Materials and Methods: This hospital based case control study was carried out in the Departments of Medicine and Biochemistry of Manipal Teaching Hospital, Pokhara, Nepal, between $1^{st}$ January 2010 and $31^{st}$ December 2011. The variables assessed were age, gender, serum CA19-9, serum haptoglobulin, serum Amyloid A. The data were analyzed using Excel 2003, R 2.8.0 Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version. Results: Out of 197 cases of pancreatic disease, maximum number of assumed cases were of adenocarcinoma of pancreas (95). Number of males (59) were more than females (36) in assumed cases of adenocarcinoma of pancreas. The mean values of CA19-9 raised considerably in cases of chronic pancreatitis, benign neoplasm and adenocarcinoma of pancreas when compared to controls. The highest augmention in CA19-9 values were in cases of adenocarcinoma of pancreas. The p-value indicates that in cases of chronic pancreatitis, there was not significant increase in precision of diagnosis. Conclusions: These statistics established that haptoglobin and SAA are useful in discriminating cancer from benign conditions as well as healthy controls.

• Asian Pacific Journal of Cancer Prevention
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• 제14권3호
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• pp.1965-1967
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• 2013

Background: To obtain the maximum additional information about the prognosis of gastric cancer, we compared CA-50 with other previously defined markers. Materials and Methods: This hospital based study was carried out in the Department of Biochemistry of Nepalese Army Institute of Health Sciences between $1^{st}$ July 2012 and $31^{st}$ December 2012. The variables collected were age, gender, AFP, CEA, CA19-9, and CA50, assayed with ELISA reader for all cases. The cut off values for serum AFP, CEA, CA19-9, and CA-50 were 10 ${\mu}g/l$, 10 ${\mu}g/l$, 37 U/ml, and 20 U/ml, respectively according to the manufacturer's instructions. Approval for the study was obtained from the institutional research ethical committee. Results: Of the 40 examined patients, 13 patients had tumors located in the upper third of the stomach, 6 patients had tumors in the middle third, 16 patients had tumors in the lower third, and 5 patients had tumors occupying two-thirds of the stomach or more. The distribution of lymph node staging of the patients was as follows: 7 patients belonged to N0, 9 patients to N1 stage, 10 patients to N2 stage, and 14 patients to N3 stage. The statistical method of Cox proportional hazards using multivariate analysis also illustrated that tumor markers including CEA (2.802), CA19-9 (2.690), CA50 (2.101), were independent prognostic factors, as tumor size (1.603), and lymph node stage (1.614). Conclusions: The tumour markers now available, like CEA, CA 19-9 and CA 50, chiefly perceive advanced gastric cancer. The preoperative rise in those tumour marker level have a prognostic significance and may be clinically helpful in choosing patients for adjuvant management.