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Objective:To investigate the value of three-dimensional reconstruction combined with serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) detection in the diagnosis and resectability evaluation of hilar cholangiocarcinoma (HCCA) before resectable lymph node metastasis.Methods:A total of 65 patients with suspected HCCA who were treated at Yiwu Central Hospital from June 2019 to June 2022 were included in the observation group. Thirty healthy people who concurrently underwent physical examinations in the same hospital were included in the control group. All participants underwent a CT three-dimensional reconstruction examination. Simultaneously, the automatic electrochemiluminescence immunoassay analyzer was used to measure serum levels of CA19-9 and CEA. The outcomes of percutaneous transhepatic cholangiography were used as the "gold standard". The consistency between CT three-dimensional reconstruction, CA19-9 detection, and CEA detection, either individually or combined, and the "gold standard" in the diagnosis of HCCA was evaluated.Results:Serum levels of CA19-9 and CEA in the observation group were (62.71 ± 10.63) U/mL and (62.71 ± 10.63) ng/mL, respectively, which were significantly higher than those in the control group [(12.37 ± 7.39) U/mL, (1.31 ± 0.97) ng/mL, t = 23.43, 11.59, both P < 0.05). The levels of CA19-9 [(71.69 ± 12.37) U/mL] and CEA [(8.89 ± 3.51) ng/mL] in patients with HCCA who had lymph node metastasis were significantly higher than those in patients with HCCA who had no lymph node metastasis [CA19-9 (56.78 ± 10.16) U/mL, CEA (6.45 ± 2.11) ng/mL, t = 4.14, 2.76, both P < 0.05].Compared with histopathological examination, the accuracy of CT three-dimensional reconstruction in typing was 85.00%. According to the "gold standard" diagnosis, CT three-dimensional reconstruction, CA19-9 detection, and CEA detection, alone and their combination, successfully detected HCCA in 22 cases (55.00%), 26 cases (65.00%), 31 cases (77.50%), and 38 cases (95.00%), respectively. The detection rate of HCCA was the highest when CT three-dimensional reconstruction, CA19-9 detection, and CEA detection were combined, and the difference was statistically significant ( χ2 = 18.15, P < 0.05). Compared with CT three-dimensional reconstruction (AUC: 0.808), CA19-9 detection (AUC: 0.721), and CEA detection (AUC: 0.703) individually, their combination (AUC: 0.913) had the highest value in the diagnosis of HCCA (all P < 0.05). Conclusion:CT three-dimensional reconstruction, CA19-9 detection, and CEA detection have a certain diagnostic value for HCCA, but the combination of CT three-dimensional reconstruction with the detection of serum levels of CA19-9 and CEA has a higher diagnostic value for HCCA, providing an effective reference for the preoperative evaluation of the resectability of HCCA in the clinic.
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Objective:To evaluate the value of detection of serum alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in opportunistic screening of liver cancer in Chinese population with a meta-analysis.Methods:Literatures on combined screening of liver cancer by AFP, CEA and CA19-9 were retrieved from CNKI, Wanfang Database, Chongqing VIP database, PubMed, Embase and Cochrane Library from the establishment of the databases to June 2023. The Quality Assessment Tool of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the literature. Stata 17.0 statistical software was used for meta-analysis, and Deeks funnel plot was used to analyze publication bias.Results:A total of 24 literatures met the inclusion criteria, including 1 471 patients with liver cancer and 2 150 controls. The overall sensitivity of AFP in liver cancer diagnosis (screening) was 0.71 (95% CI: 0.66-0.75), the total specificity was 0.86 (95% CI: 0.80-0.90), and the area under summary receiver operating characteristic (sROC) curve (AUC) was 0.82 (95% CI: 0.78-0.85). The total sensitivity of CEA in liver cancer diagnosis (screening) was 0.48 (95% CI: 0.40-0.56), the total specificity was 0.85 (95% CI: 0.79-0.89), and the AUC of sROC was 0.74 (95% CI: 0.70-0.77). The total sensitivity of CA19-9 in liver cancer diagnosis (screening) was 0.56 (95% CI: 0.50-0.61), the total specificity was 0.80 (95% CI: 0.73-0.85), and the AUC was 0.69 (95% CI: 0.65-0.73). AFP has the highest sensitivity and specificity among the three. The overall sensitivity of combined detection of AFP, CEA and CA19-9 for liver cancer diagnosis (screening) was increased to 0.89 (95% CI: 0.85-0.92), the overall specificity was 0.77 (95% CI: 0.70-0.82), and the AUC was 0.91 (95% CI: 0.88-0.93). No publication bias was found in either individual or combined test of the biomarkers. Conclusions:Detection of AFP alone has high sensitivity and specificity, and it is a tumor marker that can be used for the opportunistic screening of liver cancer. When combined tests of AFP, CEA and CA19-9 are used to screen liver cancer, the results should be interpreted more carefully.
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Objective:To evaluate the value of CEA, CYFRA21-1 and CA125 tests in opportunistic screening of non-small cell lung cancer (NSCLC) based on meta-analysis.Methods:The original research literatures on the diagnostic value of CEA, CYFRA21-1 and CA125 in Chinese NSCLC patients were searched from databases of PubMed, Embase, The Cochrane Library, CNKI, VIP, Database and Wanfang database from establishment to June 2023. The literature screening, data extraction and quality evaluation were carried out independently by two researchers. The quality evaluation tool of diagnostic accuracy studies was used to evaluate the quality of the literature. A summary receiver operating characteristic (SROC) curve was used to assess the overall effectiveness of the tests. The outcome stability and publication bias were detected by using sensitivity analysis and Deeks′ test.Results:A total of 23 studies met the inclusion and exclusion criteria were included. The results of meta-analysis showed that the overall sensitivity of CEA, CYFRA21-1 and CA125 alone in the diagnosis of NSCLC was relatively low, it was 0.49(95% CI: 0.43-0.55), 0.56(95% CI: 0.49-0.63) and 0.41(95% CI: 0.33-0.49), respectively. The overall sensitivity of the combined detection of the three markers for the diagnosis of NSCLC increased to 0.83(95% CI: 0.69-0.91), but the overall specificity decreased to 0.76(95% CI: 0.69-0.83). Conclusions:The single detection of CEA, CYFRA21-1 and CA125 is not recommended for screening NSCLC in population receiving physical examination. Although the sensitivity of the combined detection of CEA, CYFRA21-1 and CA125 for screening NSCLC is improved, but the specificity is decreased, the misdiagnosis rate is increased, so the screening effect is limited.
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Objective:To evaluate the application value of serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9 and CA72-4 detection in the opportunistic screening (healthy physical examination) of gastric cancer based on a meta-analysis.Methods:A published literature searching up to May 2023 was performed in databases of CNKI, Wanfang Databases, VIP, PubMed, Cochran and Embase for studies on CEA, CA19-9 and CA72-4 detection and diagnosis of gastric cancer. The Quality Evaluation Tool of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the literature. Stata17.0 statistical software was used for meta-analysis.Results:According to the inclusion and exclusion criteria, a total of 23 studies with 5 287 gastric cancer patients and 6 129 controls were included. The pooled sensitivity and specificity of serum CEA, CA19-9 and CA72-4 as a diagnostic marker for gastric cancer were 0.42, 0.45 and 0.52, and 0.94, 0.91 and 0.95, respectively. The area under the summary receiver operating characteristic (sROC) curve for discriminating gastric cancer was 0.82, 0.77 and 0.87, respectively. The sensitivity of combined (parallel) diagnosis of gastric cancer with the three biomarkers increased to 0.66 (95% CI: 0.54-0.76), the specificity decreased to 0.85 (95% CI: 0.81-0.89), and the area under the curve basically remained unchanged at 0.86 (95% CI: 0.83-0.89). Conclusions:Due to poor sensitivity, the application effects of serum CEA, CA19-9 and CA72-4 as biomarkers for gastric cancer screening and physical examination are limited.
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Objective:To explore the clinical features and prognosis of simultaneous double primary and single primary colorectal cancer patients.Methods:A retrospective case series study was conducted. The clinical data of 45 patients with simultaneous double primary colorectal cancer, 53 patients with single primary colon cancer and 59 patients with single primary rectal cancer in Shanxi Province Cancer Hospital from January 2015 to January 2018 were retrospectively analyzed, including gender, age, drinking history, smoking history, body mass index (BMI), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), hemoglobin, albumin, TNM stage. The clinicopathological characteristics of the three groups were compared. Survival analysis was performed using the Kaplan-Meier method to compare the overall survival of the three groups.Results:The age of simultaneous double primary colorectal cancer patients was (63±11) years old, including 28 males and 17 females; the age of single primary colon cancer patients was (61±12) years old, including 30 males and 23 females; the age of single primary rectal cancer patients was (60±11) years old, including 30 males and 29 females. There was a significant difference in BMI between patients with double primary cancer and single primary colon cancer ( P = 0.041), but there were no significant differences in gender, age, drinking history, smoking history, CEA, CA199, hemoglobin, albumin and TNM stage (all P > 0.05). There were significant differences in BMI, CEA and CA199 between patients with double primary cancer and single primary rectal cancer (all P < 0.05), but there were no significant differences in gender, age, drinking history, smoking history, hemoglobin, albumin and TNM stage (all P > 0.05). The 1-, 3- and 5-year overall survival rates of the double primary cancer patients were 95.56%, 77.78% and 62.22%, the single primary colon cancer patients were 94.34%, 81.13% and 69.81%, and the single primary rectal cancer patients were 100.00%, 88.14% and 72.88%, respectively. There was no significant difference in OS among patients with double primary cancer, single primary rectal cancer and single primary rectal cancer (both P > 0.05). Conclusions:Abnormally elevated BMI may be associated with the risk of developing simultaneous double primary colorectal cancer. Detection of CEA and CA199 is helpful in monitoring rectal cancer patients for the combination of other primary tumors. The prognosis of patients with single primary colon or rectal cancer is comparable to that of patients with simultaneous double primary colorectal cancer.
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OBJECTIVE To investigate the diagnostic efficacy of serum calcitonin(Ctn)in medullary thyroid cancer(MTC),the correlation between preoperative serum Ctn and clinicopathological features,and the risk factors affecting the progression of MTC disease during follow-up.METHODS The clinical data of 50 patients admitted to the Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine from 2011 to 2022 were systematically reviewed,the ROC curve calculated the diagnostic efficacy of Ctn and CEA levels on MTC,and the risk factors for lymph node metastasis in the central region of MTC were analyzed in univariate and multivariate,and the survival curve without disease progression was drawn to predict risk factors.RESULTS The ROC curve yields the preoperative cut-off value of Ctn was 23.81 pg/ml and the cut-off value of CEA was 3.035 ng/ml for the diagnosis of MTC.The age of disease,tumor diameter,and preoperative serum Ctn and CEA levels in MTC patients were higher than those in non-MTC patients.Ctn≥289.62 pg/ml was an independent risk factor for central lymph node metastasis in MTC.The survival curve showed that invasion of the capsule,central region metastasis,and TNM stage above T2 were risk factors for predicting disease progression(P<0.05).Patients with MTC who have disease progression have higher preoperative Ctn.CONCLUSION Serum Ctn has important clinical value in the differential diagnosis,preoperative evaluation and postoperative follow-up of MTC.
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Objective To construct a model for predicting the survival time of colorectal cancer(CRC)patients based on the preopera-tive carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)levels.Methods 313 patients with CRC from Jiangmen Central Hospital were collected and their preoperative serum CEA and CA19-9 levels were detected using a Beckman Access chemilu-minescence immunoassay analyzer.The χ2 test was used to evaluate the relationships between CEA and clinical pathological factors and between CA19-9 and clinical pathological factors,and the Kaplan-Meier survival analysis and Cox multivariate analysis were used to as-sess the survival and prognosis of patients,respectively.Results CEA and CA19-9 levels were correlated with TNM staging,clinical stagesⅠ,Ⅱ,Ⅲ,andⅣ,progression,recurrence,vascular invasion,and metastatic sites of CRC(P＜0.05).The overall survival time(OS)of patients with elevated CEA was shorter than that of patients with normal CEA,with a total of 76.85 months,while the OS of patients with normal CEA was 110.83 months(P=0.000).The same trend was observed in patients with elevated CA19-9(P=0.000).Cox multivariate analysis found that CEA and CA19-9 were independent predictors of survival in CRC patients(HR=2.190 and 2.874,95%CI=1.486-3.225 and 1.947-4.242,respectively;P＜0.05).A model formula combining CEA and CA19-9 was constructed,assig-ning a score of 0 for normal CEA,1 for elevated CEA,and 0 for normal CA19-9,1 for elevated CA19-9.The CC value was set to equal CEA score+CA19-9 score.It was found that the patients with the highest CC value had the shortest OS,while the patients with the low-est CC value had the longest OS(P＜0.05).Conclusion The established CEA and CA19-9 model formula can effectively distinguish the prognosis of CRC patients.
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SUMMARY OBJECTIVE: This study purposed to evaluate preoperative two tumor markers, namely, carcinoembryonic antigen and carbohydrate antigen (CA)19-9, in colorectal cancer for anatomotopographic location with disease stage and to assess their utility for diagnostic staging purposes. METHODS: The study retrospectively incorporated patients who had undergone surgery for colorectal cancer at our department in 2015-2018 and in whom carcinoembryonic antigen and CA19-9 tumor markers had been preoperatively analyzed. The obtained data were then statistically processed using R-project. RESULTS: A total of 155 patients had been incorporated, of whom 96 (62%) were men and 59 (38%) were women. Rectum was the most common location (74 patients, 48%), and the least represented stage was IV (18, 12%). The marker carcinoembryonic antigen was obtained in all 155 cases, while CA19-9 was in 105. The median carcinoembryonic antigen was 3 (0.34-1104.25), and the median CA19-9 was 12 (0.18-840.00). A significance was recognized between median carcinoembryonic antigen and disease stage (p-value=0.016), with stages I, II, and III (medians 2, 3, and 2) different from stage IV (median 13), while no significance for CA19-9 was recognized (p-value=0.343). No significance between either marker and location (carcinoembryonic antigen: p=0.276; CA19-9: p=0.505) was detected. The testing was performed at a significance level of alpha=0.05. CONCLUSION: This study revealed a significance between the marker carcinoembryonic antigen, but not CA19-9, and the disease stage, while no relationship of either of these markers with tumor location was found. Herewith, the study confirmed that higher carcinoembryonic antigen values may suggest the finding of more advanced forms of colorectal cancer and thus a worse prognosis of this malignant phenomenon.
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El antígeno carcinoembrionario (CEA) es un marcador tumoral ampliamente empleado en el manejo del cáncer colorrectal, especialmente en el seguimiento de los pacientes resecados con intención curativa. El objetivo de esta revisión es actualizar el rol del CEA en el manejo de los pacientes intervenidos por un cáncer de colon estadios I-III considerando la mejor evidencia disponible. Dada la sensibilidad modesta en el tumor primario (40%), la cual sube al 60-80% en los casos de recidiva, se propone la medición precoz del marcador (alrededor del mes) de las resecciones R0, toda vez que el valor debiera estar normalizado, especialmente si estaba elevado en el preoperatorio. Una elevación sostenida o un alza > de 10 ng/ml en el control precoz es indicativo de enfermedad residual y/o a distancia, lo que implica un rastreo clínico intensivo. Aunque el CEA preoperatorio tiene un valor pronóstico categórico, el CEA postoperatorio precoz elevado parece tener un valor pronóstico de recidiva superior. Un seguimiento intensivo parece razonable en los pacientes con factores de riesgo de recidiva, lo que incluye la medición del CEA en forma seriada. El umbral óptimo del CEA es motivo de controversia, con una tendencia a bajar el nivel de corte considerado normal (< 5 ng/ml) en los últimos años), lo que podría mejorar el balance entre sensibilidad y especificidad del test. Nuevas técnicas como el ADN circulante en combinación con el CEA se han propuesto para mejorar la oportunidad del diagnóstico de una recidiva, actualmente en evaluación.
Carcinoembryonic antigen (CEA) is a tumor marker widely used in the management of colorectal cancer, especially in the follow-up of patients resected with curative intent. The objective of this review is to update the role of CEA in the management of patients operated on for stage I-III colon cancer considering the best available evidence. Given the modest sensitivity in the primary tumor (40%), which rises to 60-80% in cases of recurrence, early measurement of the marker (around a month) of R0 resections is proposed, since the value should be normalized, especially if it was elevated preoperatively. A sustained elevation or a rise > 10 ng/mL at early check-up is indicative of residual and/or distant disease, which implies intensive clinical follow-up. Although preoperative CEA has a strong prognostic value, elevated early postoperative CEA seems to have a higher prognostic value for recurrence. Intensive follow-up seems reasonable in patients with risk factors for recurrence, which includes serial CEA measurement. The optimal CEA threshold is controversial, with a tendency to lower the cut-off level considered normal (< 5 ng/ml) in recent years), which could improve the balance between test sensitivity and specificity. New techniques such as circulating DNA in combination with CEA have been proposed to improve the chance of diagnosing a recurrence, currently under evaluation.
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Abstract Background: Inflammation, which is associated with an unhealthy lifestyle, plays a critical role in the development of both cardiometabolic diseases (CMD) and cancer. Carcinoembryonic antigen (CEA) is a tumor marker which also has proinflammatory properties. Recent studies have reported CEA to be associated with atherosclerosis, metabolic syndrome, and visceral adiposity. Epicardial adipose tissue (EAT) can exhibit highly inflammatory and pathogenic properties, and is a known risk factor for CMD. However, its relationship with CEA is still unknown. Objectives: This study aimed to investigate the possible association of CEA with EAT. Methods: A total of 134 Caucasian (males = 56, females = 78) individuals, aged (22-83 years), who were admitted for routine health control, were enrolled in this cross-sectional study. CEA was measured with chemiluminescent microparticle immunoassay (CMIA). EAT was measured by transthoracic echocardiography, and the visceral fat rating (VFR) was assessed by a body composition analyzing machine. The p-value <0.05 was considered statistically significant. Results: CEA levels were categorized as tertiles: T1, 0.5-1.04; T2, 1.06-1.69; and T3, ≥1.7 ng/ml. The mean age, weight, VFR, EAT, and fasting glucose, as well as the median of systolic blood pressure (SBP), creatinine, and AST increased with the increasing CEA tertiles. CEA was significantly associated with EAT (r = 0.55, P<0.001) and VFR (r = 0.36, P<0.001). Multivariate linear regression analysis confirmed that gender, age, and EAT were the significant independent variables associated with CEA. Conclusion: Individuals with increased EAT have higher levels of CEA, suggesting that this biomarker is most likely produced by EAT; however, additional investigations are required to improve the present work.
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Objective:To explore the prognostic significance of preoperative carcinoembryonic antigen (CEA) in patients with stage Ⅳ colon cancer with simultaneous liver and/or lung metastasis, and establish a predictive model.Methods:Using the SEER database, 5 149 patients diagnosed with colon cancer from 2010 to 2015 were collected based on inclusion and exclusion criteria. They were divided into a CEA positive group and a CEA negative group based on their preoperative CEA status. Based on the different CEA status and metastatic sites, we plotted different survival curves and analyzed the differences using the Log rank method. We used the Cox proportional risk model to analyze the risk factors affecting the prognosis of patients with simultaneous liver and/or lung metastasis in colon cancer, and constructed a column chart based on the results. The area under the receiver operating characteristic (ROC) curve of different variable models was calculated and the model discrimination wasevaluated. By using x-tile software, the optimal cutoff value for individual total scores was selected and risk levels were classified to predict patient prognosis.Results:CEA positive colon cancer patients with liver and/or lung metastasis had a poor prognosis, with a 5-year survival rate of 13.4%. Cox proportional risk analysis showed that CEA positive patients had an increased risk of death compared to negative patients after adjusting for other factors ( HR=1.64). After incorporating the CEA+ X, X (independent risk factors other than CEA), and AJCC T+ N models, the areas under the ROC curve were 0.712, 0.706, and 0.59, respectively. According to the prediction score given in the column chart, the x-tilie selected for the best cutoff score was 262.5, which can be divided into high-risk and low-risk populations. The Log rank test was P<0.05. Conclusions:The preoperative CEA level has important predictive value for the prognosis of stage IV colon cancer patients with simultaneous liver and/or lung metastasis. The survival prediction model and column chart for colorectal cancer patients with liver and/or lung metastasis established based on the Cox proportional risk model are of great significance for patient prognosis evaluation and are conducive to the selection of personalized treatment plans.
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Objective:To explore the values of albumin-bilirubin (ALBI) score, carcinoembryonic antigen (CEA) and combination of the two in the prognostic assessment of colorectal cancer patients with postoperative liver metastasis.Methods:The clinicopathological data of 98 colorectal cancer patients with postoperative liver metastasis who were admitted to Lianyungang Oriental Hospital and receiving adjuvant chemotherapy from January 2016 to March 2020 were retrospective analyzed. The data of serum protein, bilirubin, and CEA before chemotherapy were obtained, the relationship between serum protein and bilirubin was analyzed, and the ALBI score was calculated. The ALBI-CEA score was judged according to the ALBI score and the CEA level. ALBI score > -2.60 points was categorized as high ALBI group, and ALBI score ≤ -2.60 points was categorized as low ALBI group; CEA >5 ng/ml was categorized as high CEA group, and CEA ≤5 ng/ml was categorized as low CEA group; patients were categorized into 0, 1, and 2 points groups based on ALBI-CEA score. Overall survival (OS) and progression-free survival (PFS) of ALBI score, CEA and ALBI-CEA score subgroups were analyzed by Kaplan-Meier method; with the actual survival and progress status of the patients as the gold standard, receiver operating characteristic (ROC) curve was used to analyze the effect of 3 indicators to assess patients' OS and PFS, and area under the curve (AUC) was compared; Cox proportional hazards model was used to analyze the influencing factors of OS and PFS.Results:The median albumin and bilirubin levels of the 98 patients were 34.4 g/L (26.8-42.8 g/L) and 16.6 μmol/L (7.6-44.6 μmol/L), and the result of Pearson correlation analysis showed a negative correlation between the levels of albumin and bilirubin ( r = -0.282, P < 0.001). The 3-year OS and PFS rates in the high ALBI group were lower than those in the low ALBI group (OS rate: 9.2% vs. 33.3%, PFS rate: 7.7% vs. 18.2%), and the differences in OS and PFS between the two groups were statistically significant ( χ2 values were 27.64, 23.30, both P < 0.001). The 3-year OS and PFS rates in the high CEA group were lower than those in the low CEA group (OS rate: 7.1% vs. 42.9%, PFS rate: 7.1% vs. 21.4%), and the differences in OS and PFS between the two groups were statistically significant ( χ2 values were 23.71, 17.14, both P < 0.001). The 3-year OS rates in the ALBI-CEA score 0, 1 and 2 points groups were 77.8%, 20.9% and 2.2%, and the 3-year PFS rates were 44.4%, 9.3% and 6.5%, and there were statistical differences in OS and PFS among the three groups ( χ2 values were 102.36, 76.55, both P < 0.001). The ROC curve analysis showed that the AUC of ALBI score, CEA and ALBI-CEA score for assessing OS were 0.688 (95% CI 0.544-0.832), 0.754 (95% CI 0.618-0.890) and 0.828 (95% CI 0.723-0.933) (all P < 0.05), and the AUC for assessing PFS were 0.618 (95% CI 0.436-0.799), 0.646 (95% CI 0.464-0.829) and 0.682 (95% CI 0.494-0.870) (all P > 0.05). Multivariate Cox regression analysis showed that ALBI-CEA score was an independent influencing factor for OS (2 points vs. 0 point: HR = 17.254, 95% CI 8.385-35.504, P < 0.001) and PFS (2 points vs. 0 point: HR = 6.144, 95% CI 3.725-10.134, P < 0.001) of patients. Conclusions:The colorectal cancer patients with liver metastasis and high ALBI-CEA score are at high risk of death and disease progression and have a poor prognosis, and they are recommended to receive intensive treatment.
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Objective:To explore the value of neutrophil to lymphocyte ratio (NLR) , carcinoembryonic antigen (CEA) combined with coagulation indicators prothrombin time (PT) , activated partialthromboplastin time (APTT) , thrombin time (TT) , fibrinogen (FIB) in the differential diagnosis of benign and malignant breast nodules with a diameter of ≤1.0 cm.Methods:Patients with breast nodule diameter ≤1.0 cm who underwent physical examination in the Cancer Hospital of Xinjiang Medical University from January 2017 to March 2023 were selected as the study objects. Patients admitted from January 2017 to June 2020 were defined as the training set, and patients admitted from July 2020 to March 2023 were defined as the validation set. In the training set, there were 83 patients with benign breast nodules and 106 patients with breast cancer; In the validation set, there were 109 patients with benign breast nodules and 136 patients with breast cancer. The influencing factors of benign and malignant breast nodules were analyzed by logistic regression. Binary logistic regression was used to construct the diagnosis and prediction model of benign and malignant breast nodules. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of each index and diagnostic prediction model for benign and malignant breast nodules.Results:There were statistically significant differences between patients with benign breast nodules and patients with breast cancer in the training and validation sets in neutrophils ( t=6.76, P<0.001; t=9.14, P<0.001) , lymphocytes ( t=7.67, P<0.001; t=17.00, P<0.001) , NLR ( t=13.97, P<0.001; t=17.41, P<0.001) , CEA ( t=33.44, P<0.001; t=8.15, P<0.001) , PT ( t=15.81, P<0.001; t=60.15, P<0.001) , APTT ( t=39.50, P<0.001; t=16.34, P<0.001) , TT ( t=13.34, P<0.001; t=14.37, P<0.001) , FIB ( t=16.66, P<0.001; t=20.30, P<0.001) . The results of univariate analysis showed that neutrophils ( OR=3.52, 95% CI: 1.26-5.37, P=0.036) , lymphocytes ( OR=2.64, 95% CI: 1.52-3.72, P=0.033) , NLR ( OR=1.96, 95% CI: 1.15-3.42, P<0.001) , CEA ( OR=2.16, 95% CI: 1.29-3.05, P<0.001) , PT ( OR=1.75, 95% CI: 1.17-2.69, P<0.001) , APTT ( OR=3.11, 95% CI: 1.55-5.38, P<0.001) , TT ( OR=2.59, 95% CI: 1.38-4.11, P<0.001) , FIB ( OR=2.89, 95% CI: 1.36-4.55, P<0.001) were all influencing factors that affected the benign and malignant breast nodules with a diameter ≤1.0 cm. The results of multivariate analysis showed that NLR ( OR=2.06, 95% CI: 1.32-2.76, P<0.001) , CEA ( OR=1.19, 95% CI: 1.09-1.37, P=0.008) , PT ( OR=1.63, 95% CI: 1.05-2.11, P<0.001) , APTT ( OR=1.52, 95% CI: 1.13-2.34, P<0.001) , TT ( OR=1.64, 95% CI: 1.14-2.74, P<0.001) , FIB ( OR=1.42, 95% CI: 1.11-1.89, P<0.001) were all independent influencing factors on the benign and malignant breast nodules with a diameter ≤1.0 cm. ROC curve analysis results showed that the area under curve (AUC) of NLR, CEA, PT, APTT, TT, FIB in the diagnosis of breast cancer was 0.83, 0.65, 0.69, 0.72, 0.73, 0.70 respectively, in the training set. The sensitivity of NLR in the diagnosis of breast cancer was 76%, and the specificity was 69%. A diagnostic prediction model was established based on statistically significant indicators in multivariate analysis, with logit ( P) =1.76×NLR+21.42×CEA+5.14×PT+5.34×APTT+5.78×TT+6.52×FIB. ROC curve analysis showed that the AUC of the diagnostic prediction model used for patient differential diagnosis in the training and validation sets was 0.81 and 0.80 respectively. The AUC of diagnosis prediction model for breast cancer diagnosis of patients aged ≤60 years old and >60 years old was 0.79 and 0.77 respectively, with sensitivity of 82% and 80%, specificity of 75% and 83% respectively. The AUC of diagnosis prediction model for breast cancer with tumor diameter <0.3 cm, 0.3-0.6 cm and 0.7-1.0 cm was 0.63, 0.74 and 0.91 respectively, with sensitivity of 68%, 73%, 81%, and specificity of 72%, 77%, 84%. Conclusion:NLR, CEA, PT, APTT, TT and FIB are all independent influencing factors that affect the benign and malignant breast nodules with a diameter ≤1.0 cm. The prediction model constructed by NLR and CEA combined with coagulation indexes PT, APTT, TT and FIB has high diagnostic efficiency for benign and malignant breast nodules with a diameter ≤1.0 cm.
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Objective:To analyze the effects of apatinib on quality of life and immune function in older adult patients with advanced non-small cell lung cancer.Methods:A total of 187 older adult patients with advanced non-small cell lung cancer admitted to Taizhou Cancer Hospital from January 2017 to January 2021 were included in this study. They were divided into the control group ( n = 93) and the observation group ( n = 94). The control group was treated with carboplatin combined with pemetrexed and the observation group was treated with apatinib based on carboplatin and pemetrexed. Sign and symptoms remission was compared between the observation and control groups. The levels of tumor markers, immune function, and quality of life score were compared between the two groups before and after treatment. Results:Total remission rate in the observation group was significantly higher than that in the control group (88.30% vs. 69.89%, χ2 = 9.59, P < 0.05). After treatment, carbohydrate antigen 125, carbohydrate antigen 50, and carcinoembryonic antigen in the observation group were (16.25 ± 5.47) μg/L, (15.23 ± 3.27) μg/L and (5.91 ± 2.66) mg/L, respectively, which were significantly lower than (21.49 ± 6.61) μg/L, (19.11 ± 3.48) μg/L and (10.14 ± 2.73) mg/L in the control group ( t = 5.91, 7.86, 10.73, all P < 0.05). The percentage of CD3 + and CD4 + cells, and the ratio of CD4 +/CD8 + cells in the observation group were (69.34 ± 8.85)%, (38.15 ± 6.52)%, (1.40 ± 0.33), respectively, which were significantly higher than (64.51 ± 8.74)%, (33.55 ± 6.33)%, (1.23 ± 0.25) in the control group ( t = -3.75, -5.36, -3.97, all P < 0.05). Quality of life score was increased in each group ( P < 0.001). The amplitude of increase in quality of life score was greater in the observation group compared with the control group ( P < 0.001). Conclusion:Apatinib can effectively reduce the level of tumor markers and improve immune function in older adult patients with advanced non-small cell lung cancer and improve quality of life.
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In patients with medullary thyroid carcinoma (MTC), calcitonin (Ctn) and carcinoembryonic antigen (CEA) were the most important serum biomarkers for diagnosis, evaluation and follow-up. Approximately 0.3% to 5.9% of the thyroid nodule population could present with elevated Ctn on screening, and a diagnosis of MTC can be basically confirmed when serum Ctn > 100 pg/ml.. Ctn and CEA levels could reflect tumor burden and help determine the extent and timing of surgery. When preoperative serum Ctn >200 pg/mL or CEA >30 ng/mL, nearly more than one-third of patients had lateral neck lymph node metastasis. Few patients developed distant metastasis when Ctn<500 pg/mL, however the proportion of distant metastasis could reach 75% when CEA>100 ng/mL. In inherited MTC patients, tumors with Ctn<30 pg/mL were usually localized in the gland without metastasis. The time to normalization of serum Ctn and CEA postoperatively was one month in most patients. According to the response to initial therapy, patients with undetectable Ctn and normal CEA had a low risk of relapse and death in the follow-up period. The risk of local recurrence, LNM and distant metastasis increased as Ctn levels rose. The Ctn/CEA doubling time could predict the disease prognosis, and when it was less than 0.5 years, most patients would die.
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Objective:To analyze the diagnostic value of sex hormone combined with carcinoembryonic antigen on lymph node metastasis in breast cancer patients.Methods:52 cases of breast cancer patients who underwent surgical resection were collected and divided into non-metastasis group and metastases group after axillary lymph node ultrasonography. The blood samples was collected from patients and the levels of serum estradiol, testosterone, progesterone and carcinoembryonic antigen were detected; The diagnostic value of the above indexes in patients with lymph node metastasis was analyzed; Logistic risk regression model was used to analyze the independent risk factors for lymph node metastasis after surgical resection.Results:There were significant differences between the non-metastatic group and the metastatic group in the largest tumor diameter and menopause (all P<0.05), but there were no significant differences among other general data (all P>0.05). The serum estradiol level in the non-metastatic group was (153.97±35.55) pg/ml, the progesterone level was (0.33±0.05) ng/ml, and the carcinoembryonic antigen level was (11.44±3.77) ng/ml, while the estradiol level in the metastatic group was (207.19±52.11) pg/ml ( t=4.13, P<0.001), progesterone level (0.38±0.04) ng/ml ( t=4.01, P<0.001), carcinoembryonic antigen level (15.41±3.46) ng/ml ( t=3.94, P<0.001). The above three indicators were significantly increased in patients in the transfer group. The area under the curve of estradiol was 0.83, the area under the curve of progesterone was 0.80, the area under the curve of carcinoembryonic antigen was 0.77, the area under the curve of the combination of the three was 0.85, and the area under the curve of the combination of the three was the largest. Logistic risk regression model showed that estradiol, progesterone, and carcinoembryonic antigen levels were independent risk factors affecting lymph node metastasis in breast cancer patients (all P<0.05) . Conclusion:The sex hormone estradiol, progesterone combined with carcinoembryonic antigen has a high diagnostic value for lymph node metastasis in patients with breast cancer, and can independently predict the occurrence of lymph node metastasis in breast cancer patients.
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SUMMARY BACKGROUND: Serum tumor markers are molecules that are secreted by tumor cells and may be present in small amounts in the serum of healthy individuals. Their role as prognostic factors in lung cancer remains controversial. OBJECTIVE: To assess the prognostic role of CEA, CA 19-9, CA 15-3, and CA 125 in non-squamous non-small cell lung cancer. PATIENTS AND METHODS: A total of 112 patients with non-squamous non-small cell lung cancer from two Oncology Centers were retrospectively analyzed. Tumor marker levels were measured prior to treatment. Data regarding clinical characteristics and overall survival were collected. RESULTS: Median overall survival of all patients was 15.97 months. Pre-treatment elevations of CA 125 and CA 15-3 were associated with shorter overall survival (p=0.004 and p=0.014, respectively). Single CEA and CA 19-9 elevations were not associated with a worse prognosis. Patients with two or more elevated markers had a statistically significant decrease in overall survival (p=0.008). In the multivariate analysis, smoking status and number of positive tumor markers at diagnosis were independently associated with a worse prognosis. CONCLUSION: High pre-treatment levels of tumor markers were correlated with decreased survival in patients with non-squamous non-small cell lung cancer.
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Objective:To explore the diagnostic value of endoscopic ultrasonography (EUS) for pancreatic cystic lesions (PCLs).Methods:Clinical data of 211 patients with PCLs, who underwent EUS at least once and were pathologically confirmed in First Affiliated of Naval Medical University from January 2011 to December 2021 was retrospectively analyzed. EUS imaging characteristics, biochemical analysis of cystic fluid and pathological data were recorded. The pathological diagnosis results of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms were included in the mucinous lesion group, while pancreatic pseudocyst, serous cystic neoplasms, solid pseudopapillary neoplasms and pancreatic neuroendocrine tumors were included as non-mucinous lesions group; those with pancreatic ductal adenocarcinoma, adenocarcinoma or with atypical or cancer cells were included as malignant lesion group, and the else were included as benign lesions group. The level of CEA in cyst fluid between mucinous and non-mucinous lesions and the level of amylase in cyst fluid between benign and malignant lesion groups were compared, and the area under the curve (AUC) was calculated by drawing receiver operating characteristic curve (ROC), which was used to analyze the differential diagnosis efficiency of cyst fluid CEA and amylase test indexes. The basic characteristics and EUS imaging characteristics, and the diagnostic efficiency of EUS and liquid-based cytology and histopathology between benign and malignant lesions were studied and analyzed.Results:Among the 211 PCL patients, cyst fluid was obtained in 201 patients, of which 188 patients (93.5%) underwent cytological examination, and 33 patients were diagnosed with an accuracy rate of 17.6%; 41 cases were obtained for histological examination, and 23 cases were confirmed, with an accuracy rate of 56.1%. Among all confirmed cases, 45 cases had benign lesions, including 22 cases of mucinous lesions and 23 cases of non-mucinous lesions, with the cyst fluid CEA of 1458.16(19.80, 1500.00), 4.4(0.50, 341.14)ng/ml respectively, and the difference of cyst fluid CEA level between mucinous and non-mucinous lesions was statistically significant( P<0.05). The cyst fluid CEA<10.15 ng/ml could be used to diagnose non-mucinous PCLs with the sensitivity of 89.5%(95% CI0.686-0.981), and the specificity of 66.7%(95% CI0.438-0.837). The cyst fluid amylase levels in benign and malignant lesions were 379.00(50.00, 18405.50), 42.00(13.50, 340.00)U/L, and the difference was statistically significant ( P<0.05). The cyst fluid amylase>747.50 U/L might help to identify benign PCLs with the sensitivity of 91.7%(95% CI0.646-0.996), and the specificity of 48.0%(95% CI0.300-0.665). EUS showed that the proportion of cyst wall thickening, main duct dilatation and cystic solid components in patients with malignant lesions was significantly higher than that in patients with benign lesions, and the differences were statistically significant ( P<0.05), while there was no significant difference in the proportion of cyst wall nodules and cystic septum between the two groups. The accuracy of EUS combined with liquid-based cytology or histopathology in malignant lesions was over 80%. Conclusions:The cyst fluid CEA level can help to differentiate non-mucinous PCLs from mucinous PCLs, and the cystic amylase level could be useful to identify the benign and malignant PCLs. EUS combined with cytology or histology had high diagnostic value for malignant or potentially malignant PCLs, and EUS-FNA examination can be recommended as soon as possible for those with high-risk factors.
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Objective:To investigate the relationship between tumor volume changes, squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and the prognosis of cervical cancer patients with concurrent radiotherapy and chemotherapy and their combined prediction of prognosis.Methods:One hundred and twenty-eight patients in Shanxi Cancer Hospital from February 2018 to February 2020, with cervical cancer undergoing radical concurrent radiotherapy and chemotherapy were selected for a prospective study. According to different prognostic effects, the patients were divided into poor prognosis group (44 cases) and good prognosis group (84 cases). The general data, tumor reduction rate (TVRR), SCC-Ag, CEA, and CA125 levels were compared between the two groups, and the Logistic regression equation was used to analyze the prognostic factors of patients with concurrent radiotherapy and chemotherapy for cervical cancer. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to analyze the performance of each index and the joint prediction of prognosis. Kaplan-Meier survival curve analysis and log-rank (Mantel-Cox) were used to test the survival curves of TVRR, SCC-Ag, CEA, CA125 high-risk individuals and low-risk individuals.Results:The TVRR in the poor prognosis group was significantly lower than that in the good prognosis group: (76.63 ± 7.52)% vs. (85.54 ± 6.71)%, the SCC-Ag, CEA, CA125 were significantly higher than those in the good prognosis group: (6.98 ± 2.15) μg/L vs. (4.61 ± 1.37) μg/L, (9.34 ± 2.23) μg/L vs. (5.76 ± 1.87) μg/L, (68.79 ± 12.01) kU/L vs. (49.97 ± 15.22) kU/L, and there were statistical differences ( P<0.05). Logistic regression showed that TVRR, SCC-Ag, CEA and CA125 were significant factors influencing the prognosis of patients with concurrent chemoradiotherapy for cervical cancer ( P<0.05). Among the single indicators, TVRR predicted the highest prognosis AUC, and the combined prognostic AUC of all indicators (0.837, 95% CI 0.761 to 0.920) was higher than any single indicator, with a sensitivity of 81.82% and specificity of 84.52%. The survival curves of TVRR, SCC-Ag, CEA, CA125 between high-risk and low-risk patients showed statistically significant differences ( P<0.05). Conclusions:The changes in tumor volume, SCC-Ag, CEA, CA125 and the prognosis of patients with concurrent radiotherapy and chemotherapy for cervical cancer have a certain correlation. The combined examination of the four in the early stage is expected to become a new approach to clinically predict the prognosis of cervical cancer and make appropriate treatment plans.