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ORIGINAL ARTICLE
Year : 2014  |  Volume : 10  |  Issue : 8  |  Page : 307-309

The diagnostic value of serum carcino-embryonic antigen, alpha fetoprotein and carbohydrate antigen 19-9 for colorectal cancer


1 Department of Gastroenterology, Tianjin 4th Center Hospital, Tianjin 300140, China
2 Department of Clinical Laboratory, The People's Hospital of Wuqing, Tianjin 301700, China
3 Department of Clinical Laboratory, The Second People's Hospital of Tianjin, Tianjin 300192, China

Date of Web Publication17-Feb-2015

Correspondence Address:
Jian-Xia Yan
Department of Clinical Laboratory, The People's Hospital of Wuqing, Tianjin 301700
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.151538

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 > Abstract 

Objective: The aim of this study is to investigate whether or not serum carcino-embryonic antigen (CEA), alpha fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9) can be used as potential biomarkers for colorectal cancer (CRC) diagnosis.
Materials and Methods: Forty-six patients with pathology or cytology confirmed CRC and 36 cases with non-malignant colorectal disease (NMCD) were included in this retrospective study. The serum level of CEA, AFP and CA19-9 were arrayed and recorded for the two groups. The diagnosis sensitivity, specificity and area under the receiver-operating characteristic (ROC) curve for serum CEA, AFP and CA19-9 were calculated by the STATA-10.0 software.
Results: We found that serum CEA, AFP and CA19-9 level in CRC patients were significantly higher than in NMCDs cases (all P < 0.05). The diagnosis sensitivity of CRC for CEA, AFP and CA19-9 were 80.43%, 73.91% and 69.57%; the diagnosis specificity of CRC for CEA, AFP and CA19-9 were 75.00%, 69.44% and 61.11%. The areas under the ROC curves for CEA, AFP and CA19-9, were 0.88, 0.78 and 0.77 respectively.
Conclusion: These findings suggest that serum CEA, AFP and CA19-9 may be a useful biomarker for diagnosis of colorectal carcinoma against NMCD.

Keywords: Carbohydrate antigen 19-9, carcino-embryonic antigen, colorectal cancer, α-fetoprotein


How to cite this article:
Wang YR, Yan JX, Wang LN. The diagnostic value of serum carcino-embryonic antigen, alpha fetoprotein and carbohydrate antigen 19-9 for colorectal cancer. J Can Res Ther 2014;10, Suppl S4:307-9

How to cite this URL:
Wang YR, Yan JX, Wang LN. The diagnostic value of serum carcino-embryonic antigen, alpha fetoprotein and carbohydrate antigen 19-9 for colorectal cancer. J Can Res Ther [serial online] 2014 [cited 2020 Jun 1];10:307-9. Available from: http://www.cancerjournal.net/text.asp?2014/10/8/307/151538


 > Introduction Top


Colorectal cancer (CRC) is the fourth most commonly diagnosed solid carcinoma in the United States. In the year of 2012, about 143,460 cases of CRC were newly diagnosed. [1] It has been reported that the serum carcino-embryonic antigen (CEA), alpha fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9) were usually elevated in patients with CRC compared to healthy people. [2] Serum CEA, AFP and CA19-9 as a biomarker in the diagnosis of CRC have several advantages. [3] Firstly, the serum samples can easily get in CRC patients with mini invasive; secondly, these serum markers can be tested repeatedly; Thirdly, several biomarkers can be combined analysis for diagnosis. Here, we use the receiver-operating characteristic (ROC) curve to evaluate the efficacy of serum CEA, AFP and CA19-9 in diagnosis CRC.


 > Materials and methods Top


Patients

We screened the case files for the past 2 years in our hospital. Forty-six patients with pathology or cytology confirmed CRC and 36 cases with non-malignant colorectal disease (NMCD) were selected as retrospectively analyzed. The serum level of CEA, AFP and CA19-9 of the CRC and NMCD were recorded. In CRC group, the mean age was 61.2 ± 11.6 with 27 male cases and 19 female cases. In the NMCD group, the mean age was 56.8 ± 14.6 with 19 male cases and 17 female cases.

Statistical analysis

Statistical analysis was done by the STATA-10.0 (http://www.stata.com; Stata Corporation, College Station, TX) software package. The differences in levels of CEA, AFP and CA19-9 between CRC patients and NMCD subjects were compared using the Student's t-test. The feasibility of using CEA, AFP and CA19-9 as diagnostic tools for differentiating between malignant cases and non-malignant controls was assessed using the ROC curve analysis. [4]


 > Results Top


Serum level of carcino-embryonic antigen, alpha fetoprotein and carbohydrate antigen 19-9

The serum level of CEA, AFP and CA19-9 were 2.46 ± 1.24 μg/L, 3.57 ± 2.27 mg/L and 19.08 ± 5.67 × 10 3 U/L respectively in NMCD subjects and 8.84 ± 7.04 μg/L, 6.01 ± 2.95 mg/L and 33.97 ± 18.21 × 10 3 U/L respectively in colorectal patients [Table 1].
Table 1: The serum level of CEA, AFP and CA19 - 9 in colorectal cancer and NMCD

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Diagnostic sensitivity and specificity

For serum CEA, the diagnostic sensitivity and specificity were 80.43% and 75.00% at the cut-off point of 3.21 μg/L; for AFP, the diagnostic sensitivity and specificity were 73.91% and 69.44% at the cut-off point of 3.46 mg/L; for CA19-9 he diagnostic sensitivity and specificity were 69.57% and 61.11% at the cut-off point of 20.31 × 10 3 U/L.

The areas under the receiver-operating characteristic curves

The combined ROC curves were used to evaluate the performance of serum CEA, AFP and CA19-9 in detecting CRC. The areas under the ROC curve were 0.88, 0.78 and 0.77 for CEA, AFP and CA19-9 respectively [Figure 1].
Figure 1: Receiver-operating characteristic curve for evaluation the diagnostic value of serum carcino-embryonic antigen, alpha fetoprotein and CA19-9 in patients with colorectal cancer

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 > Discussion Top


Colorectal cancer is one of the most common types of malignant disease and remaining the leading cause of cancer-related death worldwide. [5],[6] Accurate diagnosis and proper monitoring of CRC patients remain important obstacles for successful cancer treatment. [7],[8],[9] For patients with early stage of CRC, the prognosis was relative well with the treatment of surgery. And for patients with advanced stage of CRC, the prognosis was relative poor with the treatment of chemoradiation. In the past few decades, the diagnosis and treatment for CRC have been well improved, but the prognosis of CRC was still not satisfactory. The main reason for the poor prognosis of CRC was due to lack of effective early diagnosis methods. Serum biomarkers as diagnosis tool were useful for tumor diagnosis. A number of tumor biomarkers, including CEA, AFP and CA19-9, had been extensively evaluated for their diagnostic value for CRC.

Carcino-embryonic antigen was one of the widely used biomarker for diagnosis of CRC. CEA is normally produced in gastrointestinal tissue during fetal development, but the production stops before birth. Therefore, CEA is usually present only at very low levels in the blood of healthy adults. However, the serum levels are raised in some types of cancer, which means that it can be used as a tumor marker in clinical tests. Serum from individuals with colorectal carcinoma often has higher levels of CEA than healthy individuals. [3] In our study, we find that the serum level of CEA in CRC patients were significant higher than that in NMCD subjects. And using serum CEA as a diagnostic tool, the diagnosis specificity, sensitivity were 80.43% and 75.00% respectively at the cut-off point of 3.21 μg/L.

Alpha fetoprotein is a major plasma protein produced by the yolk sac and the liver during fetal development. [10] Several articles reported that the serum level of AFP was elevated in patients with CRC. [11] We found that the serum level of AFP was higher in CRC group compared to NMCD group. But the diagnosis sensitivity and specificity was not high.

Carbohydrate antigen 19-9 also called cancer antigen 19-9 or sialylated lewis antigen is a tumor marker that is used primarily in the management of pancreatic cancer. [12] In our study, we found that the serum CA19-9 was also elevated in colorectal patients with the diagnosis sensitivity and specificity of 69.57% and 61.11% at the cut-off point of 20.31 × 10 3 U/L.


 > Conclusion Top


Serum level of CEA, AFP and CA19-9 were elevated in CRC patients compared to NMCD. And the diagnostic value of CEA, AFP and CA19-9 were acceptable according to this study. But considering the small number cases included and retrospectively study design, the conclusion should be confirmed by other well designed multiple center diagnostic trails.

 
 > References Top

1.
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.  Back to cited text no. 1
    
2.
Du M, Liu S, Gu D, Wang Q, Zhu L, Kang M, et al. Clinical potential role of circulating microRNAs in early diagnosis of colorectal cancer patients. Carcinogenesis 2014;35:2723-30.  Back to cited text no. 2
    
3.
Koness RJ. CEA: is it of value in colorectal cancer? R I Med 1995;78:164-6.  Back to cited text no. 3
    
4.
Hsieh PS, Changchien CR, Chen JS, Tang R, Chiang JM, Yeh CY, et al. Comparing results of preoperative staging of rectal tumor using endorectal ultrasonography and histopathology. Chang Gung Med J 2003;26:474-8.  Back to cited text no. 4
    
5.
Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin 2014;64:104-17.  Back to cited text no. 5
    
6.
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013;63:11-30.  Back to cited text no. 6
    
7.
Groblewska M, Mroczko B, Gryko M, Kedra B, Szmitkowski M. Matrix metalloproteinase 2 and tissue inhibitor of matrix metalloproteinases 2 in the diagnosis of colorectal adenoma and cancer patients. Folia Histochem Cytobiol 2010;48:564-71.  Back to cited text no. 7
    
8.
Ishida H, Iwama T, Tomita N, Koizumi K, Akagi K, Ishiguro M, et al. Diagnosis and management of hereditary colorectal cancer according to the JSCCR Guidelines 2012 for the clinical practice of hereditary colorectal cancer. Nihon Rinsho 2014;72:143-9.  Back to cited text no. 8
    
9.
Legolvan MP, Taliano RJ, Resnick MB. Application of molecular techniques in the diagnosis, prognosis and management of patients with colorectal cancer: A practical approach. Hum Pathol 2012;43:1157-68.  Back to cited text no. 9
    
10.
Bei R, Mizejewski GJ. Alpha fetoprotein is more than a hepatocellular cancer biomarker: From spontaneous immune response in cancer patients to the development of an AFP-based cancer vaccine. Curr Mol Med 2011;11:564-81.  Back to cited text no. 10
    
11.
Webb A, Scott-Mackie P, Cunningham D, Norman A, Andreyev J, O′Brien M, et al. The prognostic value of CEA, beta HCG, AFP, CA125, CA19-9 and C-erb B-2, beta HCG immunohistochemistry in advanced colorectal cancer. Ann Oncol 1995;6:581-7.  Back to cited text no. 11
    
12.
Shiozawa S, Tsuchiya A, Kim DH, Ogawa K. Prognostic significance of CA19-9 levels in patients with pancreatic cancer. Nihon Rinsho 2006;64 Suppl 1:297-300.  Back to cited text no. 12
    


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