| Background and ObjectiveCA 19-9 is one of the tumor relevant antigens most widely used in the clinical diagnosis, with its serum value of less than 37 KU/L being clinically significant. It has been demonstrated that CA 19-9 is valuable for the detection of pancreatic carcinoma by many studies, with its sensitivity of more than 90%, accuracy around 80% and lower specificity of about 75%. The increased level of CA 19-9 varied with different digestive diseases, such as benign diseases of pancreatic and biliary tract, of malignant gastroenteral tract. At present, the information about the value of CA 19-9 in different digestive diseases, in different phases of pancreatic and biliary malignancies, and in the different samples, such as serum, bile and pure pancreatic juice, is still limited. Due to its great significance in the early and differential diagnoses of digestive diseases, we carried out this study to discern these problems.Methods:A total of 794 cases of digestive diseases were selected from in-patients of Changzheng and Changhai hospitals from January 2000 to December 2004, with 522 malignant tumors (298 pancreatic cancer, 98 biliary cancer, 60 gastric cancer and 66 liver cancer), 272 benign digestive diseases (50 acute pancreatitis, 54 chronic pancreatitis, 138 stone of biliary tract and 30 peptic ulcer).111 control cases were selected from normal checkup population simultaneously. Serum CA 19-9 concentration was measured automatically(Chiron ACS: 180SE) in two hospitals. Other data, such as clinical documents, lab results, pathology, were gathered and managed statistically by chi-square test for qualitative data, Student's t test for quantitative data.Results:1 , Role of CA 19-9 in the diagnosis of pacreatic cancer: No marked difference between male and female (85.82% vs 75.75%; P>0.05), among different ages(age≥ 50, 50-60, 60-70, >70, values 76.19% vs 77.41%,79.76%, 84.54%, P>0.05), between adenocarcinoma and non-adenocarcinoma (80.76% vs 80.00%; P>0.05) were detected. No relationship was found between CA19-9 concentration and tumor location. The concentration of CA 19-9 was positively proportional to tumor size, reduced statistically after surgery and chemotherapy (77.77% vs 57.40%; 75.00% vs 55.76%; P<0.05). CA19-9 concentration in stage I pathologically diagnosed was clearly distinct from stage III and IV(53.33% vs 78.57%, 77.50%; P<0.05). However,no apparent difference was revealed among stage IK III and IV(80.00%> 78.57°/^ 77.50%; P>0.05).2-. Relationship between CA19-9 and treatment effect and prognosis of pancreatic cancer: Surgical resection rate of pancreatic cancer was inversely varied with CA19-9 concentration. CA19-9 fluctuated 6 months earlier than other diagnostic index (USG or CT scan) after operation or chemotherapy in responsive patients. The increased CA 19-9 level usually indicated progressive phase of malignancy, and decreased trend predicted better effect. It was recognized that the increased degree of CA 19-9 was related to the postoperative outcome, that it is of significant importance of monitoring serum CA19-9 periodically in evaluating therapy and prognosis.3 n Role of CA19-9 in discrimination between benign and malignant diseases: No difference was found between benign digestive diseases (biliary and pancreatic diseases excluded) and normal controls (0% vs 0%; P>0.05). But the distinct difference exists between the pancreaticobiliary disease group and the non-pancreaticobiliary disease group(28.92% vs 0%; PO.05); Compared with the other sites carcinomas, the CA19-9 positive rate was much higher in pancreaticobiliary cancers. However, no clear difference was detected between pancreatic cancer and biliary cancer (80.53% vs 75.51%; P>0.05), between gastric cancer and acute pancreatitis(10% vs 10%; P>0.05), and liver cancer and stone of hepatic duct(57.58% vs 42.11%; .P>0.05). If the demarcation value of CA 19-9 between the negative and positive was elevated to a proper level, the specificity of CA 19-9 could be raised obviously without the significant decrease of the sensitivity of CA 19-9. With the 100KU/L demarcation value of serum CA 19-9, the discriminating capacity was the most valuable between the pancreatic cancer and liver cancer(the sensitivity 74.16%, specificity 71.21%, accuracy 73.62%), and between the pancreatic cancer and gastric cancer(the sensitivity 74.16%, specificity 93.33%, accuracy 77.37%); In addition, at a cutoff value of 100 KU/L, the differences were most significant between the pancreatic cancer and chronic pancreatitist (the sensitivity 74.16%, specificity 77.78%, accuracy 74.71%) and between the pancreatic cancer and stone of common bile duct (the sensitivity 74.16%, specificity 82.35%, accuracy 76.49%). Under the icterus condition, the discriminating value of CA 19-9 was limited between the biliary cancer and stone of common bile duct.4> The diagnostic value of the elevated serum CA 19-9 level in the diseases of pancreatic and biliary system. For the discriminating value of CA 19-9 between benign and malignant disease, it was significantly greater for pancreatic cancer than for biliary cancer. With cholangitis or cholestasis, the discriminating value of the elevated serum CA 19-9 levels was limited for biliary cancer, the specificity of CA19-9 were lower (41.5%). CA19-9 in diagnosing pancreatic cancer was useful regardless of accompanying acute pancreatitis or cholestasis. The use of CA19-9 for the differentiation of pancreaticobiliary cancer should be applied individually, depending on the clinical situation.5^ The diagnostic value of the bile and pure pancreatic juice CA 19-9 level: the study showed that no clear difference was detected in the pure pancreatic juice between pancreatic cancer and chronic pancreatitis (P>0.05), its discriminatingvalue wasn't approved. For the bile and pure pancreatic juice, their discriminating value of the CA 19-9 levels was limited between benign and malignant disease of pancreaticobiliary system.Conclusions1 -, The specificity and sensitivity of CA 19-9 is higher in diagnosing pancreatic carcinoma. The concentration of serum CA 19-9 had relations with tumor sizes pathological stage, surgical resection and chemotherapy, but had no relations with the patients'age, sex> pathology and tumor localization.2, The possibility of surgical resection of pancreatic cancer is significantly associated with serum CA 19-9 concentration. Continual measurement of CA 19-9 plays an important role in estimating prognosis and response to treatment of patients with pancreatic resection > radiotherapy and chemotherapy.3> CA 19-9 is effective in differential diagnosis between benign and malignant diseases of digestive system, and the continual measurement is even more significant. If the demarcation value of C A 19-9 was elevated properly, the specificity of C A 19-9 could be raised obviously without the significant decrease of the sensitivity of CA 19-9.4n The diagnostic value of the elevated serum CA 19-9 in pancreatic diseases is superior to its use in biliary diseases.5^ The differential ability of CA 19-9 taken from serum,pure pancreatic juice, to distinguish benign from malignant, is limited. |
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