The Value Of Tumor Markers In The Differential Diagnosis Of Benign And Malignant Ascites

Objective:To evaluate the value of the differential diagnosis of benign and malignant ascites of four tumor markers, CEA, AFP, CA125and CA19-9, in serum and ascites and their ratio(F/S).Methods:We collected the expression levels of tumor markers in serum and ascites from91patients with ascites. All the cases had been made a definite diagnosis, including61malignant ascites and30benign ascites. The tumor markers such as CEA,AFP, CA125and CA19-9were measured by electrochemi-luminescence immunoassay(ECLI). The study was a retrospective analysis, using SPSS19.0software for statistical analysis, P<0.05.Results:1. CEA in serum and ascites, the ratio (F/S) of CEA, the ratio (F/S) of AFP, CA125in ascites, the ratio (F/S) of CA125, CA19-9in ascites and the ratio(F/S) of CA19-9of the patients with malignant ascites were significantly higher than that in patients with benign ascites(P<0.05). AFP, CA125, CA19-9in serum and AFP in ascites made no significant differences between the two groups (P>0.05).2. The areas under the ROC curve of CEA in serum, CEA in ascites, the ratio(F/S) of CEA, the ratio(F/S) of AFP, CA125in ascites, the ratio (F/S) of CA125, CA19-9in ascites and the ratio (F/S) of CA19-9were0.634,0.840,0.870,0.723,0.702,0.723,0.699,0.811. CEA in ascites, the ratio (F/S) of CEA, CA19-9in ascites, the ratio (F/S) of CA19-9, these four indicators in diagnosis of malignant ascites showed a sensitivity of67.2%,68.9%,50.8%,77.0%, a specificity of100%,93.3%,100%,83.3%, and an accuracy of0.672,0.622,0.508,0.603. CEA in ascites, the ratio (F/S) of AFP, CA125in ascites, the ratio(F/S) of CA125, showed the sensitivity of41.0%,83.6%,80.3%,70.5%.3. The combined measurement of CEA, CA125, CA19-9in ascites for malignant ascites showed a sensitivity of95.1%, signifi-cantly higher than merely detecting CEA in ascites or CA19-9in ascites or CA125in ascites(P<0.05);The combined measure-ment of the ratio(F/S) of CEA, AFP, CA125, CA19-9for malignant ascites also showed a high sensitivity of95.1%, significantly higher than the four indicators tested independently(P<0.05). When taking the detection value with a specificity of100%as the positive cutoff,the combined measurement of CEA,CA19-9, CA125in ascites, the ratio (F/S) of CEA, AFP, CA125, CA19-9, showed a sensitivity up to82.0%.4. The levels of AFP in serum and ascites in ascites due to hepatocellular carcinoma were higher than that in benign ascites (P<0.01). The areas under the ROC curve were0.845and0.836. The sensitivity, specif icity and accuracy were72.7%,93.3%,0.660and72.7%,93.3,0.627for the diagnosis of malign-ant ascites caused by hepatocellular carcinoma(positive value:AFP in serum(173.200ng/ml);AFP in ascites (24.735ng/ml)).5. The levels of CEA in serum and ascites in the malignant ascites due to tumors of digestive system were significantly higher than that in the malignant ascites due to gynecologic oncology (P<0.01).Conclusion:1. CEA in ascites, the ratio(F/S) of CEA, CA19-9in ascites and the ratio(F/S) of CA19-9had a better value for the differential diagnosis of benign and malignant ascites than AFP and CA125.2. The combined measurement of CEA, CA125, CA19-9in ascites and the combined measurement of the ratio(F/S) of CEA, AFP, CA125, CA19-9could improve the positive value of the diagnosis of malignant ascites.3. AFP in serum and ascites both had an important diagnostic value for malignant ascites caused by hepatocellular carcinoma.4. CEA in serum and ascites in the diagnosis of malignant ascites due to tumors of digestive system, had a better value than that of malignant ascites due to gynecologic oncology.