Exploring The Value Of Combined Detection Models Of CEA+CA72-4+CA19-9 And PGⅠ,PGⅡ Or PGR In The Early Diagnosis Of Gastric Carcinoma

Gastric carcinoma is the most common malignant tumor in the world,the disease has no specific symptoms in the early stage.Most of gastric carcinoma cases were diagnosed in the middle or the late stage of the disease,the overall prognosis is very poor,which seriously threatens human being’s health.Therefore,to make a definite diagnosis as to take positive treatment measures as soon as possible.This has a vital impact on the prognosis of patients who are suffering from gastric carcinoma.At present,the most accurate method to diagnose gastric carcinoma is gastroscopy.Admittedly,with the progress of medical condition,gastroscope has been widely used in our country at all levels of hospitals.But,as is known to all,gastroscopy is an invasive detection,preoperative preparations,such as gastrointestinal preparation and the well cooperation between operators and patients,are very important.All these make huge limitations to its application in the clinical.Moreover,routine gastroscopy is not suitable for census and following-up.In recent years,with the rapid development of medical technology,serum tumor markers have been widely used in the clinical owing to three sharp advantages: rapid,simple and non-invansive.The ideal tumor markers should have the following characteristics: high sensitivity,early detection of tumor patient;high specificity,can accurately identify the patients with or without carcinoma;high organ specificity,conducive to locating the organs of the tumor;the serum tumor makers level also should parallel with the degree of tumor progression and clinical staging.They can reflect the dynamic changes of tumor growth,the efficacy of medical treatments,recurrence and metastasis.At present,the tumor markers which have been widely used in the early diagnosis of gastric carcinoma are AFP(alpha fetoprotein)、NSE(2-phospho-D-glycerate hydrolase)、CEA(carcinoembryonic antigen)、 CA72-4((carbohydrate antigen 724)、CA153((carbohydrate antigen 153)、SCC(squamous cell carcinoma antigen)、CA19-9(carbohydrate antigen199)、PSA(prostate specific antign)、CA50(carbohydrate antigen50)及 CA24-2(carbohydrate antigen 242)。But up to now,no such single or several tumor markers have been found to diagnose gastric carcinoma in clinical practice.In the clinical work,the application of serum tumor markers has been widely developed.We have also found some tumor markers with high diagnostic sensitivity for gastric carcinoma.Among all those tumor markers,CEA,CA72-4,CA19-9,CA50 and CA24-2 have been proved their value in the early diagnosis of gastric carcinoma after extensive scientific verification and clinical practice,but they have not been able to meet with the demands of high sensitivity and specificity.In recent years,using the pepsinogen as new tumor marker has been scientifically validated.It can also be used as a marker to diagnose gastric carcinoma.The serum pepsinogen was divided into PGⅠ and PGⅡ,according to the different immunological activitiey.At the same time,the ratio of PGⅠ to PGⅡ,PGR is also used as an important index for the diagnosis of gastric carcinoma.Exploring the value of combined detection models of CEA+CA72-4+CA19-9 and PGⅠ,PGⅡ or PGR in the early diagnosis of gastric carcinoma.Objective: To study the value of combined detection of tumor markers CEA,CA72-4,CA19-9,CA72-4 and CA50 in the early diagnosis of gastric carcinoma and find a most effective combined detection model,then combine the most effective model with pepsinogen(PGⅠ,PGⅡ,PGR),to make an elevation in early diagnosis rate of gastric carcinoma and provide reference for clinical diagnosis and treatment.Methods 90 patients with gastric carcinoma who were treated in the Shanghai Seventh People’s Hospital of Shanghai University of TCM were selected from January 2016 to December 2016 as the experimental group,and in addition 90 normal persons who received physical examination,including gastroscope examination,during the same period were selected as control group.The serum level of CEA,CA72-4,CA19-9,CA50 and CA24-2 was detected by Auto Immunoassay Analyzer(Cobas e601).The sensitivity and specificity of the single detection and combined detection were analyzed.Find a most effective combined detection model.In the next stage,80 cases of patients with gastric carcinoma who were treated in Shanghai Seventh People’s Hospital of Shanghai University of TCM and the Renji Hospital affiliated to Shanghai Jiaotong University from January 2017 to December 2017 were selected as the experimental group.In addition,80 cases of normal persons who received a physical examination,including gastroscope examination,during the same period were selected as the control group.The serum levels of CEA,CA72-4,and CA19-9 were analyzed by Auto Immunoassay Analyzer(Cobas e601).And the expression level of PGⅠ and PGⅡ in serum was detected by enzyme-linked immunosorbent assay(Beckman AU5800).The sensitivity and specificity of the single detection and combined detection were analyzed.Results: In the first part,the sensitivity and specificity of single tumor marker detection in the diagnosis of gastric carcinoma: the highest sensitivity of a single tumor marker was CEA,the highest specificity of a single tumor marker was CA19-9.The sensitivity and specificity of combination of random two tumor markers detection in the diagnosis of gastric carcinoma: the highest sensitivity of combination of random two tumor markers was CEA+CA19-9,the highest specificity of combination of random two tumor markers was CA72-4+CA19-9.The sensitivity and specificity of combination of random three tumor markers detection in the diagnosis of gastric carcinoma: the highest sensitivity of combination of random three tumor markers was CEA+CA72-4+CA19-9,the highest specificity of combination of random three tumor markers was CEA+ CA72-4+CA19-9.The sensitivity and specificity of combination of random four tumor markers detection in the diagnosis of gastric carcinoma: the highest sensitivity of combination of random four tumor markers was CEA+CA72-4+CA19-9+CA50,the highest specificity of combination of random three tumor markers was CEA+ CA72-4+CA19-9+CA50.The sensitivity of all five tumor markers combined detection was 61.11%,the specificity of all five tumor markers combined detection was 61.11%,and the differences were statistically significant.The sensitivity and specificity of combination of random four tumor markers detection in the diagnosis of gastric carcinoma is slightly higher than combination of random three tumor markers detection(2.22%),the sensitivity and specificity of all five tumor markers detection in the diagnosis of gastric carcinoma is also slightly higher than combination of random three tumor markers detection(3.33% and 2.22%),but the elevation of the sensitivity and specificity between combination of random four tumor markers detection or all five tumor markers combined detection and combination of random three tumor markers detection was not significant.In the second part,the Serum CEA,CA72-4 、CA19-9 、PGⅡ levels were higher in the experimental group than the control group,but the serum PGⅠ and PGR levels were lower than the control group.The highest sensitivity of a single tumor marker detection in the diagnosis of early gastric carcinoma is PGR,the highest specificity is CEA.The highest sensitivity of random combination of PGⅠ,PGⅡ and PGR was PGⅠ+PGR,the highest specificity of random combination was PGⅠ+PGR.The highest sensitivity of combination detection models of serum CEA+CA72-4+CA19-9 with random single index of PGⅠ,PGⅡ or PGR was CEA+CA72-4+CA19-9+PGR.The highest specificity of combination detection models of serum CEA+CA72-4+CA19-9 with random single indices of PGⅠ,PGⅡ or PGR was CEA+CA72-4+CA19-9+ PGⅠ.The highest sensitivity of combination detection models of serum CEA+CA72-4+CA19-9 with random two indices of PGⅠ,PGⅡ or PGR was CEA+CA72-4+CA19-9+ PGⅠ+PGR.The highest specificity of combination detection models of serum CEA+CA72-4+CA19-9 and random two indices of PGⅠ,PGⅡ and PGR was CEA+CA72-4+CA19-9+ PGⅠ+PGR.Conclusion In the first part,among all the different combinations of CEA,CA50,CA24-2,CA19-9 and CA72-4,the most effective combination in diagnosing of early gastric carcinoma was as follows: all five tumor markers combined detection superior to random 4 combinations,random 4 combinations superior to random 3 combinations,random 3 combinations superior to random 2 combinations,random 2 combinations superior to single detcection.The highest sensitivity and specificity of combination of random three tumor markers was CEA+CA72-4+CA19-9,but its ensitivity and specificity in early diagnosis of gastric carcinoma were still not meet up with satisfactory.In the second part,the CEA,CA72-4,CA19-9 and PGⅠ,PGⅡ,and PGR expression levels are closely related to the occurrence and progression of gastric cancer.Combined detection especially the combined detection of CEA+CA72-4+CA19-9+PGⅠ+PGR has higher sensitivity and specificity,which can reduce the misdiagnosis rate and missed diagnosis rate of early gastric carcinoma,and facilitate early clinical development.Interventions are worthy of clinical promotion.