The Value Of Serum Tumor Markers Combined With Bile Acid Detection In The Diagnosis Of Gastric Cancer

Objective:Gastric cancer is the most common malignant tumor of the digestive tract.Although people have made great efforts in the diagnosis and treatment of gastric cancer,there are still a large number of gastric cancer patients who are diagnosed with advanced or metastatic gastric cancer.Early detection of gastric cancer remains a great challenge due to the lack of specific detection methods.Non-invasive biomarkers are increasingly used in clinical practice,which can predict and monitor tumor dynamics in real time.There have been many studies to find accurate serum and tumor biomarkers to detect gastric cancer,but there are still no recommended tumor biomarkers to diagnose gastric cancer.Our research aims to explore the value of serum tumor markers（CEA,CA19-9,CA72-4）and bile acid（TBA）in the diagnosis of gastric cancer,and provide a new reference for the diagnosis and treatment of early gastric cancer in clinical work.Methods:From July 1,2019 to July 1,2021,the clinical data of 842 patients with gastric cancer who underwent surgical treatment and lymph node dissection in the Affiliated Hospital of Qingdao University.The age,gender,degree of tumor differentiation,lymph node metastasis and serum CEA,CA19-9,CA72-4,TBA test results were collected.The control group consisted of 834 outpatients in the Affiliated Hospital of Qingdao University who underwent gastroscopy and other imaging examinations during the same period,excluding those who had malignant tumors and were comparable in age and sex.The chi-square test was used for the comparison of count data（P<0.05）;the Wilcoxon rank sum test was used for the comparison of non-normally distributed measurement data（P<0.05）,M(P₂₅～P₇₅);the comparison of multiple continuous independent samples was Kruskal-Wallis H test（P<0.05）,and post hoc test for groups with statistical significance.The correlation between CEA,CA19-9,CA72-4,and TBA in the diagnosis of gastric cancer was analyzed using binary logistic regression and regression equations were established;The ROC curve was used to analyze the diagnostic value of CEA,CA19-9,CA72-4 and TBA over 4 times in the diagnosis of gastric cancer and the predictive value of lymph node metastasis.Diagnostic value,and the predictive value of CEA,CA19-9,CA72-4 and TBA alone and combined detection as diagnostic indicators of gastric cancer.Results:The levels of serum CEA,CA72-4,and TBA in the gastric cancer group were significantly higher than those in the control group（P<0.01）.There were differences between high levels（P<0.01）,and when the increase was less than or equal to 1 times,the proportion of gastric cancer patients in the control group was significantly higher than that in the gastric cancer group.It is suggested that the levels of serum CEA,CA72-4 and TBA have certain value in the diagnosis of gastric cancer.CEA increased by more than 4times,CA19-9 increased by 1 to 2 times,2 to 4 times,and more than 4 times,CA72-4increased by 1 to 2 times,2 to 4 times,and more than 4 times,TBA increased by 1 to 4times 2 times,2 to 4 times,the proportion of gastric cancer patients in the gastric cancer group was significantly higher than that in the control group.At these elevated levels,serum CEA,CA19-9,CA72-4 and TBA have certain value in the diagnosis of gastric cancer,especially when CEA,CA19-9 and CA72-4 increase more than 4 times.There was no statistical significance in serum CEA,CA19-9,CA72-4,TBA levels and elevation in gastric cancer group with different degrees of differentiation.Serum CEA,CA19-9,CA72-4 and TBA have little reference value in the degree of differentiation of gastric cancer.Serum levels of CEA,CA19-9,and CA72-4 in the group with lymph node metastasis were significantly higher than those in the group without lymph node metastasis（P<0.01）,and the proportion of patients with lymph node metastasis was at different elevated levels of serum CEA,CA19-9 were significantly higher than the proportion of patients without lymph node metastasis（P<0.01）;gastric cancer with and without lymph node metastasis had no statistical significance in serum CA72-4 and TBA at different elevated levels（P>0.05）.Serum CEA,CA19-9,and CA72-4 have certain reference value for whether gastric cancer has lymph node metastasis,but when the serum CEA,CA19-9,CA72-4,and TBA levels increase by more than 4 times,they have predictive value for whether gastric cancer has lymph node metastasis not big.The sensitivity of combined detection of serum CEA,CA19-9,CA72-4,and TBA was higher than that of single detection,and the combined detection of the four indexes had the highest sensitivity.In the ROC curve,the maximum area under the curve（AUC）of CEA,CA72-4 and TBA joint detection is 0.626.The diagnostic value of single and combined detection is not high for gastric cancer.Conclusion:（1）The value of serum CEA,CA19-9,CA72-4 and TBA in the diagnosis of gastric cancer was not high,but it was significant only when CEA,CA19-9 and CA72-4increased more than 4 times.（2）The levels and elevated degrees of serum CA19-9,CA72-4 and TBA have little reference value for the degree of differentiation of gastric cancer.（3）Serum CEA and CA19-9 levels have little diagnostic value for gastric cancer with lymph node metastasis,and the diagnostic value is still low when the level is more than 4 times higher.（4）The sensitivity and diagnostic value of serum CEA,CA19-9,CA72-4 and TBA alone or in combination for gastric cancer are not high.