How To Explore An Elevated Serum CA19-9 In General Health Examination Population

Aim:In order to evaluate the causes of elevated serum CA19-9 levels in general health examination population and to provide appropriate guidelines for the clinical application.Methods:To evaluate the etiology, we enrolled consecutive general health examination patients between June 2008 and December 2008, selected the patients who had elevated serum CA 199 levels (CA19-9>37 U/ml),And the CA 199 level was monitored and further examination were carried out. During the follow-up, If the malignancy was detected or the serum CA 19-9 level decreased to the normal range, then the follow-up was stopped. However,if the serum CA19-9 level showed an abnormally or increasing trend,then the level was monitored until one year. Special treatment to benign diseases diagnosed during the follow-up,and take statistical analysis to the causes of elevated serum CA 199 levels according to the follow-up results.Results:â‘ Of the 33867 patients,1.7%(572/33867) subjects showed an elevated CA19-9 level,there were significant differences between males and females (P=0.001).â‘¡We followed up the 89.0%(509/33867) patients.1.8%(9/509)patients were diagnosed with malignancies,there were 4 pulmonary carcinoma,2 pancreatic cancer,2 hepatoma and 1 colon carcinoma.jointed multi tumor markers had more value in the diagnosis of malignancy (P=0.008), there were significant differences in serum CA19-9 levels between malignancy and non-malignancy (P=0.027).65.8%(335/509) patients with elevated CA19-9 were decreased to the normal range,defined as declined group, benign diseases 65.8%(175/335) and non-specific patients 52.2%(160/335).leaving 32.4% (165/509) patients their CA 199 level showed an non-decresed,difined as elevated group, including 64.2%(106/165)benign diseases and 35.8%(59/165) non-specific patients.between the declined group and elevated group,there were not significant differences between sex and serum CA19-9 levsls(P< 0.05). ut in benign diseases and non-specific patients, significant differences was seen in sex (P< 0.05),in declined group, between benign diseases and non-specific patients, significant differences was seen in serum CA19-9 levsls(P=0.002),but in elevated group,there were not significant differences (P=0.064).In the two benign diseases,we couldn't see significant differences in sex and serum CA19-9 levsls (P> 0.05),but in two non-specific patients,there were significant differences in serum CA19-9 levsls (p=0.001).â‘¢Hepato-biliary and female reproductive system diseases are more common in benign diseases which correlated with elevated serum CA 199 levels,including fatty liver,chronic cholecystitis with cholelithiasis,chronic viral hepatitis, hysteromyoma,ovarian cyst,teratoma, diabetes type 2,Hashimoto's thyroiditis,chronic bronchitis,chronic colitis with colonic polyps. In fatty liver patients, there were significant differences between hypohepatia and elevated serum CA 199 levels(P=0.004).In chronic viral hepatitis, where were significant differences in HbeAg,HBV-DNA and elevated serum CA 199 levels(P< 0.05).Conclusions:The prevalence of malignant diseases is only 1.8% in elevated serum CA19-9 patients with general health examination, CA19-9 is not a perfect tool used in early diagnosis of malignancies in General health examination patients. A lot of benign diseases especially Hepato-biliary and female reproductive system diseases (fatty liver25.3%, chronic cholecystitis with cholelithiasis 13.9%,chronic viral hepatitis 13.9%, hysteromyoma8.2% et al) can cause the elevated of serum CA19-9.Necessary imaging examination and multiple tumor markers can be jointed in clinical work.