Combined Determination of Serum CA 19-9 and Tissue Polypeptide Antigen: Why No Improvement in Pancreatic Cancer Diagnosis

Basso, Daniela; Fabris, Carlo; Favero, G. Del; Panucci, A; Plebani, Mario; Angonese, C.; Leandro, Gioacchino; Dodi, Giuseppe; Burlina, Angelo; Naccarato, R.

doi:10.1159/000226525

Cited by 16 publications

(9 citation statements)

References 6 publications

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“…Compro mised liver function, frequently found in patients with pancreatic cancer consequent to cholestasis and/or metastases, may increase the serum levels of these mark ers. This phenomenon, already described for CA 19-9 and TPA [5,[20][21][22][23][24], was also confirmed here forTPS. All three glycoproteins were found to be correlation with liver func tion tests, like ALT.…”

Section: Discussionsupporting

confidence: 89%

Clinical Utility of TPS, TPA and CA 19-9 Measurement in Pancreatic Cancer

Plebani

Basso²,

Favero³

et al. 1993

Oncology

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The aims of this study were to (1) evaluate the diagnostic utility of a new tumor marker, TPS, with respect to TPA and CA 19-9 in patients with pancreatic cancer; (2) ascertain the reliability of the markers in predicting survival, and (3) evaluate the effect of liver dysfunction on the results. CA 19-9, TPA and TPS were measured in the serum of 19 control subjects, 42 patients with pancreatic cancer, 29 with chronic pancreatitis, and 52 with extrapancreatic diseases. CA 19-9 was confirmed to be the best serological indicator of pancreatic cancer, while TPA and TPS lacked both sensitivity and specificity. Pancreatic cancer patients with liver metastases had higher mean C A19-9 and TPA, but not TPS, values than pancreatic cancer patients without metastases. A shorter survival time was associated with the presence of liver metastases and with higher serum tumor marker levels. CA 19-9, TPA and TPS were found to be correlated with liver function test results (ALT, ALP and bilirubin). In conclusion: (1) TPS adds no significant information to that obtained using CA 19-9 in the diagnosis of pancreatic cancer; (2) CA 19-9 and TPA, but not TPS, are influenced by the presence of liver metastases; (3) the main factor to influence survival is advanced disease, which is in turn associated with higher tumor marker levels, and (4) liver dysfunction can influence not only CA 19-9 and TPA, as already described, but also TPS.

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Section: Discussionsupporting

confidence: 89%

Clinical Utility of TPS, TPA and CA 19-9 Measurement in Pancreatic Cancer

Plebani

Basso²,

Favero³

et al. 1993

Oncology

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“…5 The presence of anatomical hepatic damage is a factor of great importance in influencing serum TPA; our group A patients had higher concentrations than group B.…”

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confidence: 60%

Serum tissue polypeptide antigen in pancreatic cancer and other gastrointestinal diseases.

Basso¹,

Fabris²,

Piccoli³

et al. 1989

Journal of Clinical Pathology

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Serum tissue polypeptide antigen in pancreatic cancer and other gastrointestinal diseasesTissue polypeptide antigen (TPA) is a glycoprotein produced by several tissues with keratin-like sites.' It possesses an excellent sensitivity for diagnosing pancreatic cancer2; in this neoplasm, as in other malignancies, it reflects tumour growth and extent.34 It is not specific, however, and raised TPA values have often been found in chronic pancreatitis and other inflammatory states.4The liver probably has a key role in influencing circulating TPA by two different mechanisms; (i) by releasing it from hepatic or metastatic cells into the bloodstream; and (ii) by decreasing its metabolism.We attempted to evaluate the influence of different types of liver damage on serum TPA in patients suspected of having a pancreatic malignancy. We studied 135 subjects: 32 controls (20 men, 12 women, aged 19-60); 23 affected by histologically confirmed pancreatic cancer ofduct cell origin (18 men, five women, aged 43-73) (16 had hepatic metastases); and 13 with chronic pancreatitis (12 men, one woman, aged 26-65) in whom the diagnosis was based on previously reported criteria.4 Sixty seven patients (43 men, 24 women, aged 23-81) had extra-pancreatic diseases including primary liver cell cancer (26 cases), gastric cancer (n = 3), carcinoma of the colon (n = 2), carcinoma of the hepatic hilus (n = 2), retroperitoneal sarcoma (n = 1), liver cirrhosis (n = 11), gallstones (n = 5), primary biliary cirrhosis (n = 3), irritable colon (n = 3), benign stenosis of the papilla of Vater (n = 2), duodenal ulcer (n = 2), erosive gastritis (n = 2), liver steatofibrosis (n = 1), chronic cholecystitis (n = 1), hiatus hernia (n = 1), ulcerative colitis (n = 1) and retroperitoneal haematoma (n = 1).The patients were divided into two groups: group A (n = 60) included those with anatomical liver damage (primary or metastatic cancers, cirrhosis, steatofibrosis) of whom 16

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“…The relationship found between CAR-3 and cholestasis, like that found for CA 19-9 [23], may explain why the levels of both markers, although not of pancreatic origin, are increased in particular in patients with pancratic neoplasia and biliary tract diseases. These diseases, in fact, show a higher frequency of obstructive jaundice than any other type of gastrointestinal disease.…”

Section: Discussionmentioning

confidence: 63%

“…First, its sensitivity in patients with pancreatic cancer is about 75-80%, negative findings are obtained in 25-20% cases, espe cially when the disease is at an early stage [22]. Second, the presence of jaundice greatly influences the levels of this marker, probably interfering with its catabolism [23]. Like CA 19-9, CAR-3 is an epitope expressed on a mucin-like protein [24], However, although the structure of CAR-3 is similar to that of CA 19-9, the two markers have been isolated from different cell lines.…”

Section: Discussionmentioning

confidence: 99%

Does Serum CAR-3 Play a Role in Pancreatic Cancer Diagnosis?

Basso¹,

Panozzo²,

Fabris³

et al. 1991

Oncology

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A new tumour marker, CAR-3, was isolated using the monoclonal antibody technique and measured in the sera of 27 patients with pancreatic cancer, 25 chronic pancreatitis, 30 extra-pancreatic diseases and in that of 18 healthy controls in order (1) to evaluate the diagnostic role of CAR-3 in patients with pancreatic cancer and (2) to ascertain whether liver dysfunction influences CAR-3 serum levels. The increased levels were found in 12/27 patients with pancreatic cancer (sensitivity 44.4%). No increase was found in patients with chronic pancreatitis, whereas abnormal levels were found in patients with other gastrointestinal diseases, especially those of the liver and biliary tract. Correlations were found between serum CAR-3 and (1) total bilirubin and (2) alkaline phosphatase. In conclusion, CAR-3, an antigen structurally related to CA 19–9, does not appear to be accurate enough to be considered a tumour marker. Cholestasis seems to increase CAR-3 levels as well as those of other glycoproteic tumour markers, probably by interfering with the hepatic clearance of these substances.

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Combined Determination of Serum CA 19-9 and Tissue Polypeptide Antigen: Why No Improvement in Pancreatic Cancer Diagnosis

Cited by 16 publications

References 6 publications

Clinical Utility of TPS, TPA and CA 19-9 Measurement in Pancreatic Cancer

Clinical Utility of TPS, TPA and CA 19-9 Measurement in Pancreatic Cancer

Serum tissue polypeptide antigen in pancreatic cancer and other gastrointestinal diseases.

Does Serum CAR-3 Play a Role in Pancreatic Cancer Diagnosis?

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