Diagnostic value of combined detection of CA72-4, CA19-9, and carcinoembryonic antigen comparing to CA72-4 alone in gastric cancer: a systematic review and meta-analysis

Abstract

Background Gastric cancer (GC) is one of the most common malignant tumors in humans. Carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and CA72-4 are all serum tumor markers for diagnosis of gastric cancer. However, the results of studies reporting the diagnosis of the combined three varied. In this study, the combined diagnostic performance of these 3 serum tumor markers was systematically evaluated. Methods PubMed, Embase, The Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang data were searched for literature on serum tumor markers CEA, CA19-9, and CA72-4 in the diagnosis of gastric cancer. The inclusion criteria were designed according to the Participants, Intervention, Control, Outcomes, Study (PICOS) principles. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) scoring scale was used to assess the quality of the literature. After extracting the data, Stata 16.0 software was used for meta-analysis. Results A total of 10 articles were finally included, and a total of 6,574 patients participated in diagnosis, 3,077 for confirmed GC and 3,497 for non-GC respectively. Meta-analysis results showed that the diagnostic sensitivity of the combined diagnosis of the 3 tumor markers was 0.67 [95% confidence interval (CI): 0.54, 0.77], the specificity was 0.89 (95% CI: 0.82, 0.93), the positive likelihood ratio was 5.9 (95% CI: 3.5, 9.8), the negative likelihood ratio was 0.38 (95% CI: 0.27, 0.53), and the diagnostic odds ratio (DOR) was 16 (95% CI: 8, 32). The diagnostic sensitivity of CA72-4 diagnosis alone was 0.58 (95% CI: 0.40, 0.73), specificity was 0.86 (95% CI: 0.80, 0.90), the positive likelihood ratio was 4.0 (95% CI: 3.1, 5.1), the negative likelihood ratio was 0.49 (95% CI: 0.34, 0.71), and the DOR was 8 (95% CI: 5, 14). The area under the ROC curve (AUC) values of the combined three diagnosis and CA72-4 diagnosis alone were 0.87 (95% CI: 0.83, 0.89) and 0.84 (95% CI: 0.81, 0.87), respectively, the difference was statistically significant (Z=4.86, P<0.05). Discussion The combined use of the 3 tumor markers has higher sensitivity and specificity than single marker diagnosis in the diagnosis of gastric cancer.

Global progress and future prospects of early gastric cancer screening

“…The diagnostic performance of carbohydrate antigen 72-4 (CA72-4), a mucin-like glycoprotein with a high molecular weight, is slightly superior to that of other conventional serological tumor markers for identifying gastric cancer 98 . A meta-analysis demonstrated that, among the single serological indicators for identifying gastric cancer, CA72-4 had the greatest diagnostic efficacy, with a sensitivity and specificity of 49% and 91%, respectively 99 . In the detection of progressive gastric cancer, the positivity rate of CA72-4 is almost double that of CA19-9 (37.5% versus 17.9%) 100 .…”

Linking dysbiosis to precancerous stomach through inflammation: Deeper than and beyond imaging

“…Overall, the most frequently used in clinical practice are the serum markers carcinoembryonic antigen (CEA), a glycoprotein, and carbohydrate antigen (CA)19-9, both found overexpressed in GC (193). However, these proteins, as well as other common markers such as alpha-fetoprotein, CA125 and CA72-4, lack sensitivity and sensibility, with the combined detection of CEA, CA19-9 and CA72-4 presenting greater diagnostic value (194)(195)(196). The most assessed biomarkers targeting earlier stages of gastric carcinogenesis, namely AG include serum pepsinogen (PG) levels, gastrin, and anti-H. pylori antibody detection (197).…”

Can Nano Yield Big Insights? Oligonucleotide-Based Biosensors in Early Diagnosis of Gastric Cancer

“…Despite their prevalence, supported by 95% to 99% accuracy [2,16], these methods are hindered by time-consuming processes, high cost and a dependency on sophisticated instrumentation and skilled personnel [11,17]. Furthermore, protein biomarkers detected in such tests often lack adequate specificity [4] and sensitivity [18].…”