The clinical validity of circulating tumor-associated antigens CEA and CA 19-9 in primary diagnosis and follow-up of patients with gastrointestinal malignancies

Abstract

The clinical validity of monitoring the tumor markers carcinoembryonic antigen (CEA) and CA 19-9 were investigated in 602 patients with colorectal, gastric, and pancreatic carcinomas. Sensitivity and specificity of the tests were evaluated preoperatively as well as in the postoperative follow-up for early detection of disease progression and recurrence. At a 95% level of specificity as calculated from a group of 150 patients with benign diseases, the CEA test with monoclonal antibody had a preoperative sensitivity of 39% in colorectal cancer and 21% in gastric cancer. On the other hand, CA 19-9 had a sensitivity of 19% in colorectal cancer, 21% in gastric cancer, and 89% in pancreatic cancer. In the postoperative follow-up it was found that a combination of both tumor marker tests was most profitable in gastric carcinomas, yielding an increase of sensitivity from 59%-94%, showing a high degree of complementarity. The gain in sensitivity provided by the CA 19-9 test over the CEA-test in colorectal cancer was very low. The gain in sensitivity, however, provided by the CEA test over the CA 19-9 test in pancreatic carcinoma was also very low. On the basis of these results it has to be recommended that cases with pancreatic carcinoma are to be monitored most efficiently with the CA 19-9 test, whereas in cases with colorectal cancer the CEA test should be used primarily. However, in gastric cancer the combined use of CEA and CA 19-9 represents a highly valuable basis for monitoring the course of disease.

Tissue concentrations of CEA and CA 19-9 in the carcinogenesis of colorectal carcinoma exemplified by the adenoma-carcinoma sequence

“…A similar tendency was also seen in the case of the carcinomas, but the small number of cases, here, has to be considered. These findings might be explained simply by the known fact that CA 19-9 in colorectal neoplasias has a lower sensitivity than has been shown in the case of CEA [3]. The determination of the Lewis blood group substances excluded a conceivable influence on our results by Lea'b-negative patients who, as is known, owing to a lack of glucosyltransferase, can never synthesize CA 19-9 [25].…”

“…The clinical significance of the two tumor-associated antigens, carcinoembryonic antigen (CEA) and CA , is largely to be seen in postoperative monitoring and the assessment of the efficacy of treatment [1][2][3]. They can contribute to the early diagnosis of gastrointestinal carcinomas at most in this or the * Supported by the Wilhelm-Sander-Stiftung, Neustadt/Donau (FRG) other individual case.…”

Comparison of four serum tumour markers in the diagnosis of colorectal carcinoma

“…Therefore, unlike CEA, the markers CA 19-9, CA 50 and CA 195 are probably neither useful for the primary diagnosis nor for the staging of colorectal carcinoma. Although they were developed from colorectal cell lines (Koprowski et al, 1979;Schwartz, 1990), there are indications that some of these markers could play a role in the diagnosis of pancreatic cancer (Staab et al, 1985;Paganuzzi et al, 1988;Bhargava et al, 1988). In the case of CA 19-9 a sensitivity of 89% is reported at a specificity level of 95% (Staab et al, 1985), whereas a sensitivity of 81% at a specificity of 89% is described for CA 50 (Paganuzzi et al, 1988) and a sensitivity of 64% at a specificity of 94% for CA 195 (Bhargava et al, 1988).…”

Best practice in primary care pathology: review 13

“…CA19-9 has been found to be a less sensitive marker than CEA in the follow-up of colorectal cancer 27 28…”