The relationship between preoperative CA 19-9 and CEA levels and histopathology of tumor in colorectal cancer

Abstract

Abstract Aim: Colorectal cancer is a serious disease that can result in death. The fact that cancer markers and early diagnosis increase the effectiveness of treatment reveals the need for multidimensional research on this subject. TNM classification of colorectal cancer is shows the prognosis. In our study, the relationship between preoperative CEA and CA 19-9 values and histopathology of tumor and preoperative predictive value of tumor markers in colorectal cancer patients were investigated. Materials and Methods: 153 patients diagnosed with colorectal cancer were included in the study. The histopathological data in the resection materials of the patients who were operated by General Surgery Department were collected from the pathology reports. Clinical data were collected by retrospective scanning of patient files. Results: The mean age of the patients was 64 (± 11.39) years. 51.6% were male and 48.4% were female. CEA was found to be positive in 35.3% of the patients, while this rate was 20.9% for CA 19-9. In our study, CEA and CA 19-9 positivity were significantly correlated with TNM stage of tumor, depth of invasion, lymphovascular invasion, perineural invasion, nodal involvement and metastasis. In addition, the mean age of CA 19-9 positive cases was significantly higher than the negative ones. The mean tumor size of CEA positive cases was significantly higher than the negative ones. Conclusion: CEA and CA19-9 are valuable both in demonstrating advanced stage tumors and in detecting malignancy in tumors detected in advanced ages. Since survival decreases as the stage progresses, positive CEA and CA19-9 values are both associated with worse prognosis.

Keywords

• CA-19-9
• carcinoembryonic antigen
• colorectal neoplasms

Kolorektal kanser nedeniyle opere olan hastalarda ameliyat öncesi CA 19-9 ve CEA düzeyleri ile tümörün histopatolojisi arasındaki ilişki

Abstract

Öz Amaç: Kolorektal kanser yaygın ve ölümcül bir hastalıktır. Erken tanı, kanser tedavisinin başarı yüzdesini büyük oranda arttırdığından kanser belirleyicilerinin çok yönlü olarak araştırılması gereksinimi sürmektedir. Kolorektal kanserlerde tümörün TNM sınıflaması en önemli prognostik göstergedir. Çalışmamızda kolorektal kanserli hastalardaki preoperatif CEA ve CA 19-9 değerleri ve tümörün histopatolojisi arasındaki ilişki, tümör belirteçlerinin preoperatif prediktif değeri araştırılmıştır. Gereç ve Yöntem: Araştırmaya kolorektal kanser tanısı almış 153 hasta dahil edilmiştir. Klinik veriler hasta dosyalarının retrospektif olarak taranması yoluyla toplanmıştır. CEA değeri 5 ng/ml ve üzeri olgular ve CA 19-9 değeri 35 U/ml ve üzeri olgular pozitif kabul edilmiştir. Bulgular: Hastaların yaş ortalaması 64(±11.39) olup, %51,6 sı erkek, ve %48,4’ü kadındır. Hastaların %35,3 ünde CEA pozitif olarak saptanırken bu oran CA 19-9 için %20,9’ dur. Çalışmamızda CEA ve CA 19-9 pozitifliği ile tümörün TNM Evresi, invazyon derinliği, lenfovasküler invazyon, perinöral invazyon, nodal tutulum, metastaz istatistiksel olarak anlamlı düzeyde ilişkilidir. Ayrıca CA 19-9 pozitif olguların yaş ortalaması, negatif olanlara kıyasla anlamlı derecede yüksektir. CEA pozitif olguların tümör boyutu ortalaması, negatif olanlara göre anlamlı derecede yüksektir. Sonuç: CEA ve CA19-9, hem ileri evre tümörü göstermede hem de ileri yaşlarda saptanan tümörlerde malignite saptanmasında değerlidir. Evre ilerledikçe sağ kalım düştüğünden pozitif CEA ve CA19-9 değerleri her ikisi birden daha kötü prognoz ile ilişkilidir.

Keywords

• CA-19-9
• karsinoembriyojenik antijen
• kolorektal kanser

References

1. 1. WHO Globocan Cancer Today[Internet] [https://gco.iarc.fr/today/home]Date of access: 25.11.2022.
2. 2. Fitzmaurice C, Allen C, Barber RM, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: A systematic analysis for the global burden of disease study. Jama Oncol. 2017;3(4):524-48.
3. 3. Doubeni CA, Laiyemo AO, Major JM, et al. Socioeconomic status and the risk of colorectal cancer: An analysis of more than a half million adults in the National Institutes of Health‐AARP Diet and Health Study. Cancer. 2012;118(14):3636-44.
4. 4. Kumar V AK, Aster C Temel Patoloji. In: U C, editor. İstanbul: Nobel Tıp Kitabevleri; 2014. p. 161-214.
5. 5. Akkoca AN, Yanık S, Özdemir ZT, et al. TNM and modified Dukes staging along with the demographic characteristics of patients with colorectal carcinoma. Int J Clin Exp Med. 2014;7(9):2828.
6. 6. Goldman L SA. Goldman’s Cecil Medicine. Elsevier, 2015.
7. 7. Brunicardi FC AD, Biliar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. Schwartz's Principles of Surgery Tenth Edition. McGraw Hill Education; 2015.
8. 8. Jameson JL, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine, 20th ed. New York: McGraw Hill Education; 2018. p. 576.

9. 9. Locker GY, Hamilton S, Harris J, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006;24(33):5313-27.
10. 10. Burtis CA BD. Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics. Elsevier Health Sciences; 2014. p. 722-47.
11. 11. Mitry E, Bouvier A.M, Esteve J, et al. Improvement in colorectal cancer survival: A population-based study. Eur J Cancer Care. 2005;41(15):2297-303.
12. 12. National Cancer Institute About Cancer[Internet] [https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-markers-fact-sheet#how-are-tumor-markers-used-in-cancer-care] Date of access:23.05.2023.
13. 13. Yu H, Son G-M, Joh Y-G. The clinical significance of preoperative serum levels of carbohydrate antigen 19-9 in colorectal cancer. Ann Surg Treat Res. 2013;84(4):231-7.
14. 14. Compton CC, Fielding LP, Burgart LJ, et al. Prognostic factors in colorectal cancer: College of American Pathologists consensus statement 1999. Archives of Pathology & Laboratory Medicine. 2000;124(7):979-94.
15. 15. Chen C-C, Yang S-H, Lin J-K, et al. Is it reasonable to add preoperative serum level of CEA and CA19-9 to staging for colorectal cancer? J Surg Res. 2005;124(2):169-74.
16. 16. Duffy MJ, van Dalen A, Haglund C, et al. Tumour markers in colorectal cancer: European Group on Tumour Markers (EGTM) guidelines for clinical use. Eur J Cancer Care. 2007;43(9):1348-60.
17. 17. Zheng CX, Zhan WH, Zhao JZ, et al. Prognostic value of preoperative serum levels of CEA, CA19-9 and CA72-4 in patients with colorectal cancer. World J Gastroenterol. 2001;7(3):431-4.
18. 18. Yang W, Luo Y, Hu S, et al. Value of combined detection of serum carcino‑embryonic antigen, carbohydrate antigen 19‑9 and cyclooxygenase‑2 in the diagnosis of colorectal cancer. Oncol Lett. 2018;16(2):1551-6.
19. 19. Tumay V, Guner OS. The utility and prognostic value of CA 19-9 and CEA serum markers in the long-term follow up of patients with colorectal cancer. A single-center experience over 13 years. Ann Ital Chir. 2020;91:494-503.
20. 20. Duffy MJ. Carcinoembryonic antigen as a marker for colorectal cancer: Is it clinically useful? Clin Chem. 2001;47(4):624-630.
21. 21. Goldstein MJ, Mitchell EP. Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer. Cancer Invest. 2005;23(4):338-51.
22. 22. Fernandes LC, Kim SB, Matos D. Cytokeratins and carcinoembryonic antigen in diagnosis, staging and prognosis of colorectal adenocarcinoma. World J Gastroenterol. 2005;11(5):645-8.
23. 23. Bast Jr RC, Ravdin P, Hayes DF, et al. 2000 update of recommendations for the use of tumor markers in breast and colorectal cancer: Clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19(6):1865-78.
24. 24. Grem J. The prognostic importance of tumor markers in adenocarcinomas of the gastrointestinal tract. Curr Opin Oncol. 1997;9(4):380-7.
25. 25. Sato T, Nishimura G, Nonomura A, et al. Serological studies on CEA, CA 19-9, STn and SLX in colorectal cancer. Hepatogastroenterology. 1999;46(26):914-9.