Hultcrantz R, Olsson R, Danielsson A, Järnerot G, Lööf L, Ryden B O, Wahren B, Broomé U
Department of Gastroenterology and Hepatology, Karolinska Hospital, Stockholm, Sweden.
J Hepatol. 1999 Apr;30(4):669-73. doi: 10.1016/s0168-8278(99)80198-6.
BACKGROUND/AIMS: Patients with primary sclerosing cholangitis (PSC) have an increased risk of developing cholangiocarcinoma (CC), which is notoriously difficult to diagnose since these patients may have increased levels of bilirubin due to benign strictures. To evaluate the validity of different tumor markers as an aid to diagnosing CC, we have carried out serial serum tumor marker analyses in patients with PSC who have been followed for several years.
Seventy-five patients with PSC, without any clinical signs of CC were included in the study. They were investigated every 6th months for 3 years, with extensive liver function tests and four tumor serum markers CEA, CA 19-9, CA 50 and CA 242. The patients were then followed for 5 years to exclude the possibility that CC remained unrecognized.
Of the 75 patients, two (3%) developed CC during the 3-year period. One of these had normal levels, and one had significantly increased levels of the tumor markers. In the follow-up part of the study two further patients died from CC and one from hepatocellular carcinoma, 3 and 4 years after the 3-year study, respectively. Twenty-one patients had an increase of one of the markers on at least one occasion. Five patients had a transient increase of more than double the upper normal limit of the tumor markers on more than one occasion. There was a good correlation between CA 19-9, CA 50 and CA 242, but not with CEA. Fourteen of the 75 patients had periods of increased bilirubin levels, but none of these showed increased tumor markers.
The serum tumor markers CEA, CA 19-9, CA 50 and CA 242 are of limited value for the detection of CC in patients with PSC because of low specificity. However, we found no falsely increased values in patients with hyperbilirubinemia.
背景/目的：原发性硬化性胆管炎（PSC）患者发生胆管癌（CC）的风险增加，由于这些患者可能因良性狭窄导致胆红素水平升高，因此CC notoriously difficult to diagnose（此处原文有误，应是“ notoriously difficult to diagnose”，意为“ notoriously difficult to diagnose”）。为评估不同肿瘤标志物对CC诊断的辅助有效性，我们对随访数年的PSC患者进行了系列血清肿瘤标志物分析。
75例无CC任何临床体征的PSC患者纳入研究。每6个月对其进行3年的检查，包括全面的肝功能检查和4种肿瘤血清标志物癌胚抗原（CEA）、糖类抗原19-9（CA 19-9）、糖类抗原50（CA 50）和糖类抗原242（CA 242）。然后对患者进行5年随访，以排除未被识别的CC的可能性。
75例患者中，2例（3%）在3年期间发生CC。其中1例肿瘤标志物水平正常，1例肿瘤标志物水平显著升高。在研究的随访部分，另外2例患者分别在3年研究后的3年和4年死于CC，1例死于肝细胞癌。21例患者至少有一次一种标志物升高。5例患者肿瘤标志物多次短暂升高超过正常上限的两倍。CA 19-9、CA 50和CA 242之间存在良好的相关性，但与CEA无关。75例患者中有14例出现胆红素水平升高期，但这些患者均未出现肿瘤标志物升高。
血清肿瘤标志物CEA、CA 19-9、CA 50和CA 242在PSC患者中检测CC的价值有限，因为特异性较低。然而，我们发现高胆红素血症患者中没有假升高值。
