Eleftheriadis N, Papaloukas C, Pistevou-Gompaki K
Department of Radiation Oncology, Aristotle's University of Thessaloniki, Thessaloniki, Greece.
J BUON. 2009 Oct-Dec;14(4):707-10.
Tumor markers, particularly carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP), are widely used in oncology, either in monitoring patients with metastatic colorectal cancer (CEA) or surveillance of hepatocellular carcinoma (HCC/AFP). The objective of this study was to determine the diagnostic value of CEA, CA19-9 or AFP in asymptomatic individuals.
12 asymptomatic individuals (6 males), with age range 55-82 years, referred to outpatient Gastroenterology- Oncology department for second opinion, with slightly elevated serum CEA (8 persons), CA19-9 (2 persons), and AFP (2 persons). The tumor markers were ordered from the primary practitioner or internist in order to avoid further specific examinations, such as colonoscopy. All individuals were totally asymptomatic. One of them had a known-history of 5-year surgically removed malignant pediculated sigmoid polyp and remained asymptomatic since then.
After continuous and repeated meticulous examinations in all individuals, no specific pathology was found to explain the slightly elevated tumor markers. In one male (59 years) and one female (75 years) with slightly elevated CEA levels, 2 small colonic polyps were found, which were endoscopically removed. Repeated CEA levels 3 months later remained borderline high. During follow-up, 3 years after the discovery of slightly elevated tumor markers all individuals remained asymptomatic (positive predictive value / PPV 0%).
Although further prospective studies are necessary, the preliminary results of this study showed that tumor markers are not useful for primary prevention of gastrointestinal malignancy. Moreover, slightly elevated tumor markers are confusing, leading to unnecessary examinations and stress from the individual's point of view.
肿瘤标志物，尤其是癌胚抗原（CEA）和甲胎蛋白（AFP），在肿瘤学中广泛应用，用于监测转移性结直肠癌患者（CEA）或肝细胞癌（HCC/AFP）的监测。本研究的目的是确定CEA、CA19 - 9或AFP在无症状个体中的诊断价值。
12名无症状个体（6名男性），年龄在55 - 82岁之间，因需二次诊断转诊至门诊胃肠肿瘤科室，其血清CEA（8人）、CA19 - 9（2人）和AFP（2人）略有升高。肿瘤标志物由初级医生或内科医生开具，以避免进一步的特定检查，如结肠镜检查。所有个体均完全无症状。其中一人有5年前手术切除带蒂乙状结肠恶性息肉的病史，此后一直无症状。
在对所有个体进行持续且反复的细致检查后，未发现能解释肿瘤标志物略有升高的特定病理情况。在CEA水平略有升高的一名男性（59岁）和一名女性（75岁）中，发现了2个小的结肠息肉，并通过内镜切除。3个月后复查CEA水平仍处于临界高位。在随访期间，发现肿瘤标志物略有升高3年后，所有个体均无症状（阳性预测值/PPV为0%）。
尽管有必要进行进一步的前瞻性研究，但本研究的初步结果表明，肿瘤标志物对胃肠道恶性肿瘤的一级预防并无用处。此外，肿瘤标志物略有升高会造成困扰，从个体角度来看会导致不必要的检查和压力。
