Sun Li-Qi, Peng Li-Si, Guo Jie-Fang, Jiang Fei, Cui Fang, Huang Hao-Jie, Jin Zhen-Dong
Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
World J Gastroenterol. 2021 Feb 14;27(6):501-512. doi: 10.3748/wjg.v27.i6.501.
Early detection of advanced cystic mucinous neoplasms [(A-cMNs), defined as high-grade dysplasia or malignancy] of the pancreas is of great significance. As a simple and feasible detection method, serum tumor markers (STMs) may be used to predict advanced intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs). However, there are few studies on the usefulness of STMs other than carbohydrate antigen (CA) 19-9 for early detection of A-cMNs.
To study the ability of five STMs-CA19-9, carcinoembryonic antigen (CEA), CA125, CA724, and CA242 to predict A-cMNs and distinguish IPMNs and MCNs.
We mainly measured the levels of each STM in patients pathologically diagnosed with cMNs. The mean levels of STMs and the number of A-cMN subjects with a higher STM level than the cutoff were compared respectively to identify the ability of STMs to predict A-cMNs and distinguish MCNs from IPMNs. A receiver operating characteristic curve with the area under curve (AUC) was also created to identify the performance of the five STMs.
A total of 187 patients with cMNs were identified and 72 of them showed A-cMNs. We found that CA19-9 exhibited the highest sensitivity (SE) (54.2%) and accuracy (76.5%) and a moderate ability (AUC = 0.766) to predict A-cMNs. In predicting high-grade dysplasia IPMNs, the SE of CA19-9 decreased to 38.5%. The ability of CEA, CA125, and CA724 to predict A-cMNs was low (AUC = 0.651, 0.583, and 0.618, respectively). The predictive ability of CA242 was not identified. The combination of STMs improved the SE to 62.5%. CA125 may be specific to the diagnosis of advanced MCNs.
CA19-9 has a moderate ability, and CEA, CA125, and CA724 have a low ability to predict A-cMNs. The combination of STM testing could improve SE in predicting A-cMNs.
胰腺高级别囊性黏液性肿瘤（A-cMNs，定义为高级别异型增生或恶性肿瘤）的早期检测具有重要意义。作为一种简单可行的检测方法，血清肿瘤标志物（STMs）可用于预测高级别导管内乳头状黏液性肿瘤（IPMNs）和黏液性囊性肿瘤（MCNs）。然而，除糖类抗原（CA）19-9外，关于其他STMs在A-cMNs早期检测中的作用的研究较少。
研究5种STMs（CA19-9、癌胚抗原（CEA）、CA125、CA724和CA242）预测A-cMNs以及区分IPMNs和MCNs的能力。
我们主要检测了经病理诊断为cMNs的患者中各STMs的水平。分别比较了STMs的平均水平以及STM水平高于临界值的A-cMNs患者数量，以确定STMs预测A-cMNs以及区分MCNs和IPMNs的能力。还绘制了带有曲线下面积（AUC）的受试者工作特征曲线，以确定这5种STMs的性能。
共纳入187例cMNs患者，其中72例为A-cMNs。我们发现CA19-9表现出最高的敏感性（SE）（54.2%）和准确性（76.5%），以及预测A-cMNs的中等能力（AUC = 0.766）。在预测高级别异型增生IPMNs时，CA19-9的SE降至38.5%。CEA、CA125和CA724预测A-cMNs的能力较低（AUC分别为0.651、0.583和0.618）。未确定CA242的预测能力。STMs联合检测可将SE提高至62.5%。CA125可能对晚期MCNs的诊断具有特异性。
CA19-9具有中等预测能力，CEA、CA125和CA724预测A-cMNs的能力较低。STMs联合检测可提高预测A-cMNs的SE。
