Sinha Seema Rani, Prakash Prem, Singh Rakesh Kumar, Sinha Dinesh Kumar
Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna 800014, India.
General Surgery, Indira Gandhi Institute of Medical Sciences, Patna 800014, India.
World J Gastrointest Surg. 2022 Nov 27;14(11):1272-1284. doi: 10.4240/wjgs.v14.i11.1272.
Gallbladder cancer (GBC) is one of the leading and aggressive cancers in this region of India. It is very difficult to diagnose in the early stage, as it lacks typical early signs and symptoms; thus, the diagnosis is often in the advanced stage, which ultimately leads to a poor 5-year survival outcome. Tumor markers including carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), CA 125, CA 242, and alpha fetoprotein are used as indicators in the diagnosis and prognosis of GBC.
To compare tumor marker levels between GBC and benign GB diseases (GBDs) and to assess the combined use of tumor markers to increase the diagnostic accuracy for GBC.
Patients of either sex aged ≥ 18 years, with suspected GBC (GB polyp, irregular thick GB wall, GB mass, porcelain GB) on the basis of radiological imaging were included in this study. GB wall thickness using ultrasonography and tumor markers CEA, CA 125, CA 19-9, and CA 242 in all patients were recorded. All cases after surgical intervention were divided into two groups, GBC and benign GBD, according to histopathological examination findings. The cases were followed up and clinical findings, radiological findings, and levels of tumor markers were assessed.
A total of 200 patients were included in this study, of whom 80 patients had GBC and 120 patients had benign GBD. The median (interquartile range) age was 52.0 (41.0-60.0) years and the majority of patients (132, 66.0%) were women. Tumor markers including CA 19-9, CA 125, CEA, and CA 242 were significantly elevated in patients with GBC ( < 0.001). There was a significant reduction in tumor markers at 3 and 6 mo from baseline ( < 0.001). The mean survival of patients with normal and elevated levels of tumor markers CA 125, CA 19-9, and CEA was comparable; however lymph node metastasis and CA 242 expression level were independent prognostic factors.
Serum levels of tumor markers including CA 19-9, CA 125, CEA, and CA 242 were significantly associated with GBC. However, no significant association was observed between the presence of elevated levels of any tumor marker with respect to survival. Tumor marker assessment during follow-up may represent a treatment response.
胆囊癌（GBC）是印度该地区主要的侵袭性癌症之一。由于缺乏典型的早期体征和症状，早期很难诊断；因此，诊断往往处于晚期，最终导致5年生存率不佳。包括糖类抗原19-9（CA 19-9）、癌胚抗原（CEA）、CA 125、CA 242和甲胎蛋白在内的肿瘤标志物被用作GBC诊断和预后的指标。
比较GBC与良性胆囊疾病（GBD）之间的肿瘤标志物水平，并评估联合使用肿瘤标志物以提高GBC的诊断准确性。
本研究纳入年龄≥18岁、基于影像学检查怀疑患有GBC（胆囊息肉、胆囊壁不规则增厚、胆囊肿物、瓷化胆囊）的患者。记录所有患者使用超声检查的胆囊壁厚度以及肿瘤标志物CEA、CA 125、CA 19-9和CA 242。手术干预后的所有病例根据组织病理学检查结果分为两组，即GBC组和良性GBD组。对病例进行随访，并评估临床发现、影像学发现和肿瘤标志物水平。
本研究共纳入200例患者，其中80例患有GBC，120例患有良性GBD。中位（四分位间距）年龄为52.0（41.0 - 60.0）岁，大多数患者（132例，66.0%）为女性。GBC患者中包括CA 19-9、CA 125、CEA和CA 242在内的肿瘤标志物显著升高（<0.001）。与基线相比，3个月和6个月时肿瘤标志物显著降低（<0.001）。肿瘤标志物CA 125、CA 19-9和CEA水平正常和升高的患者的平均生存期相当；然而，淋巴结转移和CA 242表达水平是独立的预后因素。
包括CA 19-9、CA 125、CEA和CA 242在内的肿瘤标志物血清水平与GBC显著相关。然而，未观察到任何肿瘤标志物水平升高与生存之间存在显著关联。随访期间的肿瘤标志物评估可能代表治疗反应。
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