Ramage J K, Donaghy A, Farrant J M, Iorns R, Williams R
Institute of Liver Studies, King's College Hospital, London, England.
Gastroenterology. 1995 Mar;108(3):865-9. doi: 10.1016/0016-5085(95)90462-x.
BACKGROUND/AIMS: The diagnosis of cholangiocarcinoma in primary sclerosing cholangitis (PSC), even with the use of current imaging techniques and brush cytology, is difficult and particularly important in patients being assessed for liver transplantation. This study investigated the accuracy of serum levels of a combination of the tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in the diagnosis of cholangiocarcinoma in patients with PSC.
Seventy-four patients with PSC were studied. Fifteen patients had tumors (11 occult on imaging), 22 had severe PSC that necessitated transplantation (with explanted liver known to be free of tumor), and 37 patients had stable PSC.
An index of the two serum tumor markers [using the formula CA19-9 + (CEA x 40)] gave an accuracy of 86% in diagnosis of cholangiocarcinoma, with 10 of the 15 cases of cholangiocarcinoma having an increased value compared with none in a group of 22 comparable cases with no tumor. In addition, 6 of the 11 patients with occult tumors had abnormal values. Ultrasonography, computerized tomographic scanning, and endoscopic retrograde cholangiopancreatography were poor predictors of the presence of tumor.
A combination of serum tumor markers will identify most occult tumors and will improve selection of appropriate cases for orthotopic liver transplantation.
背景/目的：原发性硬化性胆管炎（PSC）中胆管癌的诊断即便使用当前的成像技术和刷检细胞学检查仍很困难，在评估肝移植患者时尤为重要。本研究调查了肿瘤标志物癌胚抗原（CEA）和糖类抗原19-9（CA19-9）联合检测血清水平在PSC患者胆管癌诊断中的准确性。
对74例PSC患者进行研究。15例患者患有肿瘤（11例在影像学检查中隐匿），22例患有严重PSC需要进行移植（已知移植肝脏无肿瘤），37例患者患有稳定的PSC。
两种血清肿瘤标志物的一个指标[使用公式CA19-9 +（CEA×40）]在胆管癌诊断中的准确率为86%，15例胆管癌患者中有10例该指标值升高，而在22例无肿瘤的对照病例组中无一例升高。此外，11例隐匿性肿瘤患者中有6例该指标值异常。超声检查、计算机断层扫描和内镜逆行胰胆管造影对肿瘤存在的预测效果不佳。
血清肿瘤标志物联合检测可识别大多数隐匿性肿瘤，并将改善原位肝移植合适病例的选择。
