Hakama M, Stenman U H, Knekt P, Järvisalo J, Leino A, Hakulinen T, Maatela J, Aromaa A
Finnish Cancer Registry, Liisankatu, Helsinki, Finland.
J Med Screen. 1994 Jan;1(1):60-4. doi: 10.1177/096914139400100111.
Screening for gastrointestinal cancer is based mainly on a barium contrast x ray method and on identification of occult blood in stools. The methods are relatively expensive, not always acceptable to the participants, and there is only limited evidence of their effectiveness in reducing the mortality from gastrointestinal cancer.
To investigate the validity of several tumour markers as a screening test for stomach cancer and for colorectal cancer.
A registry of 36,265 serum samples drawn during 1968-72 was linked to the cancer registry. Follow up was during 1968-80 when 94 stomach cancers and 95 colorectal cancers were identified. One to two matched case-control design was applied, and the concentrations of CEA, CA 19-9, CA 50, and TATI were assessed.
The mean values of the markers between the cases and the controls were almost the same for the total material. Case-control differences were found between the 11 sets with an interval of less than one year between drawing the sample and diagnosis of the cancer. The highest validity was found in CEA for colorectal cancer (specificity 91%; sensitivity 64%) and in CA 19-9 for stomach cancer (specificity 74%; sensitivity 73%).
CEA, CA 19-9, CA 50, or TATI are not valid screening tests. Case-control differences were found with a potential one year screening interval, but they were not large enough for sufficient validity.
胃肠道癌筛查主要基于钡剂造影X线检查法以及粪便潜血检测。这些方法相对昂贵，参与者并非总能接受，而且在降低胃肠道癌死亡率方面其有效性的证据有限。
探讨几种肿瘤标志物作为胃癌和结直肠癌筛查试验的有效性。
将1968 - 1972年期间采集的36265份血清样本登记册与癌症登记册相联系。随访时间为1968 - 1980年，期间确诊94例胃癌和95例结直肠癌。采用1 - 2配对病例对照设计，并评估癌胚抗原（CEA）、糖类抗原19 - 9（CA 19 - 9）、糖类抗原50（CA 50）和组织多肽抗原（TATI）的浓度。
总体样本中，病例组和对照组之间标志物的平均值几乎相同。在样本采集与癌症诊断间隔时间小于1年的11组中发现了病例对照差异。结直肠癌中癌胚抗原的有效性最高（特异性91%；敏感性64%），胃癌中糖类抗原19 - 9的有效性最高（特异性74%；敏感性73%）。
癌胚抗原、糖类抗原19 - 9、糖类抗原50或组织多肽抗原并非有效的筛查试验。在潜在的1年筛查间隔中发现了病例对照差异，但差异不够大，不足以保证足够的有效性。
