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Yu CW, Wu LW, Hu JM, Chang PK. Serum CA19-9 as a predictor of incident metabolic syndrome in obese middle-aged and older men: A 9-year cohort study. Cancer Biomark 2025; 42:18758592241296282. [PMID: 40109214 DOI: 10.1177/18758592241296282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
BackgroundThe status of carbohydrate antigen 19-9 (CA19-9) in metabolic syndrome (MetS) is unknown.ObjectiveTo investigate the association between serum CA19-9 levels and incident metabolic syndrome in obese middle-aged and older men.MethodsFrom 2007 to 2015, 1,750 participants were retrospectively reviewed. Health checkup data were obtained, and participants were divided into three groups based on CA19-9 levels. Various parameters including BMI, waist circumference, blood pressure, and biochemical parameters were measured. Cox regression analysis was used to assess the association between CA19-9 levels and incident MetS. The MetS diagnostic criteria were based on the National Cholesterol Education Program Adult Treatment Panel III guidelines.ResultsThe highest CA19-9 tertile was associated with an increased risk of incident MetS, high systolic blood pressure, high waist circumference, high fasting plasma glucose, low high-density lipoprotein, and high triglyceride levels. The observation period was 9 years, during which 328 (18.7%) new-onset MetS cases were identified. Subgroup analysis showed increased risk among individuals in the highest CA19-9 tertile who were obese, male, and ≥ 50 years old.ConclusionsThere is a positive correlation between serum CA19-9 levels and incident metabolic syndrome in obese middle-aged and older men.
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Affiliation(s)
- Chun-Wei Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
| | - Li-Wei Wu
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Republic of China
- School of Medicine, National Defense Medical Center, Taipei, Republic of China
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
| | - Je-Ming Hu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Republic of China
- School of Medicine, National Defense Medical Center, Taipei, Republic of China
| | - Pi-Kai Chang
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Republic of China
- School of Medicine, National Defense Medical Center, Taipei, Republic of China
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Smith EN, Coleman A, J. Galgano S, Burgan CM, Porter KK. Cholangiocarcinoma. ONCOLOGIC IMAGING : A MULTIDISCIPLINARY APPROACH 2023:133-159. [DOI: 10.1016/b978-0-323-69538-1.00011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Ali AH, Tabibian JH, Nasser-Ghodsi N, Lennon RJ, DeLeon T, Borad MJ, Hilscher M, Silveira MG, Carey EJ, Lindor KD. Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis. Hepatology 2018; 67:2338-2351. [PMID: 29244227 DOI: 10.1002/hep.29730] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/25/2017] [Accepted: 12/08/2017] [Indexed: 12/19/2022]
Abstract
UNLABELLED Primary sclerosing cholangitis (PSC) is a risk factor for cholangiocarcinoma (CCA) and gallbladder carcinoma (GBCa). Surveillance for GBCa is recommended, but the clinical utility of surveillance for other hepatobiliary cancers (HBCa) in PSC, namely CCA and hepatocellular carcinoma (HCC), remains unclear. We aimed to determine whether surveillance is associated with better survival after diagnosis of HBCa in patients with PSC. Medical records of PSC patients seen at the Mayo Clinic Rochester from 1995 to 2015 were reviewed. Patients were included if they had ≥1 year of follow-up and developed HBCa. Patients were categorized according to their surveillance status (abdominal imaging, carbohydrate antigen 19-9, and alpha-fetoprotein). The primary endpoints were HBCa recurrence, HBCa-related death, and all-cause mortality. Overall survival was assessed by the Kaplan-Meier survival method; HBCa-related survival was assessed using competing risk regression. Tests of significance were two-tailed, and a P value <0.05 was considered statistically significant. From 1995 to 2015, a total of 79 of 830 PSC patients were diagnosed with HBCa. Cumulative follow-up was 712 and 283 person-years pre- and post-HBCa diagnosis, respectively. Seventy-eight percent of patients (54/79) developed CCA, 21% (17/79) HCC, 6% (5/79) GBCa, 3% (2/79) both CCA and HCC, and 1% (1/79) both HCC and GBCa. Fifty-one percent (40/79) were under HBCa surveillance, and 49% (39/79) were not. Patients in the surveillance group had significantly higher 5-year overall survival (68% versus 20%, respectively; P < 0.001) and significantly lower 5-year probability of experiencing an HBCa-related adverse event (32% versus 75%, respectively; P < 0.001) compared with the no-surveillance group. CONCLUSION This study demonstrates that HBCa surveillance significantly improves outcomes, including survival, in patients with PSC. (Hepatology 2018;67:2338-2351).
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Affiliation(s)
- Ahmad Hassan Ali
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ.,Texas Tech University Health Sciences Center, Amarillo, TX
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | | | - Moira Hilscher
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Marina G Silveira
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT
| | - Elizabeth J Carey
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ
| | - Keith D Lindor
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ.,Arizona State University, Phoenix, AZ
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Morinaga T, Imai K, Yamashita YI, Yamao T, Kaida T, Nakagawa S, Hashimoto D, Chikamoto A, Sumiyoshi S, Mikami Y, Baba H. Multicystic biliary hamartoma with extremely elevated CA19-9: a case report. Scand J Gastroenterol 2017; 52:916-919. [PMID: 28485658 DOI: 10.1080/00365521.2017.1322140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Multicystic biliary hamartoma (MCBH) is a rare cystic disease of the liver. We herein report a case of MCBH associated with extremely elevated levels of serum carbohydrate antigen (CA) 19-9. A 53-year-old man was referred to our hospital because of extremely elevated CA19-9 levels (more than 12,000 U/mL). Enhanced abdominal computed tomography and magnetic resonance imaging (MRI) revealed a multicystic tumor with a calcified wall in the left lobe of the liver, although no apparent intracystic nodule was detected. Because of the possibility of a malignant tumor, such as intraductal papillary neoplasm of the bile duct or cystadenocarcinoma, the patient underwent left hepatectomy. Based on the postoperative pathological findings, the lesion was diagnosed as MCBH. The serum CA19-9 level drastically decreased after surgery. We encountered a rare case of MCBH with extremely elevated CA19-9 levels.
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Affiliation(s)
- Takeshi Morinaga
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Katsunori Imai
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Yo-Ichi Yamashita
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Takanobu Yamao
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Takayoshi Kaida
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Shigeki Nakagawa
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Daisuke Hashimoto
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Akira Chikamoto
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Shinji Sumiyoshi
- b Department of Diagnostic Pathology , Kumamoto University Hospital , Kumamoto , Japan
| | - Yoshiki Mikami
- b Department of Diagnostic Pathology , Kumamoto University Hospital , Kumamoto , Japan
| | - Hideo Baba
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
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Souza-Gallardo LM, de la Fuente-Lira M, Galaso-Trujillo R, Martínez-Ordaz JL. [Persistent elevation of Ca 19-9 and an unexpected finding. A case report]. CIR CIR 2016; 85:449-453. [PMID: 27609089 DOI: 10.1016/j.circir.2016.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 07/03/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tumour markers are substances produced by the tumour itself, or by the host in response to a tumour. These markers could be measured either in the blood or in body secretions. One of the most common tumour markers used in gastrointestinal diseases is Ca 19-9. It is the marker most used for pancreatic cancer, but can be elevated in many benign processes. Thus, it is not a specific marker. CLINICAL CASE The case is presented of a male patient with 4 years of moderate abdominal pain, weight loss, and persistent elevation of Ca 19-9. After an extensive work-up, renal and hepatic cysts were found, as well as steatosis and, apparently, a gallbladder polyp. With these findings and the persistent elevation of Ca 19-9, it was decided to operate the patient. An exploratory laparoscopy was performed showing multiple, yellowish nodular lesions all over the hepatic surface suggestive of metastases, as well as simple hepatic cysts. Pathology reported biliary hamartomas, steatosis, and chronic cholecystitis. After 2years of follow up, although there is no evidence of malignant neoplasia, there is still an elevation of Ca 19-9. CONCLUSION The persistent elevation of Ca 19-9 is probably due to the presence of multiple benign diseases such as steatosis, urolithiasis, hepatic and renal cysts, and cholecystitis. An algorithm is needed for healthy patients with elevated levels of Ca 19-9 marker, in order to lower costs, avoid misdiagnoses, and improve management.
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Affiliation(s)
- Luis Manuel Souza-Gallardo
- Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
| | - Mauricio de la Fuente-Lira
- Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Roberto Galaso-Trujillo
- Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Luis Martínez-Ordaz
- Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Abstract
BACKGROUND AND AIM Immunoglobulin G4-associated cholangitis (IAC) shares many similar symptoms with cholangiocarcinoma (CCA). However, the treatment and the prognosis are substantially different. This study aimed to identify the important markers for the differential diagnosis of these 2 diseases. METHODS Thirty IAC patients and 275 CCA patients were reviewed retrospectively for their clinical symptoms, serological tests, and imaging characteristics. Posttreatment responses were also studied. RESULTS IgG4 had 100% specificity for IAC at a cutoff of 6 times the upper normal limit. IAC patients had a significantly higher incidence of weight loss (P=0.025) and a higher level of weight loss (P=0.008) than CCA patients. The positive rates of biological markers CA199, CA242, and CEA in CCA and IAC were 81.5% versus 42.9%, 45.5% versus 4.5%, and 29.2% versus 7.1%, respectively. Levels of these tumor markers in CCA were significantly higher than in IAC (P<0.05). The thickened wall [17/18 (94.4%) vs. 3/10 (30%), P=0.001] and the occupying lesion on the bile duct [1/18 (5.6%) vs. 8/10 (80%), P<0.001] were found to be significantly different in IAC and CCA, respectively, by endoscopic ultrasonography. Autoimmune pancreatitis was the most frequently observed comorbidity of IAC (25/30). All IAC patients respond positively to steroid treatment. CONCLUSIONS Increased tumor markers, 6-fold higher levels of serum IgG4, and other organs' involvement could be the reference factors for a differential diagnosis of IAC and CCA. Endoscopic ultrasonography might be an effective imaging tool for diagnosis, although clinical signs and symptoms of IAC and CCA are similar. Experimental steroid treatment can be useful in the diagnosis for certain difficult cases.
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Detection of benign hilar bile duct stenoses - A retrospective analysis in 250 patients with suspicion of Klatskin tumour. Ann Med Surg (Lond) 2016; 8:43-9. [PMID: 27257485 PMCID: PMC4878841 DOI: 10.1016/j.amsu.2016.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/01/2016] [Accepted: 05/03/2016] [Indexed: 12/13/2022] Open
Abstract
Introduction The aim of this study was to identify clinical, laboratory and radiological parameters to distinguish benign from malignant stenoses of the proximal bile duct. Methods Between 1997 and 2011, 250 patients were referred to our clinic with hilar bile duct stenoses suspicious for Klatskin tumour. Medical histories, clinical data, pre-interventional laboratory tests, imaging findings, as well as therapeutic approach and patient outcome were compared to final histological results. All data were retrieved from our prospectively maintained database and analysed retrospectively. Results We found benign bile duct lesions in 34 patients (13.6%). Among the entire study population, uni- and multivariate analyses of 18 clinicopathological parameters revealed that patient age, serum alkaline phosphatase, tumour marker CA19-9 and presence of tumour mass in computed tomography were independent predictors for malignant biliary stenoses (p < 0.05). Receiver operator characteristic curve showed that a CA19-9 serum level of 61.2 U/ml or more has a sensitivity, specificity and diagnostic accuracy for predicting the malignant nature of the hilar biliary stenoses of 74.6%, 80.0% and 83.5%, respectively. Surgical resection could be avoided by preoperative work-up and surgical exploration in 10 out of 34 patients with benign lesions. Rates of major liver resections performed were 66.7% in the benign lesion group and 90.7% in the Klatskin tumour group. Conclusion Despite improvements of preoperative diagnostics, it remains difficult to differentiate between benign and malignant hilar bile duct stenosis. Even explorative laparotomy was not able to safely exclude Klatskin tumour in all cases and therefore major liver resection was inevitable.
Identification of clinical, laboratory and radiological parameters to distinguish benign from malignant strictures of the proximal bile duct. Retrospective analysis in 250 patients with suspicion of Klatskin tumour. Patient age, alkaline phosphatase, CA19-9 and presence of tumour mass in CT scan are predictors for malignant stenosis of the proximal bile duct.
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Yilmaz B, Roach EC, Koklu S. An Unusual Cause of a High Carbonhydrate Antigen 19-9 Level in an Elderly Individual: Polycystic Liver Disease. J Am Geriatr Soc 2015; 63:1487-8. [DOI: 10.1111/jgs.13541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Bulent Yilmaz
- Department of Gastroenterology; School of Medicine; Hacettepe University; Ankara Turkey
| | - Emir Charles Roach
- Department of Gastroenterology; School of Medicine; Hacettepe University; Ankara Turkey
| | - Seyfettin Koklu
- Department of Gastroenterology; School of Medicine; Hacettepe University; Ankara Turkey
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The relation between CA 19-9 level and early-phase insulin secretion in normoglycemic and prediabetic subjects. Int J Biol Markers 2015; 30:e169-73. [PMID: 25588858 DOI: 10.5301/jbm.5000130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Carbohydrate antigen (CA) 19-9 is used as a clinical tumor marker of pancreatic cancer; recent studies report that CA 19-9 is also associated with changes in blood glucose levels. The aim of the present study was to investigate the relationship between serum CA 19-9 levels and early-phase insulin secretion in nondiabetic individuals. METHODS We enrolled 269 normoglycemic participants and 172 prediabetic participants who had undergone the 75-g oral glucose tolerance test during their annual health examination. Insulin secretion was estimated using the disposition index (DI) [(Δinsulin(0-30 min)/Δglucose(0-30 min) × (1/HOMA-IR)], which is an adjusted measure of relationship between β-cell sensitivity and insulin sensitivity. RESULTS Serum CA 19-9 level was significantly higher in the prediabetic participants than in the normoglycemic participants. Simple linear regression analysis showed a negative correlation between CA 19-9 levels and DI for all participants and prediabetic participants (r = -0.126, p = 0.009, and r = -0.189, p = 0.002, respectively). However, in the normoglycemic participants, CA 19-9 levels did not correlate with DI. For all participants, and prediabetic subjects, multivariate linear regression analysis revealed that serum CA 19-9 levels were one of the independent predictors of DI (adjusted β = -0.098, p = 0.025, and adjusted β = -0.177, p = 0.004, respectively). CONCLUSIONS Serum CA 19-9 levels significantly correlate with early-phase insulin secretion in the prediabetic individuals. Our results indicate that CA 19-9 may be involved in the endocrine function of pancreas.
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Kim SH, Baek CO, Lee KA, Park TS, Baek HS, Jin HY. Clinical implication of elevated CA 19-9 level and the relationship with glucose control state in patients with type 2 diabetes. Endocrine 2014; 46:249-55. [PMID: 24114405 DOI: 10.1007/s12020-013-0058-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 09/07/2013] [Indexed: 10/26/2022]
Abstract
The aim is to investigate whether there is a difference in CA 19-9 levels between diabetes and healthy subjects except malignancies and associated factors with CA 19-9 in diabetes. We performed a retrospective analysis in 146 type 2 diabetes and 154 healthy subjects who visited our medical institution from 2005 to 2009. We compared the CA 19-9 in each group, and analyzed clinical and biochemical variables in diabetes. The average value of CA 19-9 in diabetes was higher than that of healthy subjects significantly (14.1 vs 8.1 U/mL, p < 0.01). CA 19-9 had a positive correlation with HbA1c (r = 0.22), fasting plasma glucose (r = 0.24), and C-reactive protein (r = 0.38) in diabetes (p < 0.05). 48 type 2 diabetes who showed decreased CA 19-9 during follow-up of 1.8 ± 1.0 years were also improved in glucose control state. The proportion of insulin use for glucose control was significantly higher in the group of CA 19-9 ≥ 37 U/mL (75.0 %) as compared with the group of CA 19-9 < 37 U/mL (34.0 %). CA 19-9 was significantly higher in the patients with diabetic peripheral neuropathy (DPN) as compared with those without DPN (p = 0.02). However, after excluding the influences from glycemic control state, significant difference was not observed. Our results indicate not only that CA 19-9 is influenced by glycemic control state but also can be elevated irrespective of any malignancy in diabetes. Therefore, CA 19-9 should be interpreted carefully in diabetic patients when CA 19-9 is used as the tool for malignancy screening.
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Affiliation(s)
- Sun Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Gungiro 20 (634-18, Keum-Am Dong), Deok Jin Gu, Jeonju, 561-712, South Korea
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Venkatesh PGK, Navaneethan U, Shen B, McCullough AJ. Increased serum levels of carbohydrate antigen 19-9 and outcomes in primary sclerosing cholangitis patients without cholangiocarcinoma. Dig Dis Sci 2013; 58:850-7. [PMID: 23007734 DOI: 10.1007/s10620-012-2401-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 08/28/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Carbohydrate antigen 19-9 (CA 19-9) is the serum marker used to diagnose cholangiocarcinoma (CCA) in patients with primary sclerosing cholangitis (PSC). AIM We investigated long-term outcomes in patients with PSC and elevated CA 19-9 levels without CCA. METHODS A total of 166 PSC patients with serum levels of CA 19-9 without CCA followed at a single center from 1998 to 2011 were included. Patients with and without elevated CA 19-9 levels (greater than 129 U/ml) were compared. RESULTS Fifty-two (31.3 %) of the 166 patients with PSC without CCA had elevated serum CA-19-9. Patients with elevated CA-19-9 were followed for a mean of 4 years and 12 (23.1 %) died. They were more likely to have higher PSC risk score (1.67 ± 1.30 vs. 0.91 ± 1.53, p = 0.003) and dominant strictures (31 (59.6 %) vs. 21 (18.4 %), p < 0.001). In 17/52 (32.7 %) of patients with elevated CA-19-9, no etiology was identified; cholestasis and cholangitis were associated with elevated levels in 24/52 (48.1 %) and 11/52 (21.2 %), respectively. There were 32 of 52 (62.5 %) that underwent orthotopic liver transplantation (OLT) in elevated CA 19-9 group compared to 66/114 (56.9 %) without (p = 0.66). The median OLT-free survival with elevated CA 19-9 was 9 years from PSC diagnosis compared to 14 years without. Although there was a trend, there was no significant difference in the OLT-free survival on Kaplan-Meier analysis (log rank p = 0.12). CONCLUSIONS Thirty-two percent of patients with PSC had elevated serum CA 19-9 in the absence of CCA. There was a trend towards shorter OLT-free survival in PSC patients with elevated CA-19-9.
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Affiliation(s)
- Preethi G K Venkatesh
- Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Yeo D, Perini MV, Muralidharan V, Christophi C. Focal intrahepatic strictures: a review of diagnosis and management. HPB (Oxford) 2012; 14:425-434. [PMID: 22672543 PMCID: PMC3384871 DOI: 10.1111/j.1477-2574.2012.00481.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/12/2012] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Focal intrahepatic strictures are becoming more common owing to more prevalent and accurate cross-sectional imaging. However, data relating to their management are lacking. The purpose of the present review was to synthesize the current evidence regarding these lesions and to formulate a strategy for diagnosis and management. METHODS A literature search of relevant terms was performed using Medline. References of papers were subsequently searched to obtain older literature. RESULTS Focal intrahepatic strictures involve segmental hepatic ducts and/or left and right main hepatic ducts during their intrahepatic course. Most patients are asymptomatic while the minority present with vague abdominal pain or recurrent sepsis and only rarely with jaundice. Investigations used to distinguish benign from malignant aetiologies include blood tests (CEA, Ca19.9), imaging studies [ultrasonography (US), computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and fluorodeoxyglucose-positron emission tomography (FDG-PET)], endoscopic modalities [endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic ultrasound (EUS)/cholangioscopy] and tissue sampling (brush cytology/biopsy). CONCLUSIONS A focal intrahepatic stricture requires thorough investigation to exclude malignancy even in patients with a history of biliary surgery, hepatolithiasis or parasitic infection. If during the investigative process a diagnosis or suspicion of malignancy is demonstrated then surgical resection should be performed. If all diagnostic modalities suggest a benign aetiology, then cholangioscopy with targeted biopsies should be performed.
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Affiliation(s)
- David Yeo
- University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.
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Huang Y, Xu Y, Bi Y, Xu M, Lu J, Wang T, Li M, Chen Y, Liu Y, Huang F, Xu B, Zhang J, Wang W, Ning G. Relationship between CA 19-9 levels and glucose regulation in a middle-aged and elderly Chinese population. J Diabetes 2012; 4:147-52. [PMID: 22176810 DOI: 10.1111/j.1753-0407.2011.00179.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate carbohydrate antigen (CA) 19-9 levels in subjects with different glucose regulation status and assess the relationship between CA 19-9 and glucose regulation status in a Chinese population aged 40 years and older. METHODS A total of 2792 participants aged 40 years or older with no history of diabetes were enrolled in the present study from the Songnan region, Shanghai, China. Each participant received a two-point (at 0 and 2 hours) 75-g oral glucose tolerance test and measurements of hemoglobin A1c (Hb(A1c)) and CA 19-9 were made. RESULTS The CA 19-9 levels increased gradually from normal glucose regulation to impaired glucose regulation to new-onset diabetic patients (8.81, 9.84, and 11.08 U/mL, respectively, P < 0.0001 for trend). In new-onset diabetic patients, the CA 19-9 levels were positively and significantly associated with fasting plasma glucose (r = 0.20, P < 0.0001), 2 h post-load plasma glucose (r = 0.17, P = 0.0007), and Hb(A1c) (r = 0.19, P = 0.0001). Meanwhile, patients with new-onset diabetes had 3.31-fold (OR, 4.31; 95% CI, 2.00-9.32) increased higher odds ratio of elevated CA 19-9 as compared with those with normal glucose regulation after adjustments for confounders. CONCLUSIONS The CA 19-9 levels were significantly higher in diabetic and patients with impaired glucose regulation compared with subjects with normal glucose regulation. Diabetic status was independently associated with elevated CA 19-9. These results imply that CA 19-9 might also relate to the endocrine function of the pancreas.
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Affiliation(s)
- Yun Huang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
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Sinakos E, Saenger AK, Keach J, Kim WR, Lindor KD. Many patients with primary sclerosing cholangitis and increased serum levels of carbohydrate antigen 19-9 do not have cholangiocarcinoma. Clin Gastroenterol Hepatol 2011; 9:434-9.e1. [PMID: 21334457 DOI: 10.1016/j.cgh.2011.02.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 02/01/2011] [Accepted: 02/07/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Patients with primary sclerosing cholangitis (PSC) have an increased incidence of cholangiocarcinoma (CCA). Carbohydrate antigen 19-9 (CA 19-9) is the main serum marker used to diagnose CCA, although increased levels of CA 19-9 are also associated with other hepatic complications. We evaluated the long-term outcomes in patients with PSC and significant increases in levels of CA 19-9. METHODS We analyzed data from all Mayo Clinic patients with PSC and serum levels of CA 19-9 greater than 129 U/mL from 2000-2010 (n = 73). We reviewed patients' records for CCA diagnosis, other malignancies, recurrent bacterial cholangitis, and persistent cholestasis. RESULTS Thirty-seven percent of patients reviewed had no evidence of CCA after a median follow-up time of 30 months. The initial levels of CA 19-9 from patients without CCA were significantly lower than those from patients with CCA (286 vs 895 U/mL, P < .0001). At the start of the study, patients without CCA were more likely to have cirrhosis, compared with patients with CCA (48% vs 24%, P = .03), and lower levels of bilirubin (2 vs 6.8 mg/dL, P = .003), compared with patients with CCA. No factors known to affect CA 19-9 levels were identified in 33% of patients without CCA; endoscopic treatment and recurrent bacterial cholangitis were associated with levels of CA 19-9 in 26% and 22% of these patients, respectively. CONCLUSIONS Thirty-seven percent of patients with PSC who have serum levels of CA 19-9 greater than 129 U/mL do not have CCA. Additional studies should be performed to determine the outcomes of these patients.
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Affiliation(s)
- Emmanouil Sinakos
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA
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16
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Malaguarnera G, Giordano M, Paladina I, Rando A, Uccello M, Basile F, Biondi A, Carnazzo S, Alessandria I, Mazzarino C. Markers of bile duct tumors. World J Gastrointest Oncol 2011; 3:49-59. [PMID: 21528090 PMCID: PMC3083496 DOI: 10.4251/wjgo.v3.i4.49] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 02/23/2011] [Accepted: 03/02/2011] [Indexed: 02/05/2023] Open
Abstract
Biliary tract carcinomas are relatively rare, representing less than 1% of cancers. However, their incidence has increased in Japan and in industrialized countries like the USA. Biliary tract tumors have a poor prognosis and a high mortality rate because they are usually detected late in the course of the disease; therapeutic treatment options are often limited and of minimal utility. Recent studies have shown the importance of serum and molecular markers in the diagnosis and follow up of biliary tract tumors. This review aims to introduce the main features of the most important serum and molecular markers of biliary tree tumors. Some considerable tumor markers are cancer antigen 125, carbohydrate antigen 19-9, carcinoembryonic antigen, chromogranin A, mucin 1, mucin 5, alpha-fetoprotein, claudins and cytokeratins.
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Affiliation(s)
- Giulia Malaguarnera
- Giulia Malaguarnera, Clorinda Mazzarino, Department of Biomedical Science, University of Catania, via Androne 83, 95124 Catania, Italy
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17
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Atiq M, Javle M, Dang S, Lee JH. Cholangiocarcinoma: an endoscopist's perspective. Expert Rev Gastroenterol Hepatol 2010; 4:601-11. [PMID: 20932145 DOI: 10.1586/egh.10.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The incidence of cholangiocarcinoma is on the rise. This may be related in part to higher detection rates secondary to sophisticated endoscopic modalities. These tumors pose a significant diagnostic dilemma. High index of suspicion, careful interpretation of serum markers and utilization of endoscopic techniques, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, help to establish the diagnosis. Imaging modalities are crucial in the evaluation of these tumors. They help to define the extent of the native lesion, which may dictate its resectability, as well as evaluate for metastasis. Therapeutic options are somewhat limited, short of surgical resection. Newer chemotherapeutic agents, as well as endoscopy-targeted therapy, may improve the overall treatment success rate, although experience is somewhat limited at this time. Endoscopic intervention is essential for palliation.
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Affiliation(s)
- Muslim Atiq
- Divison of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, Houston, TX, USA
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18
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Juntermanns B, Radunz S, Heuer M, Hertel S, Reis H, Neuhaus JP, Vernadakis S, Trarbach T, Paul A, Kaiser GM. Tumor markers as a diagnostic key for hilar cholangiocarcinoma. Eur J Med Res 2010; 15:357-61. [PMID: 20947473 PMCID: PMC3458701 DOI: 10.1186/2047-783x-15-8-357] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 06/18/2010] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Hilar cholangiocarcinoma is the fourth most common gastrointestinal malignancy. CA19-9 and CEA are helpful devices in the management of gastrointestinal malignancies and belong to clinical routine in surgical oncology. But the validity of these parameters in terms of tumor extension and prognosis of bile duct malignancies still remains unclear. METHODS From 1998 to 2008, we obtained preoperative CA19-9 and CEA serum levels in 136 patients with hilar cholangiocarcinoma. We correlated tumor stage, resectability rate and survival with preoperative CA 19-9 and CEA serum levels. RESULTS CA19-9 (UICC I: 253 ± 561U/ml; UICC II: 742 ± 1572 U/ml; UICC III: 906 ± 1708 U/ml; UICC IV: 1707 ± 3053U/ml) and CEA levels (UICC I: 2.9 ± 3.8U/ml; UICC II: 4.6 ± 6.5 U/ml; UICC III: 18.1 ± 29.6 U/ml; UICC IV: 22.7 ± 53.9 U/ml) increase significantly with rising tumor stage. Patients with pre?operative serum levels of CA19-9 (>1000U/ml) and CEA (>14.4ng/ml) showed a significant poorer resectability rate and survival than patients with lower CA19-9 and CEA serum levels respectively. CONCLUSION CA19-9 and CEA serum levels are associated with the tumor stage. If preoperatively obtained CA19-9 and CEA serum levels are highly elevated patients have an even worse survival and the frequency of irresectability is significantly higher.
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Affiliation(s)
- B Juntermanns
- Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Germany
| | - S Radunz
- Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Germany
| | - M Heuer
- Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Germany
| | - S Hertel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Germany
| | - H Reis
- Institute of Pathology and Neuropathology, University Hospital of Essen, Germany
| | - JP Neuhaus
- Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Germany
| | - S Vernadakis
- Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Germany
| | - T Trarbach
- Department of Medicine, West German Cancer Centre, University Hospital of Essen, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Germany
| | - GM Kaiser
- Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Germany
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Abstract
Primary sclerosing cholangitis is a cholestatic liver disease characterized by inflammation and fibrosis of intra-/extrahepatic bile ducts, leading to multifocal strictures. Primary sclerosing cholangitis exhibits a progressive course resulting in cirrhosis and the need for liver transplantation over a median period of 12 years. The disease is frequently associated with inflammatory bowel disease and carries an increased risk of colorectal cancer and cholangiocarcinoma. Despite extensive research, there is currently no effective medical treatment. Multiple drugs are shown to be ineffective in halting disease progression, including ursodeoxycholic acid, the most widely evaluated drug. High-dose ursodeoxycholic acid (28-30 mg/kg/day) was recently shown to increase the adverse events rate. Endoscopic or radiological dilatation of a 'dominant' stricture may lead to symptomatic and biochemical improvement. However, liver transplantation is the only life-prolonging treatment for patients with end-stage disease. Studies with promising drugs, such as antibiotics, antifibrotic agents and bile acid derivatives, are eagerly awaited.
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Affiliation(s)
- Emmanouil Sinakos
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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20
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Liggett T, Melnikov A, Yi QL, Replogle C, Brand R, Kaul K, Talamonti M, Abrams RA, Levenson V. Differential methylation of cell-free circulating DNA among patients with pancreatic cancer versus chronic pancreatitis. Cancer 2010; 116:1674-80. [DOI: 10.1002/cncr.24893] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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21
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Waanders E, van Keimpema L, Brouwer JT, van Oijen MGH, Aerts R, Sweep FCGJ, Nevens F, Drenth JPH. Carbohydrate antigen 19-9 is extremely elevated in polycystic liver disease. Liver Int 2009; 29:1389-95. [PMID: 19515221 DOI: 10.1111/j.1478-3231.2009.02055.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Carbohydrate antigen 19-9 (CA19-9) is used as a biomarker to differentiate benign from malignant gastrointestinal disorders. We examined the value of CA19-9 measurement in polycystic livers after observing high CA19-9 cyst fluid levels in a benign polycystic liver case. METHODS We determined CA19-9 levels in serum (n=120) and hepatic cyst fluid (n=81), from patients with polycystic livers (n=109) and simple hepatic cysts (n=24). Further, we analysed CA19-9 expression in normal and polycystic liver tissue (n=17). RESULTS Cyst fluid CA19-9 levels from both polycystic livers and simple hepatic cysts were extremely high (median 91 000 U/ml, range 14-15 870 000 U/ml; median 85 000 U/ml, range 332-1 744 000 U/ml respectively). Serum CA19-9 levels were significantly higher in polycystic liver patients (median 30 U/ml, range 0-1200 U/ml) compared with patients with simple hepatic cysts (median 10 U/ml, range 3-200 U/ml, P=0.0011). Serum CA19-9 levels correlated with those in cyst fluid (r=0.3979, P=0.0399), polycystic liver volume (r=0.3870, P=0.0025) and the size of the largest cyst (simple cysts group; r=0.5319, P=0.0280). Cyst epithelia showed strong CA19-9 expression. Evacuation of cyst fluid in four patients resulted in a dramatic decrease in the serum CA19-9 levels (60-95%). CONCLUSIONS CA19-9 levels are high in the cyst fluid and serum of polycystic liver disease patients due to production and secretion by cyst epithelia. It does not reflect malignancy in these patients and may be of value as a biomarker for intervention efficiency assessment.
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Affiliation(s)
- Esmé Waanders
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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22
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Bennett JJ, Green RH. Malignant masquerade: dilemmas in diagnosing biliary obstruction. Surg Oncol Clin N Am 2009; 18:207-14, vii. [PMID: 19306807 DOI: 10.1016/j.soc.2008.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The hepatobiliary surgeon must be as familiar with the nonmalignant processes that can affect the extrahepatic biliary tree as they are with the malignant causes. Subtleties in the patient's history, presentation, and imaging studies may prevent unnecessary extensive hepatobiliary resection. The focus of this article deals with the etiology of nonmalignant obstruction at the biliary bifurcation and hilum and the mid-bile duct. It does not focus on either choledocholithiasis or pancreatitis, the two most common causes of distal bile duct obstruction. Obstruction from pancreatic cancer is also not the focus of this discussion.
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Affiliation(s)
- Joseph J Bennett
- Department of Surgical Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
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23
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Marrelli D, Caruso S, Pedrazzani C, Neri A, Fernandes E, Marini M, Pinto E, Roviello F. CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions. Am J Surg 2009; 198:333-9. [PMID: 19375064 DOI: 10.1016/j.amjsurg.2008.12.031] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 11/28/2008] [Accepted: 12/03/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obstructive jaundice is frequently associated with false CA19-9 elevation in benign conditions. The diagnostic accuracy of this tumor marker was evaluated in the present longitudinal study. METHODS In 128 patients admitted for obstructive jaundice (87 with pancreato-biliary malignancy and 41 benign disease) serum CA19-9 was measured. Statistical analysis of marker levels obtained before and after endoscopic biliary drainage was performed in 60 patients. RESULTS Elevated CA19-9 levels (>37 U/mL) were found in 61% of benign cases and 86% of malignancies. After biliary drainage, decrease of serum CA19-9 was observed in 19 of 38 malignant cases and in almost all benign cases (Wilcoxon matched pairs test: P = .207 and P <.001, respectively). Receiver operating characteristic (ROC) analysis identified a cut-off value of 90 U/mL to be associated with improved diagnostic accuracy after biliary drainage (sensitivity 61%, specificity 95%). CONCLUSIONS In the presence of successfully drained obstructive jaundice, CA19-9 serum levels that remain unchanged or measure more than 90 U/mL are strongly indicative of a malignant cause of obstruction. However, the real clinical utility of this marker remains controversial.
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Affiliation(s)
- Daniele Marrelli
- Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico Le Scotte, Siena, Italy.
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24
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Ong SL, Sachdeva A, Garcea G, Gravante G, Metcalfe MS, Lloyd DM, Berry DP, Dennison AR. Elevation of carbohydrate antigen 19.9 in benign hepatobiliary conditions and its correlation with serum bilirubin concentration. Dig Dis Sci 2008; 53:3213-7. [PMID: 18465243 DOI: 10.1007/s10620-008-0289-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Accepted: 04/09/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Carbohydrate antigen 19.9 (CA19.9), a tumor marker for malignancies of the hepatobiliary tract and pancreas, has frequently been shown to be deranged in a number of non-malignant conditions that are associated with jaundice. This study aims to demonstrate the correlation between CA19.9 and serum bilirubin concentration in patients with benign conditions and to determine the frequency of a false-positive increase in CA19.9 in patients being investigated for potential HPB malignancies. METHODS This is a retrospective review of 83 consecutive patients presenting with an abnormal CA19.9 and radiological or clinical features suggestive of HPB malignancy subsequently shown to have benign disease. All patients were thoroughly investigated and followed up until the diagnosis of malignancy could be safely excluded. RESULTS Serum bilirubin, sodium, lymphocyte count, neutrophil:lymphocyte ratio (NLR), beta-human chorionic gonadotrophin (HCG), and age were found to correlate with CA19.9 by Pearson's correlation (P = 0.001, P = 0.006, P = 0.006, P < 0.001, P = 0.012, and P = 0.049, respectively). In multivariate regression analysis, bilirubin was identified as an independent variable that may predict CA19.9 level (P = 0.028). CONCLUSION CA19.9 level is significantly influenced by serum bilirubin and elevated levels have been observed in patients with non-malignant HPB conditions. Adjusting CA19.9 according to bilirubin levels is likely to improve the specificity of this antigen in the differential diagnosis of benign and malignant HPB diseases and its reliability in the monitoring of disease response to chemotherapy.
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Affiliation(s)
- S L Ong
- Department of Hepatobiliary & Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE4 5PW, UK.
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25
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Ong SL, Garcea G, Puls F, Richards C, Mulcahy K, Grant A, Dennison AR, Berry DP. IgG 4-Positive Sclerosing Cholangitis Following Autoimmune Pancreatitis With Deranged CA19.9. Int J Surg Pathol 2008; 19:84-7. [DOI: 10.1177/1066896908319777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sclerosing cholangitis is an autoimmune condition characterized by lymphocytic infiltration within the biliary epithelium leading to multifocal stricturing of the biliary tree. Primary sclerosing cholangitis (PSC) is the most common type encountered clinically. However, a similar process may occur in conjunction with autoimmune pancreatitis (AIP), known as AIP-associated sclerosing cholangitis (AIP-SC). This subtype is associated with an elevated IgG4 level and the presence of a number of autoantibodies. AIP-SC shows good response to steroid treatment, distinguishing it clinically from PSC. The authors report a case of AIP-SC in a patient who had previously undergone a biliary bypass for AIP-induced chronic pancreatitis. The presentation of jaundice and grossly elevated tumor marker, CA19.9, raised the concern of malignancy. The uncertainty of the diagnosis was resolved when AIP-SC was confirmed on liver biopsy, with a concomitantly elevated serum IgG4 level. The disease went into remission with steroid treatment.
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Affiliation(s)
- Seok L. Ong
- University Hospitals of Leicester, Leicester, United Kingdom,
| | - Guiseppe Garcea
- University Hospitals of Leicester, Leicester, United Kingdom
| | - Florian Puls
- University Hospitals of Leicester, Leicester, United Kingdom
| | - Cathy Richards
- University Hospitals of Leicester, Leicester, United Kingdom
| | - Kevin Mulcahy
- University Hospitals of Leicester, Leicester, United Kingdom
| | - Allister Grant
- University Hospitals of Leicester, Leicester, United Kingdom
| | | | - David P. Berry
- University Hospitals of Leicester, Leicester, United Kingdom
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26
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Uygur-Bayramicli O, Dabak R, Orbay E, Dolapcioglu C, Sargin M, Kilicoglu G, Guleryuzlu Y, Mayadagli A. Type 2 dıabetes mellıtus and CA 19-9 levels. World J Gastroenterol 2007; 13:5357-9. [PMID: 17879406 PMCID: PMC4171326 DOI: 10.3748/wjg.v13.i40.5357] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To prospectively investigate serum CA 19-9 levels in type 2 diabetic patients in comparison with age- and gender-matched control subjects.
METHODS: We recorded duration of diabetes and examined fasting glucose levels, HbA1c levels and serum CA 19-9 levels in 76 type 2 diabetic patients and 76 controls. Abdominal CT was performed in order to eliminate abdominal malignancy in the diabetic and control groups.
RESULTS: The average CA 19-9 level was 46.0 ± 22.4 U/mL for diabetic patients whereas it was 9.97 ± 7.1 U/mL for the control group (P < 0.001 ). Regression analysis showed a positive correlation between diabetes and CA 19-9 independent from age, gender, glucose level and HbA1c level (t = 8.8, P < 001 ). Two of the diabetic patients were excluded from the study because of abdominal malignancy shown by CT at the initial evaluation. For all patients, abdominal CT showed no pancreatic abnormalities.
CONCLUSION: CA 19-9 is a tumor-associated antigen, which is elevated in pancreatic, upper gastrointestinal tract, ovarian hepatocellular, and colorectal cancers, as well as in inflammatory conditions of the hepatobiliary system, biliary obstruction and in thyroid diseases. Diabetes has been claimed to be a risk factor for pancreatic cancer, which is increasing its incidence and has one of the lowest survival rates of all cancers. CA 19-9 is used in the diagnosis of pancreatic cancer but is also a marker of pancreatic tissue damage that might be caused by diabetes. We propose that a higher cut-off value of CA 19-9 should be used in diabetics to differentiate benign and malignant pancreatic disease, and subtle elevations of CA 19-9 in diabetics should be considered as the indication of exocrine pancreatic dysfunction.
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