Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.706
Peer-review started: September 18, 2022
First decision: November 15, 2022
Revised: November 28, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 28, 2023
Processing time: 124 Days and 4.2 Hours
The diagnostic and economic value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and CA72-4 for gastrointestinal malignant tumors lacked evaluation in a larger scale.
To reassess the diagnostic and economic value of the three tumor biomarkers.
A retrospective analysis of all 32857 subjects who underwent CEA, CA19-9, CA72-4, gastroscopy and colonoscopy from October 2006 to May 2018 was conducted. Then, we assessed the discrimination and clinical usefulness. Total cost, cost per capita and cost-effectiveness ratios were used to evaluate the economic value of two schemes (gastrointestinal endoscopy for all people without blood tests vs both gastroscopy and colonoscopy when blood tests were positive).
The analysis of 32857 subjects showed that CEA was a qualified biomarker for colorectal cancer (CRC), while the diagnostic efficiencies of CA72-4 were catastrophic for all gastrointestinal cancers (GICs). Regarding early diagnosis, only CEA could be used for early CRC. The combination of biomarkers didn’t greatly increase the area under the curve. The economic indicators of CEA were superior to those of CA19-9, CA72-4 and any combination. At the threshold of 1.8 μg/L to 10.4 μg/L, all four indicators of CEA were lower than those in the scheme that conducted gas-trointestinal endoscopy only. Subgroup analysis implied that the health checkup of CEA for people above 65 years old was economically valuable.
CEA had qualified diagnostic value for CRC and superior economic value for GICs, especially for elderly health checkup subjects. CA72-4 was not suitable as a diagnostic biomarker.
Core Tip: This is a retrospective study to reassess the diagnostic and economic value of traditional tumor biomarkers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and CA72-4 for gastrointestinal malignant tumors in a large sample with novel indicators. Instead of increasing the diagnostic value, CA72-4 should be removed from the list of the health checkup items to avoid the waste of social medical resources for CEA were superior to those of CA19-9, CA72-4 or any other combinations in which it could be applied for early colorectal cancer and a health checkup of CEA for people above 65 years old was economically valuable.