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
Studies showed that blood carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) could be used to diagnose gastric cancer (GC) and colorectal cancer (CRC). Blood CA72-4 could be a potential biomarker to diagnose GC and CRC. A positive result in blood test would lead the subject to undergo further examinations.
Large-scale clinical application showed an extremely high false positive rate of CA72-4 for diagnosis, which leads to the waste of medical resources and heave social medical burden. The massive data and real-world diagnostic cohorts make it possible to further explore the diagnostic and economic value of biomarkers.
Through a real-world diagnostic cohort, we aimed to reassess the diagnostic and economic value of CEA, CA19-9, and CA72-4 for gastrointestinal malignant tumors in a large sample.
Data from patients the medical examination center, outpatient department or inpatient department of Zhongshan Hospital of Fudan University from October 2006 to May 2018 were retrospectively evaluated. Four economic indicators were used to evaluate the economic value of tumor biomarkers. The diagnostic value of the three biomarkers was further evaluated.
The clinical benefits of CEA were higher than those of CA19-9, while the clinical benefits of CA72-4 were the lowest. The combination of biomarkers in the CRC and gastrointestinal malignant tumors significantly increased the AUC by less than 0.3, while that in GC did not. Compared to the economic indicators of the single biomarker CEA, the combination of biomarkers is not superior. 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 gastrointestinal 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 gastrointestinal cancers, especially for health checkup subjects above 65 years old while CA72-4 was not suitable as a diagnostic biomarker.
In real world, many people undergo only blood tests but not gastrointestinal endoscopy when receiving a health checkup. Those undergone gastrointestinal endoscopy were at a higher risk of digestive diseases, which leads to an inevitable selection bias. Future researches may emphasize on the involvement of patients with normal CEA, CA19-9, CA72-4 Levels to decrease the number of false negative subjects.