Cheng Y, Sun YS, He YM. ST2, PIVKA-II, CEA, CA125 and their combinations in elderly liver metastases cancers: Development of a diagnostic scoring model. World J Gastrointest Oncol 2026; 18(7): 118940 [DOI: 10.4251/wjgo.v18.i7.118940]
Corresponding Author of This Article
Yun Cheng, Research Fellow, Department of Integrated Traditional Chinese Medicine and Western, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, No. 42 Baiziting, Nanjing 210009, Jiangsu Province, China. chengyun_nj@163.com
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Oncology
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Cheng Y, Sun YS, He YM. ST2, PIVKA-II, CEA, CA125 and their combinations in elderly liver metastases cancers: Development of a diagnostic scoring model. World J Gastrointest Oncol 2026; 18(7): 118940 [DOI: 10.4251/wjgo.v18.i7.118940]
World J Gastrointest Oncol. Jul 15, 2026; 18(7): 118940 Published online Jul 15, 2026. doi: 10.4251/wjgo.v18.i7.118940
ST2, PIVKA-II, CEA, CA125 and their combinations in elderly liver metastases cancers: Development of a diagnostic scoring model
Yun Cheng, Yan-Sha Sun, Yong-Ming He
Yun Cheng, Yong-Ming He, Department of Integrated Traditional Chinese Medicine and Western, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, Jiangsu Province, China
Yan-Sha Sun, Department of Oncology, Huai’an Hospital of Huai’an City, Huai’an 223200, Jiangsu Province, China
Author contributions: Cheng Y was responsible for research design, funding application, data analysis, review and editing, communication and coordination, ethical review, copyright and licensing, and follow-up; Sun YS, He YM were responsible for data analysis and paper writing; He YM participated in research design; and all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, approval No. KY-2025-028.
Informed consent statement: All research participants or their legal guardians provided written informed consent prior to study registration.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No other data available.
Corresponding author: Yun Cheng, Research Fellow, Department of Integrated Traditional Chinese Medicine and Western, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, No. 42 Baiziting, Nanjing 210009, Jiangsu Province, China. chengyun_nj@163.com
Received: January 30, 2026 Revised: February 12, 2026 Accepted: April 1, 2026 Published online: July 15, 2026 Processing time: 156 Days and 12.3 Hours
Abstract
BACKGROUND
Liver metastasis worsens prognosis in elderly colorectal and lung cancer patients, yet early diagnosis is hindered by atypical symptoms and suboptimal biomarker sensitivity. Soluble growth-stimulating gene 2 (ST2), protein induced by vitamin K absence or antagonist-II (PIVKA-II), carcinoembryonic antigen (CEA), and carbohydrate antigen 125 (CA125) have each been implicated in tumor progression and hepatic microenvironment remodeling, but their synergistic diagnostic value in this population remains unevaluated. We hypothesize that integrating these four serum markers with clinical risk factors into a weighted scoring model will improve diagnostic accuracy and enable reliable risk stratification in elderly patients.
AIM
To identify optimal biomarkers and develop a diagnostic scoring model for elderly liver metastatic cancers.
METHODS
This retrospective study enrolled 480 elderly patients with colorectal or lung cancer. Patients were randomly divided 7:3 into construction (n = 336) and validation (n = 144) sets. Univariate analysis and binary logistic regression identified independent risk factors for liver metastases. A scoring model incorporating ST2, PIVKA-II, CEA, CA125, and fatty liver history was developed. Model performance was assessed using receiver operating characteristic curves, area under the curve, calibration curves, and C-index.
RESULTS
Serum ST2, PIVKA-II, CEA, and CA125 levels and fatty liver history were significantly higher in the liver metastasis group (P < 0.05). All five were confirmed as independent risk factors for liver metastasis (P < 0.05). The ST2 + PIVKA-II + CEA + CA125 combination achieved the optimal balance between sensitivity and specificity. A scoring model was developed: Fatty liver history (2 points), ST2 ≥ 64.34 pg/mL (2), PIVKA-II ≥ 40 mAU/mL (3), CEA ≥ 5.7 ng/mL (3), CA125 ≥ 35 U/mL (2). Liver metastasis incidence increased with risk level: Low (0-5 points), intermediate (6-9), and high (10-12). The C-index was 0.840 in the construction group and 0.786 in the validation group, with calibration curves closely matching ideal curves.
CONCLUSION
The combined four-marker panel and novel scoring model effectively predict liver metastasis risk, offering a reliable tool for early diagnosis and risk stratification in elderly patients.
Core Tip: Based on the logistic regression analysis, a risk scoring model incorporating soluble growth-stimulating gene 2, protein induced by vitamin K absence or antagonist-II, carcinoembryonic antigen, carbohydrate antigen 125, and fatty liver history was developed to predict liver metastasis in elderly colorectal and lung cancer patients. The soluble growth-stimulating gene 2 + protein induced by vitamin K absence or antagonist-II + carcinoembryonic antigen + carbohydrate antigen 125 combination achieved the optimal diagnostic balance (area under the curve = 0.896), with specificity reaching 98.42%. Risk stratification significantly correlated with metastasis incidence (93.2% in high-risk vs 10.4% in low-risk). This quantitative model provides a simple, non-invasive tool for early identification of high-risk patients, facilitating personalized surveillance and timely intervention.
