Assessment of tumor markers CA 19-9, CEA, CA 125, and CA 242 for the early diagnosis and prognosis prediction of gallbladder cancer

Seema Rani Sinha; Prem Prakash; Rakesh Kumar Singh; Dinesh Kumar Sinha

doi:10.4240/wjgs.v14.i11.1272

Assessment of tumor markers CA 19-9, CEA, CA 125, and CA 242 for the early diagnosis and prognosis prediction of gallbladder cancer

World J Gastrointest Surg. 2022 Nov 27;14(11):1272-1284. doi: 10.4240/wjgs.v14.i11.1272.

Authors

Seema Rani Sinha¹, Prem Prakash², Rakesh Kumar Singh³, Dinesh Kumar Sinha⁴

Affiliations

¹ Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna 800014, India.
² General Surgery, Indira Gandhi Institute of Medical Sciences, Patna 800014, India.
³ Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India.
⁴ Radiation Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna 800014, Bihar, India. drdineshkumarsinha@gmail.com.

Abstract

Background: Gallbladder cancer (GBC) is one of the leading and aggressive cancers in this region of India. It is very difficult to diagnose in the early stage, as it lacks typical early signs and symptoms; thus, the diagnosis is often in the advanced stage, which ultimately leads to a poor 5-year survival outcome. Tumor markers including carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), CA 125, CA 242, and alpha fetoprotein are used as indicators in the diagnosis and prognosis of GBC.

Aim: To compare tumor marker levels between GBC and benign GB diseases (GBDs) and to assess the combined use of tumor markers to increase the diagnostic accuracy for GBC.

Methods: Patients of either sex aged ≥ 18 years, with suspected GBC (GB polyp, irregular thick GB wall, GB mass, porcelain GB) on the basis of radiological imaging were included in this study. GB wall thickness using ultrasonography and tumor markers CEA, CA 125, CA 19-9, and CA 242 in all patients were recorded. All cases after surgical intervention were divided into two groups, GBC and benign GBD, according to histopathological examination findings. The cases were followed up and clinical findings, radiological findings, and levels of tumor markers were assessed.

Results: A total of 200 patients were included in this study, of whom 80 patients had GBC and 120 patients had benign GBD. The median (interquartile range) age was 52.0 (41.0-60.0) years and the majority of patients (132, 66.0%) were women. Tumor markers including CA 19-9, CA 125, CEA, and CA 242 were significantly elevated in patients with GBC (P < 0.001). There was a significant reduction in tumor markers at 3 and 6 mo from baseline (P < 0.001). The mean survival of patients with normal and elevated levels of tumor markers CA 125, CA 19-9, and CEA was comparable; however lymph node metastasis and CA 242 expression level were independent prognostic factors.

Conclusion: Serum levels of tumor markers including CA 19-9, CA 125, CEA, and CA 242 were significantly associated with GBC. However, no significant association was observed between the presence of elevated levels of any tumor marker with respect to survival. Tumor marker assessment during follow-up may represent a treatment response.

Keywords: Benign gallbladder; Benign lesions; Sensitivity; Specificity; Survival; Tumor markers.