Liu HN, Yao C, Wang XF, Zhang NP, Chen YJ, Pan D, Zhao GP, Shen XZ, Wu H, Liu TT. Diagnostic and economic value of carcinoembryonic antigen, carbohydrate antigen 19-9, and carbohydrate antigen 72-4 in gastrointestinal cancers. World J Gastroenterol 2023; 29(4): 706-730 [PMID: 36742169 DOI: 10.3748/wjg.v29.i4.706]
Corresponding Author of This Article
Tao-Tao Liu, MD, Doctor, Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. liu.taotao@zs-hospital.sh.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 28, 2023; 29(4): 706-730 Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.706
Diagnostic and economic value of carcinoembryonic antigen, carbohydrate antigen 19-9, and carbohydrate antigen 72-4 in gastrointestinal cancers
Hai-Ning Liu, Can Yao, Xiao-Fan Wang, Ning-Ping Zhang, Yan-Jie Chen, Dong Pan, Guo-Ping Zhao, Xi-Zhong Shen, Hao Wu, Tao-Tao Liu
Hai-Ning Liu, Xiao-Fan Wang, Ning-Ping Zhang, Yan-Jie Chen, Xi-Zhong Shen, Hao Wu, Tao-Tao Liu, Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Can Yao, Department of Gastroenterology and Hepatology, Minhang District Central Hospital, Fudan University, Shanghai 201199, China
Dong Pan, Department of Internet Technology Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Guo-Ping Zhao, Chinese National Human Genome Center at Shanghai, Zhujiang Hospital, Central Lab, Institute of Plant Physiology and Ecology, Shanghai Institute for Biological Sciences, Shanghai 200032, China
Author contributions: Liu HN, Yao C, and Wang XF contributed equally to this work; Liu HN, Wu H, and Liu TT conceived and designed the experiments; Liu HN, Yao C, and Wang XF drafted the manuscript; Liu HN, Yao C, Wang XF, and Pan D extracted the data; Liu HN, Zhang NP, and Chen YJ performed the statistical analyses; Zhao GP and Shen XZ revised the article; all authors finished reading and approving the final manuscript of this study.
Institutional review board statement: The study was reviewed and approved by the Zhongshan Hospital of Fudan University Institutional Review Board (Approval No. B2018-234).
Informed consent statement: The informed consent was waived from the patients.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at liu.taotao@zs-hospital.sh.cn. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tao-Tao Liu, MD, Doctor, Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. liu.taotao@zs-hospital.sh.cn
Received: September 18, 2022 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
Abstract
BACKGROUND
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.
AIM
To reassess the diagnostic and economic value of the three tumor biomarkers.
METHODS
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).
RESULTS
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.
CONCLUSION
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.
