Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2022; 14(11): 1272-1284
Published online Nov 27, 2022. 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
Seema Rani Sinha, Prem Prakash, Rakesh Kumar Singh, Dinesh Kumar Sinha
Seema Rani Sinha, Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
Prem Prakash, General Surgery, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
Rakesh Kumar Singh, Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
Dinesh Kumar Sinha, Radiation Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna 800014, Bihar, India
Author contributions: Sinha DK was the guarantor and designed the study; Sinha SR, Prakash P, and Singh RK participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Sinha SR, Prakash P, Singh RK, and Sinha DK revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by Institutional Ethics Committee vide letter (Approval No. 479/IEC/2018/IGIMS).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dinesh Kumar Sinha, MD, Additional Professor, Radiation Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Sheikhpura, IGIMS, Patna 800014, Bihar, India. drdineshkumarsinha@gmail.com
Received: July 13, 2022
Peer-review started: July 13, 2022
First decision: July 31, 2022
Revised: August 20, 2022
Accepted: October 12, 2022
Article in press: October 12, 2022
Published online: November 27, 2022
Processing time: 135 Days and 0.5 Hours
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; Tumor markers; Survival; Benign lesions; Sensitivity; Specificity

Core Tip: Gallbladder cancer (GBC) is one of the leading and aggressive cancers, which is often diagnosed in the advanced and metastatic stage as it lacks typical early signs and symptoms. This study assessed the different tumor markers separately and in combination, to determine the diagnostic accuracy of these markers and prognostic significance in GBC. The level of tumor markers was significantly elevated in GBC. There was no association between the presence of elevated levels of any marker and survival; however, it showed response to treatment with a significant reduction in tumor markers at 3 mo and 6 mo.