Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.100820
Revised: January 20, 2025
Accepted: February 7, 2025
Published online: March 27, 2025
Processing time: 72 Days and 16.6 Hours
Early detection of rectal cancer poses significant challenges. Current diagnostic methods, including colonoscopy, imaging techniques, and fecal tests, have limitations such as invasiveness, cost, and varying sensitivity. This study evaluated the diagnostic value of preoperative serum tumor markers in rectal cancer patients.
To investigate the value of a multi-marker approach for the preoperative diagnosis of rectal cancer.
A retrospective analysis of 250 patients diagnosed with rectal cancer between July 2022 and July 2024 was conducted. Preoperative alpha-fetoprotein levels, carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), CA19-9, CA15-3, and CA72-4 were analyzed. All blood samples were collected under standardized conditions, including fasting status and proper storage methods, within two weeks before surgery. Diagnostic performance was assessed using receiver operating characteristic curve analysis. Correlations among clinicopathological features were also evaluated.
CEA demonstrated the highest diagnostic performance among individual tumor markers with an area under the curve (AUC) of 0.78 [95% confidence interval (CI): 0.73-0.83]. However, a combination of CEA, CA19-9, and CA72-4 showed superior performance, achieving an AUC of 0.87 (95%CI: 0.83-0.91). Significant correlations were observed between CEA levels and several clinicopathological features, including tumor stage (P < 0.001), lymph node involvement (P = 0.002), and distant metastasis (P < 0.001). Furthermore, in a subgroup analysis of patients diagnosed after July 2022, the integration of fecal occult blood testing with the tumor marker panel (CEA + CA19-9 + CA72-4) significantly improved diagnostic accuracy, increasing the AUC to 0.91 (95%CI: 0.86-0.96).
A multimarker approach combining CEA, CA19-9, and CA72-4 with fecal occult blood testing enhances the preoperative assessment of patients with rectal cancer. These findings suggest potential improvements in risk stratification and management of patients with rectal cancer.
Core Tip: This study highlights the effectiveness of a multi-marker approach for the preoperative diagnosis of rectal cancer. Analysis of serum levels of the tumor markers carcinoembryonic antigen, cancer antigen 19-9, and cancer antigen 72-4, along with fecal occult blood testing, demonstrated improved diagnostic accuracy, with an area under the curve of 0.91. Significant correlations between elevated carcinoembryonic antigen levels and clinicopathological features, such as tumor stage and lymph node involvement, suggest that this combined strategy could enhance the risk stratification and management of patients with rectal cancer, ultimately aiding in earlier detection and better clinical outcomes.