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
Research background

Tumor markers such as carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA 125), CA 242, and CA 19-9 have been widely used for the diagnosis of various types of cancer. Many researchers have focused on gallbladder cancer (GBC) and CEA or CA125, but no research has been carried out on all four markers together, especially in India.

Research motivation

This study focuses on the assessment of tumor markers CA 19-9, CEA, CA 125, and CA 242 for the early diagnosis and prognosis prediction of GBC.

Research objectives

The present study included patients with suspected GBC to assess different tumor markers separately and in combination, to determine their diagnostic accuracy and prognosis of GBC.

Research methods

This observational study was conducted in 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. All cases after surgical intervention were divided and grouped into two groups, the GBC group and benign GB disease group, according to histopathological examination findings. The cases were followed up and clinical findings, radiological findings, and tumor markers were assessed.

Research results

The key findings indicated that the median (interquartile range) age was 52.0 (41.0-60.0) years and 132 (66.0%) patients were women. The median levels of serum glutamic oxaloacetic transaminase (SGOT) (P = 0.001) and serum glutamic pyruvic transaminase (SGPT) (P = 0.012) were significantly higher in the GBC group than in the benign GBD group but were within the normal range in both groups. GB wall thickness was increased twofold in patients with GBC. Tumor markers including CA 19-9, CA 125, CEA, and CA 242 were significantly elevated in patients with GBC (P < 0.001). Serum levels of CA 19-9, CA 125, and CA 242 were significantly associated with age (P < 0.05). The sensitivity of CA 19-9 and CA 242 was comparatively higher than CEA and CA 125 in different stages of GBC. The sensitivity was 3.8% when all four markers exceeded the critical values. CA 242 had the highest sensitivity of 86.3%, and CA 125 had the highest specificity of 93.3% for the diagnosis of GBC. There was a significant reduction in tumor markers at 3 and 6 mo from baseline (P < 0.001).

Research conclusions

All four markers were important but in this study, CA 242 followed by CA 19-9 was most sensitive for the detection of GBC while CA125 was most specific for the diagnosis of GBC; however, CA 242 and CA 19-9 in combination were more specific and sensitive.

Research perspectives

Currently, there is only one study from China that has reported the combined use of these tumor markers to increase the diagnostic specificity and sensitivity for GBC. This study was conducted to make an early diagnosis of GBC on the basis of tumor markers, which itself will lead to better survival outcomes.