Prognostic Value of CA in Colorectal Cancer
19.9
Levels
XAVIER FILELLA, M.D.,* R. MOLINA, M.D.,* J. J. GRAU, M.D.,t J. M. PIQUE, M.D.,4 J. C. GARCIA-VALDECASAS, M.D.,§ E. ASTUDILLO, M.D.,§ A. BIETE, M.D., || J. M. BORDAS, M.D.,¶ A. NOVELL, M.D.,§ E. CAMPO, M.D.,# and A. M. BALLESTA, M.D.*
Pretreatment serum levels of carbohydrate antigen 19.9 (CA 19.9) and carcinoembryonic antigen were measured in 293 patients with colorectal cancer. Carbohydrate antigen 19.9 was above the cut-off limit of 37 U/mL in 35% of patients. Carbohydrate antigen 19.9 sensitivity was related to tumor stage. Carcinoembryonic antigen was above the cut-off level of 3.5 ng/mL in 61% of patients, and the simultaneous use of two markers increased sensitivity to 66%. The main use of pretreatment levels of CA 19.9 in locoregional cancer is in prognosis. Carbohydrate antigen 19.9 provided more prognostic information than that obtained by conventional staging methods. In patients with Dukes' C tumors, additional information was obtained for allocation of these patients into groups at low or high risk of recurrence. Prognostic significance of carcinoembryonic antigen was not independent of Dukes' classification.
From the Departments of Clinical Biochemistry (Unit of Cancer Research), * Oncology, t Gastroenterology, t Surgery, § Radiotherapy, || Endoscopy,¶ and Pathology, # Hospital Clinic i Provincial, Barcelona, Spain
Several studies have reported abnormal CA 19.9 serum levels in patients with colorectal cancer, as well as its relationship to Dukes' classification. The possible application ofCA 19.9 values in prognosis, however, is unknown. Likewise, the clinical usefulness of simultaneous CEA and CA 19.9 evaluation is not clear. The aim of this prospective study was to evaluate the sensitivity of CA 19.9 in patients with colorectal cancer, their relationship with Dukes' classification, tumor location and nodal involvement, as well as their prognostic significance. The sensitivity and prognostic value of CA 19.9 and CEA also were
T ^ UMOR MARKERS ARE useful tests in the management of patients with cancer.",2 Generally, tumor markers are not useful for diagnosis because of their low specificity and sensitivity. They are useful tests in the follow-up of neoplastic patients, however. Moreover, several authors propose tumor markers as a prognostic index in different tumors.35 The carcinoembryonic antigen (CEA) is the most commonly used tumor marker in patients with colorectal cancer. It use as an early diagnostic index for recurrence during follow-up after radical surgery has been well established by several authors.6-8 In the past 10 years, antibodies against many colorectal tumor antigens have been described. Carbohydrate antigen 19.9 (CA 19.9) is a tumor marker described by molecular hybridation techniques.9 This structure was identified by Magnani et al.'0 "' as a syalylated lacto-N-fucopentaose II, an oligosacharide related to Lewis A blood-group substance.
compared. Patients and Methods Pretreatment serum levels of CA 19.9 and CEA were measured in 293 patients with colorectal cancer. These patients were staged according to Dukes' classification modified by Astler and Coller.'2" 3 The group included four patients in stage A, 16 in stage B 1, 91 in stage B2, two in stage Cl, 94 in stage C2, 25 in stage Dl, and 61 in stage D2. The number of positive nodes was known in 81 of 96 patients in stage C. Forty-seven tumors were localized in the right colon (cecum and ascending colon), 34 tumors in the transverse colon (hepatic flexure, transverse colon, and splenic flexure), 127 tumors in the left colon (descending colon and sigmoid colon), and 85 tumors in the rectum. Carbohydrate antigen 19.9 was measured by a commercially solid-phase immunoradiometric method (Sorin, Saluggia, Italy). A cut-off value of 37 U/mL was used, as
Address reprint requests to Xavier Filella, M.D., Department of Clinical Biochemistry, Hospital Clinic i Provincial, Villarroel, 170, 08036 Barcelona, Spain. Accepted for publication September 12, 1991.
55
TABLE 1. Pretreatment Levels ofCA 19.9 in Patients with Colorectal Cancer >37 U/mL Stage
No.
No. (%)
A Bi B2 Total B Cl
4 16 91 107 2 94 96 25 61 86
1 2 (12.5) 16 (18) 18 (17) 0 33 (35) 33 (34) 8 (32) 42 (69) 50 (58) 102 (35)
C2 Total C Dl D2 Total D Total
Ann. Surg. JUlY 1992
FILELLA AND OTHERS
56
293
Mean
SD
Median
Value
19.9
Levels
XAVIER FILELLA, M.D.,* R. MOLINA, M.D.,* J. J. GRAU, M.D.,t J. M. PIQUE, M.D.,4 J. C. GARCIA-VALDECASAS, M.D.,§ E. ASTUDILLO, M.D.,§ A. BIETE, M.D., || J. M. BORDAS, M.D.,¶ A. NOVELL, M.D.,§ E. CAMPO, M.D.,# and A. M. BALLESTA, M.D.*
Pretreatment serum levels of carbohydrate antigen 19.9 (CA 19.9) and carcinoembryonic antigen were measured in 293 patients with colorectal cancer. Carbohydrate antigen 19.9 was above the cut-off limit of 37 U/mL in 35% of patients. Carbohydrate antigen 19.9 sensitivity was related to tumor stage. Carcinoembryonic antigen was above the cut-off level of 3.5 ng/mL in 61% of patients, and the simultaneous use of two markers increased sensitivity to 66%. The main use of pretreatment levels of CA 19.9 in locoregional cancer is in prognosis. Carbohydrate antigen 19.9 provided more prognostic information than that obtained by conventional staging methods. In patients with Dukes' C tumors, additional information was obtained for allocation of these patients into groups at low or high risk of recurrence. Prognostic significance of carcinoembryonic antigen was not independent of Dukes' classification.
From the Departments of Clinical Biochemistry (Unit of Cancer Research), * Oncology, t Gastroenterology, t Surgery, § Radiotherapy, || Endoscopy,¶ and Pathology, # Hospital Clinic i Provincial, Barcelona, Spain
Several studies have reported abnormal CA 19.9 serum levels in patients with colorectal cancer, as well as its relationship to Dukes' classification. The possible application ofCA 19.9 values in prognosis, however, is unknown. Likewise, the clinical usefulness of simultaneous CEA and CA 19.9 evaluation is not clear. The aim of this prospective study was to evaluate the sensitivity of CA 19.9 in patients with colorectal cancer, their relationship with Dukes' classification, tumor location and nodal involvement, as well as their prognostic significance. The sensitivity and prognostic value of CA 19.9 and CEA also were
T ^ UMOR MARKERS ARE useful tests in the management of patients with cancer.",2 Generally, tumor markers are not useful for diagnosis because of their low specificity and sensitivity. They are useful tests in the follow-up of neoplastic patients, however. Moreover, several authors propose tumor markers as a prognostic index in different tumors.35 The carcinoembryonic antigen (CEA) is the most commonly used tumor marker in patients with colorectal cancer. It use as an early diagnostic index for recurrence during follow-up after radical surgery has been well established by several authors.6-8 In the past 10 years, antibodies against many colorectal tumor antigens have been described. Carbohydrate antigen 19.9 (CA 19.9) is a tumor marker described by molecular hybridation techniques.9 This structure was identified by Magnani et al.'0 "' as a syalylated lacto-N-fucopentaose II, an oligosacharide related to Lewis A blood-group substance.
compared. Patients and Methods Pretreatment serum levels of CA 19.9 and CEA were measured in 293 patients with colorectal cancer. These patients were staged according to Dukes' classification modified by Astler and Coller.'2" 3 The group included four patients in stage A, 16 in stage B 1, 91 in stage B2, two in stage Cl, 94 in stage C2, 25 in stage Dl, and 61 in stage D2. The number of positive nodes was known in 81 of 96 patients in stage C. Forty-seven tumors were localized in the right colon (cecum and ascending colon), 34 tumors in the transverse colon (hepatic flexure, transverse colon, and splenic flexure), 127 tumors in the left colon (descending colon and sigmoid colon), and 85 tumors in the rectum. Carbohydrate antigen 19.9 was measured by a commercially solid-phase immunoradiometric method (Sorin, Saluggia, Italy). A cut-off value of 37 U/mL was used, as
Address reprint requests to Xavier Filella, M.D., Department of Clinical Biochemistry, Hospital Clinic i Provincial, Villarroel, 170, 08036 Barcelona, Spain. Accepted for publication September 12, 1991.
55
TABLE 1. Pretreatment Levels ofCA 19.9 in Patients with Colorectal Cancer >37 U/mL Stage
No.
No. (%)
A Bi B2 Total B Cl
4 16 91 107 2 94 96 25 61 86
1 2 (12.5) 16 (18) 18 (17) 0 33 (35) 33 (34) 8 (32) 42 (69) 50 (58) 102 (35)
C2 Total C Dl D2 Total D Total
Ann. Surg. JUlY 1992
FILELLA AND OTHERS
56
293
Mean
SD
Median
Value
