Ann Surg Treat Res.  2021 Nov;101(5):266-273. 10.4174/astr.2021.101.5.266.

Limits of serum carcinoembryonic antigen and carbohydrate antigen 19-9 as the diagnosis of gallbladder cancer

• Kang JS
• Hong SY
• Han Y
• Sohn HJ
• Lee M
• Kang YH
• Kim HS
• Kim H
• Kwon W
• Jang JY

• KMID: 2521848
• DOI: http://doi.org/10.4174/astr.2021.101.5.266

Abstract

Purpose
Although serum CEA and CA 19-9 have been widely utilized for the diagnosis of gallbladder cancer (GBC), few studies have examined the diagnostic performance of them. This study aimed to investigate the diagnostic performance of these 2 biomarkers and demonstrate their clinical usefulness in diagnosing GBC.
Methods
Between January 2000 and March 2020, a total of 751 GBC patients and 2,310 normal controls were included. Serum CEA and CA 19-9 were measured preoperatively. Receiver operating characteristic curves were obtained, and the sensitivity and specificity of each biomarker were evaluated.
Results
In terms of differentiating GBC from the control, the sensitivity and specificity of serum CEA at 5 ng/mL was 12.1% and 99.1%, respectively, and those of serum CA 19-9 at 37 IU/mL were 28.7% and 94.5%, respectively. The optimal cutoff values of CEA and CA 19-9 were set to 2.1 ng/mL and 26 IU/mL in the receiver operating characteristic curves, respectively. The sensitivities of CEA and CA 19-9 at new cutoff values slightly increased but remained low (CEA, 42.9%; CA 19-9, 38.2%). When differentiating early-stage GBC from advanced tumor, the sensitivity and specificity, were 14.2% and 96.1% for CEA (cutoff value, 5 ng/mL) and 33.6% and 90.1% for CA 19-9 (cutoff value, 37 IU/mL), respectively.
Conclusion
Serum CEA and CA 19-9 levels are not suitable for screening GBC patients from controls. New promising biomarkers with higher sensitivity should be explored.

Keyword

Biomarkers; Diagnosis; Gallbladder; Sensitivity and specificity

Figure

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  Fig. 1 Distribution of serum biomarkers at the preoperative period. (A) Log-transformed CEA level. (B) Log-transformed serum CA 19-9 level.

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  Fig. 2 Distribution of log-transformed serum CA 19-9 level according to the American Joint Committee Cancer 7th cancer staging.

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  Fig. 3 Receiver operating characteristics (ROC) curve of 2 tumor markers for diagnostic gallbladder cancer. The optimal cutoff value was determined at the point on the ROC curve with the highest vertical distance from the 45° diagonal line. The optimal cutoff value was 2.1 ng/mL of CEA (A) and 26 IU/mL of CA 19-9 (B).

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