Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1272
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
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.
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.
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.
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.
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).
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.
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.