ObjectiveTo study the preoperative evaluation value of serum tumor markers (CA72-4, CEA, CA199 and CA125) in patients with gastric cancer. MethodsSerum levels of tumor markers (CA72-4, CEA, CA199 and CA125) and clinical pathological data of 70 patients with gastric cancer before operation who underwent surgical treatment in the Gastrointestinal Surgery Department of Second Affiliated Hospital of Kunming Medical University in June 2013 to 2014 June were retrospectively analyzed. ResultsThere were some connection between the concentration of the serum CA72-4 and the tumor diameter, TNM staging, invasion depth, and the number of lymph node metastasis (P < 0.05), between CA199 and tumor size, TNM staging, and invasion depth (P < 0.05), between CEA, CA125 and tumor diameter, TNM staging and distant metastasis (P < 0.05), but the CA72-4, CA72-4, CEA and CA125 had nothing to do with patient' age and gender. ConclusionThe serum tumor markers of CA724, CEA, CA199, and CA125 have clinical application value in preoperative evaluation of gastric cancer.
Objective To investigate the diagnostic value of tumor marker combining the probability of malignancy model in pulmonary nodules. Methods A total of 117 patients with pulmonary nodules diagnosed between January 2013 and January 2016 were retrospectively analyzed. Seventy-six cases of the patients diagnosed with cancer were selected as a lung cancer group. Forty-one cases of the patients diagnosed with benign lesions were selected as a benign group. Tumor markers were detected and the probability of malignancy were calculated. Results The positive rate of carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), neuron-specific enolase (NSE), cytokeratin marker (CYFRA21-1), and the probability of malignancy in the lung caner group were significantly higher than those of the benign group. The sensitivity, specificity, and accuracy of CEA, CA125, NSE, CYFRA21-1 combined detection were 72.37%, 73.17%, and 72.65%, respectively. Using the probability of malignancy model to calculate each pulmonary nodules, the area under ROC curve was 0.743 which was higher than 0.7; and 28.5% was selected as cut-off value based on clinical practice and ROC curve. The sensitivity, specificity, and accuracy of the probability of malignancy model were 63.16%, 78.05%, and 68.68%, respectively. The sensitivity, specificity, and accuracy of tumor marker combining the probability of malignancy model were 93.42%, 68.29%, and 92.31%, respectively. The sensitivity and accuracy of tumor marker combining the probability of malignancy model were significantly improved compared with tumor markers or the probability of malignancy model single detection (P<0.01). Conclusion The tumor marker combining the probability of malignancy model can improve the sensitivity and accuracy in diagnosis of pulmonary nodules.
Objective To investigate the value of tumor type M2 pyruvate kinase ( M2-PK) in the differential diagnosis of pleural effusion. Methods A total of 146 patients with pleural effusion during January 2006 to December 2008 were recruited at the department of respiratory medicine of the Shantou Affiliated Hospital and the First Affiliated Hospital of Sun Yat-sen Medical College. Pleural effusion was malignant in 72 cases ( 52 cases with lung cancer and 20 cases with metastatic lung cancer) and benign in 74 cases ( 54 cases with infective pleural effusion and 20 with transudation effusion) . The patients were divided into a malignant pleural effusion group, an infective pleural effusion group, and a transudation group.Then the infective group was further divided into subgroups of tuberculosis pleural effusion group andparapneumonic effusion group. The concentration of tumor M2-PK in pleural fluid obtained during the first thoracocentesis was measured by enzyme-linked immunosorbent assay( ELISA) . Results The concentration of tumor M2-PK was significantly higher in the malignant pleural effusion group compared with the benignpleural effusion groups ( P lt; 0. 01) . Significant differences were also found in the concentration of tumor M2-PK between malignant pleural effusion caused by lung cancer and metastatic lung cancer( P lt; 0. 05) .When the cutoff value of tumor M2-PK was set at 18. 68 U/mL, the sensitivity, specificity, and accuracy for the diagnosis of malignant pleural effusion was 87. 6% , 86. 0% , and 87. 4%, respectively. Furthermore,the detection of tumor M2-PK in combination with CEA showed better diagnostic sensitivity( 96. 0% ) ,specificity ( 85. 0% ) , and accuracy ( 91. 1% ) . Conclusions The detection of tumor M2-PK in pleural effusion is of some clinical significance in the differential diagnosis of benign and malignant pleural effusion.The detection of tumor M2-PK in combination with CEA is a good diagnostic tool with high sensitivity andspecificity.
Objective To evaluate the diagnostic value of serum pro-gastrin-releasing peptide (Pro-GRP) in patients with small cell lung cancer. Methods We searched MEDLINE, EMBASE, The Cochrane Library and other databases (1966 to Sept 2009) to collect studies which evaluated the diagnostic value of Pro-GRP in patients with small cell lung cancer. The heterogeneity of the included studies was tested by the Cochrane Collaboration’s software RevMan 4.2. The Summary Receiver Operating Characteristic (SROC) curve and meta-analyses were performed by MetaDisc. Results A total of 256 relevant articles were retrieved and 19 were included in our review. Eleven studies involving 1 447 patients were included. Meta-analyses showed that the heterogeneity among studies was high (P﹤0.000 01, I2=69.3%), the pooled sensitivity was 0.717 and the pooled specificity was 0.963. Subgroup analyses indicated that 9 of the studies which used the LD (Limited diseases) SCLC group (P=0.003, I2=65.5%, SEN=0.637, SPE=0.968, SROC AUC=0.724 3) had heterogeneity and ED (Extensive diseases) SCLC group (P=0.2, I2=27.0%, SEN=0.766, SPE=0.968, SROC AUC=0.935 5) had no heterogeneity. And 15 of the studies of Pro-GRP which were determined by acmmercial sandwich ELISA (Japan) group (P=0.000 1, I2=68.5%) had heterogeneity. Three of the studies of Pro-GRP which were determined by ELISA (Germany) group (P=0.948 7, I2=0.001%) had no heterogeneity. Conclusion Pro-GRP could be regarded as one of the reference tests in patients with small cell lung cancer, but higher quality trials are required.
Objective To systematically review the diagnostic value of combined detection of K-ras gene mutation in peripheral blood and serum tumor markers for pancreatic cancer. Methods Databases including PubMed, The Cochrane Library (Issue 3, 2016), Elsevier, BMJ, CBM, CNKI and WanFang Data were searched from 2000 to March 2016 to collect diagnostic tests about the diagnostic value of combined detection of K-ras gene mutation in peripheral blood and serum tumor markers in pancreatic cancer. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 23 studies involving 2?071 patients were included. The results of meta-analysis showed that the sensitivity (SE) and specificity (SP) of K-ras gene mutation in peripheral blood were 65% and 92% respectively in the diagnosis for pancreatic cancer. The results of the detection of tumor marker CA19-9 were 78% and 81% respectively. The SE and SP indexes in the parallel and serial combinations of CA19-9 together with CA242 were 85%, 72%, 70% and 83% respectively. And the SE, SP indexes in the parallel and serial combinations of K-ras gene mutation combined detection with CA19-9 were 90%, 63%, 47% and 96%. The positive likelihood ratio of the parallel combination of K-ras gene mutation in peripheral blood and CA19-9 (+LR=10.89) was higher than the other three detection methods, while the negative likelihood ratio of the serial combination of K-ras gene mutation in peripheral blood and CA19-9 (-LR=0.15) was lower than the other three detection methods, which indicated that the combined detection of K-ras gene mutation in peripheral blood and and CA19-9 had a better diagnostic performance than the single dectection of K-ras gene mutation or CA19-9 or the combined detection of CA19-9 and CA242 respectively. Comparing the area under curve (AUC) of SROC curve of the two combined diagnoses, the results showed that the diagnostic value of the parallel combination of K-ras gene mutation in peripheral blood and CA19-9 (AUC=0.87) was higher than that of the parallel combination of serum tumor markers CA19-9 and CA242. Conclusion Current evidence indicates that the combined detection of K-ras gene mutation and and tumor marker CA19-9 levels in peripheral blood can improve the diagnostic accuracy for pancreatic cancer. Due to the limited quantity and quality of included studies, above conclusions need to be verified by conducting more high quality studies.
ObjectiveTo systematically review the value of human epididymis protein 4 (HE4) in early diagnosis of endometrial cancer. MethodsDatabases including The Cochrane Library (Issue 1, 2013), PubMed, MEDLINE (Ovid), CNKI, CBM and WanFang Data were electronically searched for relevant studies on HE4 versus the golden standard (pathological examination) in the diagnosis of endometrial cancer from inception to April 2013. Meanwhile, relevant journals were also manually searched. Two reviewers independently screened literature according to the inclusion and exclusion criteria, and evaluated the included studies using the QUADAS items. Then, meta-analysis was performed using RevMan 5.1 and Meta-DiSc 1.0. ResultsFinally, a total of 16 studies involving 2 299 women (1 088 endometrial cancer patients diagnosed according to the golden standard, of which, 504 with benign uterine disease and 707 with normal cervical) were included. The results of meta-analysis showed that, as for HE4 in early diagnosis of endometrial cancer (SEN=57%, 95%CI 0.54 to 0.60; SPE=92%, 95%CI 0.91 to 0.94; +LR=6.92, 95%CI 5.00 to 9.58;-LR=0.46, 95%CI 0.39 to 0.55; DOR=18.38, 95%CI 12.21 to 27.69; AUC=0.881 7). ConclusionThe current study indicates that serum HE4 is more sensitive and low specific when applied in patients with endometrial cancer, which is worth of being used in clinic. Due to the limitation of low quality of the included studies, more high quality trials are required to verify the above conclusion.
ObjectiveTo investigate the diagnosis, treatment, and prognosis of the postoperative intestinal obstruction of gastrointestinal cancer. MethodThe clinical data of 58 patients with postoperative intestinal obstruction of gastrointestinal cancer from January 2011 to January 2013 were analyzed retrospectively. ResultsIn 58 patients with postoperative intestinal obstruction, there were 46 cases of incomplete intestinal obstruction, 12 cases of complete obstruction. Seventeen cases were treated conservatively and 41 cases were accepted laparotomy. The surgical exploration found that there were 4 cases of strangulated abdominal internal hernia, 4 cases of volvulus, 1 case of stercoral obstruction, 2 cases of intussusception, 9 cases of adhesive intestinal obstruction, and 21 cases of tumor recurrence. There were 32 patients with high tumor markers before laparotomy, including 19 cases of tumor recurrence. Fourteen cases had no obvious tumor lesions detected by PET-CT, but recurrence and metastasis were found by surgical exploration. ConclusionsThe recurrent postoperative intestinal obstruction of gastrointestinal cancer mostly means recurrence and metastasis, with poor prognosis. Early laparotomy may improve the prognosis and the quality of life, elevated tumor markers have some links with tumor recurrence and PET-CT is not sensitive for multiple nodular metastases.
Objective To evaluate diagnostic value of tumor marker — the serum neuron specific enolase (NSE) in patients with suspected small cell lung cancer with lung pathological diagnosis as the gold standard. Methods A search in The Cochrane Library, PubMed, OVID, MEDLINE, EMbase, Cancerlit, China National Knowledge Infrastructure (CNKI), and CBM, was conducted from 1966 to 2008. Hand searches and additional searches were also conducted. Criteria for inclusion were established based on validity criteria for diagnostic research published by the Cochrane Methods Group on Screening and Diagnostic Tests. Subsequently, the characteristics of the included articles were appraised and extracted. Statistical analysis was performed employing Revman 4.2 software. Heterogeneity of the included articles was tested, which was used to select the proper effect model to calculate pooled weighted sensitivity and specificity. The Summary Receiver Operating Characteristic (SROC) curve was performed and the area under the curve (AUC) was calculated. Finally, sensitivity analysis was performed. Results Six articles entered this meta-analysis: four English articles, one Japanese article and one Chinese article. The quality level of the articles was C. the studies involving 2,366 patients (579 SCLC and 1,847 NSCLC patients that were diagnosed by using the gold standard) were included. The meta-analysis reported that the heterogeneity among studies was high (P=0.005, I2=70.4%), pooled sensitivity was 0.59, 95%CI 0.55 to 0.64, and pooled specificity was 0.88, 95%CI 0.87 to 0.90. The likelihood ratio was 8.17 and 0.31, respectively. The summary ROC of the meta-disc software and the area under the curve was 0.905 0. These data suggested that NSE had a relatively high false negative rate (41%) and a relatively low false positive rate (12%). Conclusion The tumor marker NSE is has diagnostic value of small cell lung cancer, but more high quality trials are required.
Objective To study the usefulness of combined detection of 4 tumor markers in patients with recrudescent and metastatic breast cancer. Methods The serum levels of CA153, CEA, TPS and CA125 were determined by chemiluminescence immunoassay. A total of 1245 subjects entered the study. Sensitivities of the tests were evaluated in 1 000 patients with breast cancer (102 preoperative patients and 898 postoperative patients) and 245 with benign breast disease. Results The serum levels of CA153, CEA and TPS were significantly elevated in preoperative patients compared with metastatic patients (Plt;0.001). The serum levels of CA153, CEA, TPS and CA125 were significantly elevated in metastatic patients compared with non-metastatic patients (Plt;0.001). The sensitivity of the 4 tumor markers were significantly elevated in metastatic patients compared with preoperative and postoperative non-metastatic patients (Plt;0.05). The sensitivity of combined detection of the 4 tumor markers were 56.72% and 94.68% in preoperative patients and metastatic patients, respectively. The CEA elevation was bly correlated with CA153 and TPS levels (all P=0.000 1, r=0.410 and 0.396, respectively). Conclusion Combined detection of the 4 tumor markers may play a guiding role in post-therapeutic monitoring of breast cancer in progressive, recrudescent and metastatic patients.
Objective To evaluate the diagnostic value of serum neuron specific enolase (NSE) in patients with small cell lung cancer. Methods We searched MEDLINE, EMBASE, The Cochrane Library and other databases (1966 to March 2007) to collect studies which evaluated the diagnostic value of NSE in patients with small cell lung cancer. The heterogeneity of included studies was tested by the Cochrane Collaboration’s software RevMan 4.2. The Summary Receiver Operating Characteristic (SROC) curve and meta-analyses were performed by MetaDisc. Results Fifteen studies involving 4221 patients (672 SCLC and 3549 NSCLC patients, all diagnosed by the gold standard) were included. Meta-analyses showed that the heterogeneity among studies was high (P=0.000 2, I2=66.1%), the pooled sensitivity was 0.67 (95%CI 0.64 to 0.71) and the pooled specificity was 0.91 (95%CI 0.90 to 0.92). Subgroup analyses indicated that 4 of the studies which used the reagent supplied by The Academy of Military Medical Sciences (P=0.33, I2=13.4%, AUC= 0.9672, SE=0.0393) and another 4 which used the reagent supplied by Roche (P=0.23, I2=29.9%, AUC=0.8311, SE=0.0836) had no heterogeneity. Conclusion NSE could be regarded as one of the reference tests in patients with small cell lung cancer, but more high quality trials are required.