담도 및 췌장 악성종양에서의 CA19-9의 진단적 가치에 대한 평가

명승재(Sung Jae Myung),최승목(Sung Mok Choi),김은옥(Eun Ok Kim),최호순(Ho Soon Choi),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),민영일(Young Il Min),류진숙(Jin Sook Ryu) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.3

N/A Background/Aims: The CA19-9 is a tumor marker used for gastrointestinal tumors, especially pancreatic cancer and biliary tract malignancy. However, it was also reported that there are some CA19-9 positive parients with benign diseases. The aim of this study is to evaluate the diagnostic value of CA19-9 in malignant and benign pancreaticobiliary diseases. Methods: Serum CA19-9 levels were measured by radioimmunoassay in 514 patients (biliary diseases: 154, pancreatic diseases: 96, others: 264) who visited Asan Medical Center from February 1993 to February 1994. Results: The positive rates(>37U/ml) of CA19-9 were 67.3% and 47.9% in malignant and benign biliary diseases, 69.6% and 14.8% in malignant and benign pancreatic diseases, 21.3% and 20.0% in other malignant and benign diseases, respectively. The value of CA19-9 in benign biliary disease was significantly more elevated in the patients with cholangitis (median 65.5 U/ml) than patients without cholangitis (median 17.0 U/ml)(p0.01). In patients with benign and malignant biliary diseases, there was a positive correlation between CA19-9 and parameters representing biliary obstruction(alkaline phosphatase and bilirubin). In 7 patients with gallstone disease CA19-9 levels were significantly decreased after stone removal(p( 0.05). Follow-up levels of CA19-9 in 35 patients with biliary malignancy were also decreased after treatment(curative resection in 30 patients, chemotherapy in 2 patients, radiotherapy in 2 patients and management of cholangitis in 1 patient, respectively)(p(0.05). Sensitivity of CA19-9 at a cutoff value of 37 U/ml in pancreatic cancer was 69.6%, biliary malignancy 67.3%. Specificity in pancreatic cancer was 85.2%, biliary malignancy 52.1%. Positive predictive value in pancreatic cancer was 92.3%, biliary malignancy 65.3%. Conclusions: The measurement of CA19-9 can be used as an adjunctive test in the differential diagnosis of malignant and benign pancreaticobiliary diseases. On interpretation of an increased value of CA19-9 in these patients we should consider various conditions such as cholangitis or biliary obstruction with false positive value. (Korean J Gastroenterol 1995;27:347 - 355)

췌담도 악성 종양 진단시 임상 상태를 고려한 개별적인 CA19-9 기준치의 적용 및 그 유용성; Receiver Operating Characteristic Curve를 이용한 분석

김홍자,명승재,원선영,최원범,이정희,박철성,윤광희,김석균,남승우 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.32 No.5

High preoperative serum CA 19-9 levels can predict poor oncologic outcomes in colorectal cancer patients on propensity score analysis

Jung Kyong Shin,김희철,Woo Yong Lee,Seong Hyeon Yun,Yong Beom Cho,Jung Wook Huh,Yoon Ah Park,Ho-Kyung Chun 대한외과학회 2019 Annals of Surgical Treatment and Research(ASRT) Vol.96 No.3

Purpose: The purpose of this study is to evaluate the prognostic value of preoperative serum CA 19-9 levels in colorectal cancer patients. Methods: Between 2008 and 2011, 4,794 consecutive patients who underwent curative resection for colorectal cancer were analyzed. These patients were classified into 2 groups according to preoperative CA 19-9 (high CA 19-9: ≥37 ng/mL, n = 440; normal CA 19-9: <37 ng/mL, n = 4,354). We used 1:20 propensity score matching to adjust for potential baseline confounders between groups. Results: After matching, 424 patients (10.5%) among 4,021 patients with colorectal cancer showed a high pre-CA 19-9 level (≥37 ng/mL). There were no significant differences between these 2 groups in age, sex, preoperative CEA level, or T, N, and M stage after matching. Of the 424 patients with high pre-CA 19-9, 141 (33.3%) exhibited cancer recurrence more frequently than patients with normal preoperative CA 19-9 (18.5%). Patients with an elevated preoperative CA 19-9 level showed significantly poorer survival than those with normal levels. The 5-year overall survival rate was 79.7% in the high preoperative CA 19-9 group and 91.9% in the normal preoperative CA 19-9 group (P < 0.001). The 5-year disease-free survival rate was 70.2% in the high preoperative CA 19-9 group and 82.7% in the normal preoperative CA 19-9 group (P < 0.001). Conclusion: Patients with an elevated preoperative CA 19-9 level in colorectal cancer have a significantly poorer prognosis than those with normal levels of CA 19-9. We therefore suggest preoperative CA 19-9 level can be used as an additional prognostic indicator of poor outcomes in colorectal cancer.

자궁내막증에서 중증도와 재발의 예측인자로서 혈청 CA19-9의 임상적 유용성

나용진 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.24

Objective: Because endometriosis is difficult to diagnose and has a high recurrence rate after treatment, a reliable serum marker of endometriosis is necessary. Therefore, the aim of this study is to measure the serum CA19-9 in patients with endometriosis before and after treatment and during recurrence, and to assess the usefulness of these levels in the diagnosis, clinical follow up and prediction of recurrence in endometriosis. Subject and Methods: Eighty-eight patients who visited the department of Obstetrics and Gynecology from January 2006 to December 2007 and were diagnosed as endometriosis by laparoscopy or explo-laparotomy were enrolled. A retrospective analysis of serum CA19-9 levels at 1 month before and 3 to 6 months after initiation of treatment was done. Results: The serum CA19-9 levels of endometriosis group(36.6 ±53.4 mean ± 2SD, U/ml) before treatment was significantly higher than control group(9.4 ±8.6)(p<0.05). Overal sensitivity rate for CA19-9 levels was 53.4%. The sensitivity rate for endometriosis, stage 3 and 4(85.4%, 55.0%) was significantly higher than that, stage 1 and 2(p<0.05). The serum CA 19-9 level in endometriosis group showed a significant increment according to stages(p<0.05) and levels decreased significantly after treatment(p<0.05). The serum CA 19-9 level was also higher at recurrence after treatment(p<0.05). Conclusion: The serum CA19-9 levels are a useful marker for diagnosing severity of disease, monitoring efficacy of treatment and predicting recurrence in endometriosis. 목적: 자궁내막증 환자에서 치료 전 후와 재발시의 CA19-9 혈청값의 동태를 분석함으로써 자궁내막증의 진단 및 임상경과 추적검사와 재발에 대한 예측인자로서의 유용성을 알아보고자 하였다. 연구 방법 : 2006년 1월부터 2007년 12월까지 월경통이나 불임, 골반통 등을 주소로 부산대학교병원 산부인과 외래를 내원한 환자 중, 복강경 및 개복술 시행 후 자궁내막증이 확인된 88명을 대상으로 하였다. 내원시와 치료 개시 후 3-6개월에 추적검사된 CA 19-9을 후향성으로 조사, 분석(retrospective analysis)하였다. 결과 : 자궁내 막증 환자군의 혈청 CA19-9의 치료 전 평균치는 36.6±53.4로 대조군의 9.4±8.6에 비하여 유의하게 높았고, CA19-9의 전체 민감도는 53.4 % 였으며 3, 4기의 경우 각각 85.4% 및 55.0% 로 1, 2기에 비하여 유의하게 증가하였다(p<0.05). 또한 병기에 비레하여 유의한 상승을 확인할 수 있었으며 치료 후 역시 유의한 감소를 확인할 수 있었다(p<0.05). 또한 치료 종결 후 보다 재발 시 혈청 CA19-9의 농도가 유의하게 증가하였다(p<0.05). 결론: 혈청 CA19-9는 자궁내막증 환자에서 진단 시 질환의 중증도를 판정하고 치료 경과 및 재발예측을 위한 추적검사로서 유용하다.

폐쇄성 황달 및 급성 담도염 환자에서 단기간의 담즙 배액이 혈청 및 담즙의 Carcinoembryonic Antigen과 CA19-9월 진단적 가치에 미치는 영향

조현근,정준표,박효진,이관식,정재복,전재윤,이상인,문영명,강진경 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.32 No.6

위암,대직장암 환자에서 혈청 CEA 및 CA 19-9의 수술전 및 수술 후의 변동에 관한 연구

하홍근,이승도 高神大學 醫學部 1989 高神大學醫學部 論文集 Vol.5 No.1

Prognostic Role of CA 19-9 in Patients with Hepatocellular Carcinoma

( Hae Lim Lee ),( Sung Won Lee ),( Jeong Won Jang ),( Si Hyun Bae ),( Jong Young Choi ),( Nam Ik Han ),( Seung Kew Yoon ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Serum carbohydrate antigen 19-9 (CA 19-9) is a commonly used tumor marker for pancreatic and biliary cancer. However, it was recently suggested that CA 19-9 level could be elevated in hepatocellular carcinoma (HCC) patients with aggressive phenotype or stemness features. This study aimed to evaluate the significance and prognostic role of serum CA 19-9 in patients diagnosed with HCC. Methods: This study enrolled 534 consecutive patients newly diagnosed with HCC and with serum CA 19-9 values at baseline between 2008 and 2017. Patients with combined hepatocellular-cholangiocarcinoma and other malignancies at baseline were excluded. Results: During a median follow-up of 27.5 months (range 0.1-141.1), 178 patients (33.6%) survived and 180 (34.0%) expired. Baseline CA 19-9 level was within normal range in 410 patients (77.5%) and elevated (CA 19-9 > 37 U/mL) in 119 (22.5%). Patients with elevated CA 19-9 had a larger tumor size, a higher proportion of multiple tumors and portal vein tumor thrombosis than patients with normal CA 19-9 (all P values were < 0.05), and therefore presented with more advanced tumor characteristics. The cumulative overall survival (OS) in patients with elevated CA 19-9 was significantly lower than that in patients with normal CA 19-9 (P< 0.001). In the multivariate analysis, elevated CA 19-9 was an independent prognostic factor for OS (HR, 1.52; 95% CI, 1.06-2.16; P=0.021). Subgroup analysis revealed that elevated CA 19-9 was associated with poor prognosis across all BCLC stages. The validity of CA 19-9 increased particularly in patients with CTP class A or AFP > 100 ng/ml. Conclusions: Elevated CA 19-9 level is significantly associated with poor prognosis and advanced tumor characteristics in HCC patients. The CA 19-9 test is a simple adjuvant method that can be performed to predict the prognosis of HCC patients.

췌장암에서 병기에 따른 혈청 CEA및 CA 19-9의 임상적 의의

김광희,이흥식,김창덕,류호상,현진해 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.3

위암환자의 혈청 CEA , CA19 - 9 및 AFP 에 관한 연구

최환준(Hwan Jun Choi),이신호(Shin Ho Lee),박무인(Moo In Park),우인기(In Ki Woo),김병립(Byung Lip Kim),최종수(Jong Soo Choi),지상근(Sang Geun Ghi),구자영(Ja Young Koo),정숙금(Sook Kum Jeong),허만하(Man Ha Huh) 대한내과학회 1994 대한내과학회지 Vol.47 No.5

Objectives: For the diagnosis and evaluation of gastric cancer, various methods including upper GI series, endoscopy, ultrasound, CAT scan are used with serum tumor markers, especially CEA, CA19-9 and AFP. Although many studies were done to evaluate the clinical usefulness of serum tumor markers for the diagnosis and management of gastrointestinal cancer, the studies which was done in depth on gastric cancer alone were few. In this study we, therefore, evaluated clinical significance of serum CEA, CA19-9 and AFP of 712 gastric cancer patients for the diagnosis and management of gastric cancer. Methods: Serum levels of CEA, CA19-9 and AFP were measured in 712 eases of gastric cancer including 346 operative cases to evaluate the clinical usefulness of these markers for the diagnosis and management of gastric cancer. The cutoff level of serum CEA, CA19-9 and AFP were 10 ng/ml, 37 U/ml and 20 ng/ml, respectively. The serum levels were correlated with the stage, the location, the gross type, the depth of invasion, the nodal and distant metastasis. AFP-positive cases were analysed seperately and immunohistochemical staining was done to asses the presence of AFP, EGF and TGF β in the cancer tissue. Results: 1) Overall positivity of CEA, CA19-9 and AFP was 27.8% (198 cases), 32.7%; (233 cases) and 5.6% (30 cases/540 cases), respectively. 2) There was no difference in the positivity of serum CEA and CA19-9 according to locations and gross types of the cancer, but significant (p<0.05) difference in the positivity of serum CEA and CA19-9 was noted between cases of early gastric cancer (3.0% and 0.0%) and advanced gastric cancer (19.2% and 30.4%). 3) The positivity of serum CEA of stage IV (35.5%) was significantly (p<0.05) higher than that of stage II (4.4%), stage IIIA (10.2%) and stage IIIB (15.1%). Furthermore, 70.4% of the cases of positive serum CEA belonged to stage IV. On the other hand, serum CA19-9 positivity was 6.7%, 23.7%, 34.0% and 45.5% for the stage II, stage IIIA, stage IIIB and stage IU, respectively, showing significant difference between stage II and stage IIIA, IIIB, IV and between stage IIIA and stage IV (p<0.05). 4) The cases with perigastric tissue invasion (T₄) marked highest positivity (26.6%) of serum CEA level, but there was no correlation between positivity of serum CEA and depth of invasion. In the case of CA19-9, serum positivity v as 2.9%, l.5%, 29.3% and 39.8% for T₁, T₂, T₃, and T₄, respectively, showing relatively good correlation between CA19-9 positivity and depth of invasion. 5) The positivity of serum CEA and CA19-9 of NO group (3.0% and 9.9%, respectively) was significantly (p<0.05) lower than those of N2 group (15.7% and 24.5%, respectively). The positivity of N2 group (29.4% and 42.4%, respectively) was significantly higher than that of NO group and N2 gorup (p<0.05). 6) In the cases of metastasis present, CEA and CA19-9 positivity was 42.5% and 49.3%, respectively, which was significantly (p<0.05) higher than that of metastasis-negative cases (7.6g and 17.39, respectively). Between sites of metastasis, there was no difference in the positivity of CEA and CA19-9. 7) CEA and CA19-9 positivity in AFP-positive gastric cancer was 66.7%, 46.7%, respectively, and 83.3%, of cases belonged to stage IV, while distant metastasis was present in 73.3% of cases, among which liver was the most common site (43.3%). The AFP was demonstrated in the cancer tissue of 21 cases (91.3%) of 23 cases on which immunohistochemical staining was done. TGF β and EGF were present in 17 cases (81.0%) and 9 cases (42.9%) of AFP-positive 21 cases. Conclusion: Serum CEA and CA19-9 was not useful as a screening test in the diagnosis of gastric cancer, but may be useful in differentiating between early and advanced cases, in determining depth of invasion, and in detecting nodal and distant metastasis. Especially, CA19-9 was superior to CEA in stage grouping and in determining depth of invasion. AFP may be of some help in pred

결장 및 직장암 환자에서 혈청과 면역조직화학 염색에서 CA19-9의 의의

김민수(Min Soo Kim),주호민(Ho Min Joo),홍성우(Seong Wo Hong),강윤경(Yun Kyung Kang),천정우(Jung Woo Chun),장여구(Yeo Goo Chang),백인욱(In Wook Paik),이혁상(Hyucksang Lee) 대한외과학회 2008 Annals of Surgical Treatment and Research Vol.75 No.5

Purpose: There has been much debate about the significance of the CA19-9 level for predicting the prognosis of colorectal cancer patients. This study aimed to evaluate the prognostic value of the preoperative serum CA19-9 level and the CA19-9 expression in the tumor tissues of colorectal cancer patients Methods: One hundred patients with colorectal cancer and who had been treated by resection were studied. We assessed the correlations of the preoperative serum CA19-9 level and the status of the CA19-9 immunohistochemical staining with the clinicopathologic features, including the prognosis of the patients. Results: The preoperative serum CA19-9 level had significant correlation with the status of CA19-9 immunohistochemical staining. The presence of distant metastasis was significantly correlated with an elevated level of serum CA19-9. The depth of tumor, the presence of lymph node metastasis, the TNM stage and tumor cell differentiation were significantly correlated with the status of the CA19-9 immunohistochemical staining. In addition, the gross morphology, depth of tumor, the presence of lymph node metastasis, the TNM stage, the status of the CA19-9 immunohistochemical staining and the serum CEA level were correlated with survival on univariate analysis. However, multivariate analysis did not validate the status of CA19-9 immunohistochemical staining as a significantly independent predictor of the prognosis. Conclusion: The CA19-9 expression was frequently observed in advanced stage tumor tissue, yet its expression in tumor tissue or the preoperative CA19-9 serum level did not show independent prognostic value for colorectal cancer patients.