위암환자의 혈청 CEA , CA19 - 9 및 AFP 에 관한 연구 = Serum CEA , CA19 - 9 and AFP in Gastric Cancer

다국어 초록 (Multilingual Abstract)

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다국어 초록 (Multilingual Abstract)

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