ABSTRACT
THE GOAL: The goal of this work was to give advantage to EUS as endoscopic method in diagnosis and following therapeutic treatment of pancreatic cancer in relation to radiological methods of CT and CTA. MATERIAL AND METHODS: The study included 49 patients, 20 women and 29 men hospitalized at the Clinic for gastroenterohepatology, due to suspicion on pancreatic cancer during observed 2 years period. All cancers were histologically and cytologically confirmed. The patients underwent ERCP as a mandatory part of staging and all patients underwent endoscopic ultrasound as well as CT or CT angiography. RESULTS: Testing of differences was carried out using Fisher's exact test in open-source software R. The following characteristics were tested: involvement of the blood vessels, lymph nodes, metastases, tumor size and duodenum infiltration. Results showed statistically significant difference at the 0.05 level for EUS, CT and CT angiography. Risk ratio showed that EUS is less effective in detecting infiltration of blood vessels within a malignant process then CTA where RR=0.52, CI 0.2-1.38, p-value=0.33. EUS and CTA are equal in the diagnosis of enlarged lymph nodes affected by malignancy where RR=1.3, CI 0.75-1.42, p-value=0.09. Comparison according to distant metastases showed that EUS is less effective compared to CT in approximately 30% of cases. In the diagnosis of duodenal infiltration EUS is in 5% of cases less accurate than the CT with the RR=0.95, CI 0.27-3.32, p-value=0.76, but the CTA method is more efficient because the comparison of EUS and CTA showed RR=12.52, CI 0.2-1.38, p-value=0.33. EUS as a diagnostic method is dominant in determining the size of malignant lesions located in the pancreas as compared to CT and CTA. CONCLUSION: EUS as endoscopic method compared to CT and CTA is one of the more invasive methods of examination but due to its ability to be performed immediately, to locate a changes smaller than 5 mm and the target biopsy option, to measure the change and that in many cases determine the relationship of malignant lesions with blood vessels, along with visualization of the surrounding lymph nodes and metastases in neighboring organs, we may give this method an advantage over other methods in the preoperative staging of patients with pancreatic cancer.
ABSTRACT
PURPOSE: Among diverse tumor markers, pretreatment evaluation and follow-up detection of recurrence in colorectal cancer are generally evaluated by serum carcinoembryonic antigen (CEA) levels. However, there have been some reports about the low accuracy and high false-positive results of CEA in colorectal cancer. We investigated the clinical utilities of CYFRA 21-1 by comparing CEA and cancer antigen 19-9 (CA 19-9) in pretreatment and recurrent colorectal cancer. METHODS: Using a solid-phase immunoradiometric assay, serum levels of CYFRA 21-1, CEA and CA 19-9 were analyzed in 132 patients with primary colorectal cancer, 124 healthy controls, 104 patients with benign colorectal disease and 19 patients with recurrent colorectal cancer. We determined three different cutoff values to evaluate the sensitivity of diagnostic performance in pretreatment and recurrent colorectal cancer. RESULTS: CYFRA 21-1 (≥ 1.13 ng/ml) had a sensitivity of 47 %, compared with 37 % for CEA (≥ 3.05 ng/ml) and 32.6 % for CA 19-9 (≥ 23.1 ng/ml) in the initial staging of primary colorectal cancer. Using different cutoff values, CYFRA 21-1 showed higher sensitivity for pretreatment colorectal cancer than CEA and CA 19-9 in adenocarcinoma and adenosquamous carcinoma of this study. A mildly significant correlative relationship was noted between Dukes' stages and three tumor markers (p < 0.01). The areas under the receiver operating characteristic curves of CYFRA 21-1, CEA and CA 19-9 were 0.81 ± 0.03, 0.74 ± 0.03 and 0.62 ± 0.04, respectively, for discriminating colorectal cancer patients from patients with benign colorectal disease. In addition, CYFRA 21-1 was determined as the most sensitive tumor marker for evaluating recurrent colorectal cancer for all cutoff values. CONCLUSION: This study showed that CYFRA 21-1 could be a useful and dependable tumor marker for pretreatment and recurrent colorectal cancer. Further prospective studies on its usefulness with respect to the prognosis and utility of combined tumor markers are needed.
ABSTRACT
BACKGROUND: Despite progress in surgical techniques and adjuvant treatments, the prognosis for advanced gastric cancer has not improved. Knowledge of the kinds of tumor markers that might indicate the postoperative prognosis for gastric cancer is important in detecting microscopic residual cancers but still needs to be developed. METHODS: The serum levels of carcinoembryonic antigen (sCEA) and carbohydrate antigen 19-9 (sCA19-9), as well as the CEA, the CA19-9, and the tissue-type plasminogen activator levels in peritoneal washings (pCEA, pCA19-9, pTPA) were measured in 57 patients with gastric cancer who had undergone laparotomies from Oct. 1996 to Mar. 1997. The relationships between the positivity of tumor markers and several clinicopathological factors were evaluated by using a univariate analysis. Also, the significance of tumor markers in predicting the survival and the recurrence of disease was analyzed. RESULTS: The positivity of pCEA and pCA19-9 increased according to the stage (p<0.01) and the presence of serosal invasion (P<0.01). When pCEA or pCA19-9 is positive, the rate of curative surgery in those patients was lower than it was in the patients with negative tumor markers (p<0.01 and p<0.05, respectively). The positivities of pCEA, sCA19-9, pCA19-9 were higher in recurring cases than in nonrecurring cases after curative surgery (p<0.01, p<0.01, and p<0.05, respectively). The positivities of the tumor markers pCEA and pCA19-9 in the 4 cases with peritoneal seeding at the laparotomy were significantly different from those in the 53 cases with no peritoneal seeding (p<0.01) and (p<0.01), respectively pCEA. The risk of peritoneal recurrence after curative surgery was higher in pCEA positive cases than in negative cases (p=0.016) and in serosal positive and pCEA positive cases than in the other cases (p=0.016). CONCLUSION: pCEA and pCA19-9 are useful prognostic factors and an adjuvant treatment to prevent peritoneal recurrence should be considered, especially, in patients presenting positive pCEA with positive serosal invasion.