Clinic al ef f ic ac y of v arious tumor marke rs in me dic al s cree nin g

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1 : * =A b s t r a c t = Clinic al ef f ic ac y of v arious tumor marke rs in me dic al s cree nin g Kim Ji Youn, M.D., Seong Chun Shim, M.D., Hyun Sik Jeong, M.D, and Seung Sei Lee, M.D. Department of Internal M edicine, Sungkyunkwan University K angbuk Samsung H osp ital, Seoul, K orea B ackg round : Many tumor markers have been investigated for early diagnosis of the malignancy, yet they were turned out to be inappropriate for the purpose. This study was carried out to investigate the efficacy of tumor markers. Meth ods : Employing radioimmunoassay, CEA, AFP, CA19-9, PSA, CA125 were done in 31,389 patients(20,878 males, 10,511 females) who visited our medical screening center from Jan to Dec Re s ult s : T otal mean value of CEA is ng/ ml(male: , female: ). Male showed significantly higher level of CEA. Only 2 subjects had values over 25 ng/ ml, and one was diagnosed to have stomach cancer but the other did not. T otal mean value of AFP is ng/ ml (male: ng/ ml, female: ng/ ml). Female showed significantly higher level of measured AFP. One had AFP value over 400 ng/ ml and was diagnosed of hepatoma. T otal mean value of CA19-9 is ng/ ml,(male: ng/ ml, female: ng/ ml). Female showed significantly higher CA subjects (male: 31, female: 34) showed measured CA19-9 level over 37 ng/ ml. 5 subjects had values over 100 ng/ ml and 1 subject w as diagnosed of pancrease cancer. T otal mean value of PSA is ng/ ml. 90 subjects showed measured PSA level over 4 ng/ ml and mean value in this group w as ng/ ml. 54 subjects were older than age out of 90 subjects were diagnosed of prostate cancer. T otal mean value of CA125 is ng/ ml. 160 subjects showed measured CA125 level over 35 ng/ ml. 19 subjects had value over 100 ng/ ml and none of the malignancy was detected. Con c lu s ion : T umor markers are inappropriate measures for screening of malignancy. (Korean J Med 60: , 2001) Key W ords : T umor markers, Carcinoembryonic antigen, Alpha- fetoprotein , 108, ( )

2 Kim Ji Youn, et al : Clinical efficacy of various tumor markers in medical screening.,,,,,.,,,..,,, 10 mm 5 mm, G.I.Abelev Alpha- fetoprotein (AFP) Carcinoembryonic antigen (CEA), CA19-9, Prostatespecific antigen (PSA), CA125.,,,.,,,.,,.,,,,,,.,,. 100%, 100%,.,,...., , ,878, 10, ,389 CEA (RIA- gnost CEA CIS bio international Co., France), AFP (RIA Diasorin Co. Italia), CA19-9 (RIA T RUQUANT. GI Biomira Diagnostics Co, Canada), PSA (RIA - mat Sangted Co., Germany), CA125 (RIA - count DPC Co.,USA) cut- off value CEA 10 ng/ ml, AFP 15 ng/ ml, CA U/ ml, PSA 4 ng/ ml, CA U/ ml.,, X, X. SPSS t-test ANOVA. 1. CEA CEA 31,382 21,055 10, ng/ ml,

3 : T able 1. T umor markers according to ag e g roups Age(yr) Sex N CEA(ng/ ml) AFP(ng/ ml) CA19-9(U/mL) PSA(ng/ ml) CA125(U/mL) Male * < Total N, number; *p <0.05 Female * * Male 10, * Female 5, * * Male 6, * Female 2, * Male 2, * Female 1, * Male * * Female * Male * Female * Male 20, * Female 10, * T able 2. T um or m arkers below and ov er ag e 50 Age Sex N CEA (ng/ ml) AFP (ng/ ml) CA19-9(U/ ml) PSA (ng/ ml) CA 125(U/ ml) Male 17, * <50 Female 8, * T otal 26, Male 3, * >50 Female 1, * T otal 10, N, number; *p < ng/ ml ng/ ml (T able 1). CEA (p <0.001). CEA r= p < CEA ng/ ml, ng/ ml 50 (p <0.001) (T able 2). CEA cut- off 10 ng/ ml 25 (0.08 %) ng/ ml ( : ) (T able 3). (CEA=35 ng/ ml). CEA 4 4 cut- off. 10 ng/ ml 25. CEA 20%, 99.9%, 0.04%. 2. AFP AFP ,020 10, ng/ ml, ng/ ml, ng/ ml (T able 1). 20, 30 AFP 100 ng/ ml 18. AFP

4 3 : T able 3. Distribution and ag e of sex according to cut - off v alue tumor marker N ( M, F ) % Mean SD(ng/ ml) Range CEA> (23, 2) (ng/ ml) CEA < 10 31,364 (21,440, 10,724) (ng/ ml) AFP > (37, 47) (ng/ ml) AFP < 15 31,305 (21,012, 10,293) (ng/ ml) CA 19-9>37 65 (31, 34) (U/ ml) CA 19-9<37 31,324 (21,023, 10,301) (U/ ml) PSA> (ng/ ml) PSA<4 20, (ng/ ml) CA125> (U/ ml) CA125<35 10, (U/ ml) N, number; M, male; F, female. 20, ng/ ml, ng/ ml. AFP AFP 2, ng/ ml, ng/ ml (T able 2). AFP cut- off 15 ng/ ml (0.21%) (T able 3) ng/ ml, AFP ng/ ml 61, ng/ml 4 400ng/mL 1. AFP 400 ng/ml ng/ml, 32.4 ng/ ml, ng/ ml 3. AFP cut- off 15 ng/ml 31,305, 15 ng/ ml AFP 100%, 99.7%, 4.76%. 3. CA19-9 CA ,387 21,020, 10, U/ ml, U/ ml U/ ml (T able 1). CA19-9 (p <0.001). CA CA U/ ml, U/ ml 50 (p <0.001) (T able 2). CA19-9 cut- off 37 U/ ml 65 (0.20 %) 31, U/ ml ; ) (T able 3). CA19-9 cut- off 37 U/ ml 1 (34.21 U/ ml), 37 U/ ml 65 1 ( U/ ml). CA %, 99.8%, 1.54%. 4. PSA PSA ng/ ml (T able 1). PSA 60 (p <0.001). PSA PSA ng/ ml, ng/ ml 50 (p <0.001) (T able 2). PSA 4 ng/ ml 90 (0.43%), ng/ ml ( ) (T able 3) (0.26%)

5 Korean Journal of Medicine : Vol. 60, No. 2, (0.17%) ng/ ml, 120 ng/ ml, 9.34 ng/ ml, 6.59 ng/ ml. PSA cut- off 4 ng/ ml 20,722, 4 ng/ ml PSA 100%, 99.6%, 4.44%. 5. CA125 CA125 10, U/ ml (T able 1). CA125 r= p < CA U/ ml, U/ ml 50 (p <0.001) (T able 2). 160 (1.58 %) CA U/ ml, U/ ml ( ; ) (T able 3). 100 U/ ml 19.. CA125 cut- off 35 U/ ml 9,992, 35 U/ ml 160. CA125 0%, 98.4%, 0% (0.2%). 26, (0.057%), 4 (0.013%), 15 (0.048%), 5 (0.016%), 4 (0.01%), 4 (0.013%), 4 (0.013%), 3 (0.01%), 2 (0.006%),,,, 1 (0.003%). (CEA ng/ ml), (CEA ng/ ml), (AFP 412 ng/ ml), (PSA 196 ng/ ml, 120 ng/ ml, 6.59 ng/ ml, 9.34 ng/ ml), (CA U/ ml) 8.,,,, x- ray ( ).,, X... PSA,., PSA..,.., 1).. CEA ng/ ml CIS Bio International 814 CEA. Stevens CEA ng/ ml ng/ ml 4 ).. Vay Liang,,, CEA 3 ) CEA. CEA. CEA 4 CEA ( : ). CEA 10 ng/ ml 25,

6 Kim Ji Youn, et al : Clinical efficacy of various tumor markers in medical screening ng/ ml, ng/ ml. CEA. CEA 20%, 99.9%, 0.04%. AFP ng/ ml Ruoslohti E AFP. AFP 5 ) 20, ng/ ml, ng/ ml 18. cut- ff 15 ng/ ml ng/ ml. 66,,, AFP AFP 24.7 ng/ ml, 32.4 ng/ ml, ng/ ml, 400 ng/ ml. AFP 100%, 99.7% 4.76%. CA19-9,,,, 6 ). CA U/ ml Fujirebio diagnostics inc , U/ ml U/ ml U/ ml U/ ml. CA19-9 cut- off 37 U/ ml 1 (34.21 U/ ml), 37 U/ ml 65 1 ( U/ ml). CA %, 99.8%, 1.54%. James CA % 92%. 7 ) CA19-9. PSA ng/ ml Joseph E Oesterling PSA ng/ ml. 8 ) Stamey 1g PSA 0.2 ng/ ml. 9) ng/ ml, ng/ ml PSA. 4 ng/ ml PSA 196, 120, 6.59, 9.34 ng/ ml. PSA 100%, 99.6%, 4.44%. PSA. 72.2%, 29.8%. PSA PSA, (72.22% vs 4.44%). CA U/mL Centocor diagnostics in USA U/ ml U/ ml, U/ ml 50 CA125 10). CA125,, 11) CA U/ ml

7 : CA U/ m U/ ml 0%, 100%, 0. CA125..., AFP 400 ng/ ml CT CA U/ ml. PSA 10 ng/ ml.. CEA 10 ng/ ml 25 1 (37.46 ng/ ml), 1 (11.72 ng/ ml).. CEA 4 CEA ( : ). AFP cut- off 15 ng/ ml AFP 24.7 ng/ ml, 32.4 ng/ ml, ng/ ml, 400 ng/ ml.. CA ( U/ ml). PSA 90 4 ng/ ml ng/ ml, 120 ng/ ml, 6.54 ng/ ml, 9.34 ng/ ml, 65.. CA U/ ml 1. PSA, PSA 50. :.,..,. : ,389 ( 20,878, 10,511 ) CEA, AFP, CA19-9, PSA, CA125., X. : 1) CEA ng/ ml, ng/ml ng/ ml. CEA cut- off 10 ng/ ml 25 (0.08%) ng/ ml ( : ) ng/ml (CEA=35 ng/ ml). 2) AFP ng/ ml, ng/ ml, ng/ ml. AFP cut- off 15 ng/ ml (0.21%) ng/ ml, AFP ng/ ml 61, ng/ ml ng/ ml 1. AFP 400 ng/ ml 1. 3) CA U/ ml, U/ ml U/ ml. CA19-9 cut- off 37 U/ ml 65 (0.20%) 31, U/ ml ( ; ). 5 CA U/ ml,

8 3 :. 4) PSA ng/ ml. PSA 60 (p <0.001). PSA 4 ng/ ml 90 (0.43%), ng/ ml ( ) (0.26%) (0.17%) ng/ ml, 120 ng/ ml, 9.34 ng/ ml, 6.59 ng/ ml. 5) CA U/ ml. 160 (1.58%) CA U/ ml, U/ ml ( ; ). 100 U/ ml 19.. :. R E F E R E N CE S 1) Susan EB and Dan LL. Use of serum tumor marker in cancer diagnosis and management. Seminars in oncology, Vol 14 N o J une, ) T suneo K, T omoko K. P rosp ective investigation of tumor markers and risk assessment in early cancer screening. Cancer Vol 73, N o April 1, ) Vay Liang W. Go, MD. Carcinoembryonic antigen. Cancer Vol January, ) Stevens DP, Machy IR. Increased carcinoembryonic antigen in heavy cigarette smokers. Lancet 2: , ) Zamcheck N. Carcinoembryonic antigen. Quantitative variations in circulating levels in benign and malignant digestive disease. A dv Intern M ed 19: , ) Waldmann T A, McIntire KR. The use of a radioimmunoassay f or alpha-fetop rotein In the diagnosis of malignancy. Cancer 34: , ) Gold P, Freedman SO. Sp ecific carcinoem bryonic antigen of the human digestive system. J Exp M ed 122: , ) James MR, Marci RC, Anil KR, Marc DS. The clinical utility of the CA 19-9 radioimmuniassay for the diagnosis of panceatic cancer p resenting as pain or weight loss. A rch Intern M ed 149: , ) Joseph EO, Steven JJ, Cristopher G, Harrt AG, Cynthia JG, Laurel AP, Michael ML. Serum p rostate sp ecific antigen in a community based p op ulation of healthy men establishment of age sp ecific range. JA M A 270(7): , ) T homas CMG, Segers MFG, Houx PEW. Comparison of the analytical characteristics and clinical usef ulness in tumor monitoring of fif teen hcg immunoassay kits. A nn Clin B iochem 22: , ) Ian Jacob and Robert C, Bast, Jr. The CA 125 tumor-associated antigen: a review of the literature. H uman rep roduction 4(1):1-12,

Cy fr a U s e f u ln e s s of c y f ra a s a tu m or m ark e r o f lu n g c a n c e r

Cy fr a U s e f u ln e s s of c y f ra a s a tu m or m ark e r o f lu n g c a n c e r : 62 4 2002 Cy fr a 21-1, * * =A b s t r a c t = U s e f u ln e s s of c y f ra 2 1-1 a s a tu m or m ark e r o f lu n g c a n c e r Hyun Duk Park, M.D., Hyun Sik Jeong, M.D., Jeung Sik Park, M.D., Sung