Monitoring Serum Tumor Markers In Esophageal Cancer Patients And Their Clinical Significance

Background With the environmental pollution and the increase in unfavorable chances in people’s life, the incidence of malignant tumors keeps increasing, of which more than 60% are of digestive tract cancer. The incidence of esophageal squamous cell carcinomas (ESCC) in China belongs to the top few countries in the world. The occurrence of esophageal cancer (EC)is related to the long-term food intake which contains nitrosamine, surrounding environment, geographical and genetic factors, and dietary structure which lacks of vitamins and trace elements. In recent decades, although the new technology and new methods emerge endlessly in the diagnosis and treatment of esophageal cancer, the death rate of esophageal cancer patients has not been greatly reduced. The reason for it is that 50% of the ESCC patients on the first visit to a doctor were at the medium or the late stage in China. By surgical treatment,5-year-survival rate was only 15%-20%. But esophageal cancer surgery at an earlier stage can increase the 5-year-survival rate to 70%. As a result, to raise the survival rate, early diagnosis and treatment is the key to the patients with ESCC. Tumor markers due to simple application, economic, rapid, noninvasive, have been widely used clinically. Currently the total of tumor markers have amounted to hundred kinds, but an ideal tumor marker which can be used clinically for ESCC diagnosis has not been found yet. So how to make use of molecular biology techniques to improve the detection rate by such markers has become the main target of current clinical and basic medical research.Objectives By measuring the expression levels of serum tumor markers (CA19-9, CEA, SCC-Ag, CYFRA21-1) in esophageal cancer patients, to investigate the serum levels in the diagnosis of esophageal cancer and to explore its clinical application significance, and to evaluate 4 kinds of tumor markers combined together to detect ESCC during clinical diagnosis and the relationship between the serum level changes and the cure rate.Methods Sixty cases of hospitalized patients with ESCC were selected as study subjects from January of 2012 and December of 2013 admitted to the Department of Oncology and the Department of Digestive Diseases, the Third Affiliated Hospital of Xinxiang Medical College, including 32 male patients and 28 female cases, mean age 68.0±9.5 years. All patients were diagnosed by gastroscopy and pathological histology, and they had not received radiation and chemotherapy or surgery on their first hospital visit. At the same time,60 healthy cases coming for routine physical examinations,31 male cases,29 female cases, mean age 55.0±15.8 years old, were assigned as the control group. Serum samples (fasting venous blood5ml) were collected from the healthy controls and from the esophageal cancer subjects two days before chemotherapy or on admission immediately, 20 days after the second chemotherapy cycles, and 20 days after the fourth chemotherapy cycles, respectively; chemoluminescence immune clamp method was used to detect the levels of CA19-9, CEA, SCC-Ag, and CYFRA21-1 in 60 cases of esophageal cancer group and those of the control group.Result (1) The serum CA19-9, CEA, SCC-Ag, CYFRA21-1 levels of esophageal cancer patients were significantly higher than those of the healthy control group, which had a significant difference (P< 0.05). (2) The positive detection rate of CYFRA21-1in the study group was 46.7%, which was much higher than that of CA19-9(20.0%), CEA (11.7%), SCC-Ag(30.0%. (3)The sensitivityof CEA and CA19-9, SCC-Ag, and CYFRA21-1 tumor markers was 11.67%,25%,30%,46.67%, respectively; and the accuracy was 43.3%, 47.0%,53.4%,71.1%, respectively; the levels of CYFRA21-1 was statistically significant compared with those of the other 3 tumor markers. When two of the tumor markers were combined, the sensitivity and the accuracy of CYFRA21-1+SCC-Ag were 55.0% and 72.3%, respectively; the sensitivity and the accuracy of CEA+CA19-9 were 33.3% and 50%, respectively. CYFRA21-1、SCC-Ag combined detection rate was higher in both sensitivity and accuracy compared with any other single detection and the combination of CEA+CA19-9 detection. When CA19-9, CEA, SCC-Ag, CYFRA21-1 tumor markers were joined together, the sensitivity and the accuracy were 65% and 74%, respectively, which was higher than any other single tumor marker or two-two combination tumor markers, and the difference was of significance statistically(P<0.001). (4) The levels of CA19-9, SCC-Ag, CYFRA-21 were significantly lowered after 4-cycle chemotherapy compared with those before chemotherapy, and the difference was significant(P<0.05).Conclusions (1) The sensitivity and accuracy of single tumor marker CYFRA21-1 detection were the highest, and CYFRA21-1 serum detection is valuable in the diagnosis of EC clinically. The sensitivity and the accuracy of CYFRA21-1+SCC-Ag coalition detection of ESCC are higher than any of the single tumor marker detection, or the combination of CEA+CA19-9 detection. When CA19-9, CEA, SCC-Ag, CYFRA21-1 tumor markers are combined to detect EC, their sensitivity and accuracy can be much higher than any other single or two-two combination method. Therefore, multiple tumor marker detection may improve the sensitivity and accuracy of ESCC detection. (2)There is no significant difference between cell differentiation and serum levels of tumor markers.