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Abstract
Background/Aims
Diagnostic tests for carcinoembryonic antigen (CEA) in ascites have been performed in various malignant cases, but there is only few data on the applicability of CEA for colorectal cancer (CRC) patients with peritoneal carcinomatosis. We aimed to determine the usefulness of CEA in ascites (aCEA) as a diagnostic parameter for CRC with peritoneal carcinomatosis.
Methods
Between January 2000 and May 2013, the medical records of 259 patients who underwent paracentesis for the evaluation of ascites were retrospectively reviewed. CRC patients with ascites (n=82) and patients with nonmalignant ascites (n=177) were evaluated. Patients who had other malignancies, including gastric or ovarian cancer, with ascites were excluded. The optimal diagnostic cut-off value of aCEA for CRC with peritoneal carcinomatosis was determined using receiver operating characteristic curve analysis. The value of aCEA for predicting the occurrence of peritoneal carcinomatosis was evaluated using a logistic regression model.
Results
The optimal cut-off value of aCEA to diagnose CRC with peritoneal carcinomatosis was 3.89 ng/mL, and the area under the curve for aCEA was 0.996 (sensitivity 96.3%, specificity 100%, positive predictive value 100%, negative predictive value 98.3%). Multivariate logistic regression analysis showed that aCEA was an independent factor predicting the occurrence of peritoneal carcinomatosis.
References
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Fig. 1.
Levels of aCEA in the benign and CRC groups. aCEA, carcinoembryonic antigen in ascites; CRC, colorectal cancer.
Fig. 2.
ROC curve of diagnostic parameters. ROC, receiver operating characteristic; aCEA, carcinoembryonic antigen in ascites; sCEA, serum carcinoembryonic antigen.
Table 1.
Baseline Characteristics in Enrolled Patients
| Benign group (n=177) | CRC group (n=82) | |
|---|---|---|
| Median age (range) | 59 (17–87) | 65 (37–47) |
| Gender | ||
| Male | 126 (71.2) | 54 (65.9) |
| Female | 51 (28.8) | 28 (34.1) |
| Performance status a | ||
| 0 | 133 (75.1) | 57 (69.5) |
| 1 | 41 (23.2) | 23 (28.0) |
| 2 | 3 (1.7) | 2 (2.5) |
| Diagnostic method of CRC | ||
| Colonoscopic biopsy | 72 (87.8) | |
| Surgery | 10 (12.2) | |
| Diagnostic method of peritoneal | ||
| carcinomatosis | ||
| Cytology in ascites | 9 (11.0) | |
| CT image | 73 (89.0) | |
| Metastasis | ||
| Peritoneum only | 17 (20.7) | |
| Liver | 26 (31.7) | |
| Lung | 1 (1.2) | |
| Bone | 1 (1.2) | |
| Distant lymph node | 37 (45.2) | |
| Cytology | ||
| Positive | 0 (0.0) | 16 (21.1) |
| Negative | 168 (100.0) | 60 (78.9) |
Table 2.
Comparison of Diagnostic Parameters
| aCEA (ng/mL) | sCEA (ng/mL) | |
|---|---|---|
| Cut-off value | 3.885 | 8.635 |
| Sensitivity (%) | 96.3 | 84.2 |
| Specificity (%) PPV (%) | 100 100 | 91.3 81.0 |
| NPV (%) | 98.3 | 92.9 |
| AUC | 0.996 | 0.914 |
Table 3.
Factors Predicting the Occurrence of Peritoneal Carcinomatosis
OR, odds ratio; CI, confidence interval; aCEA, carcinoembryonic antigen in ascites; sCEA, carcinoembryonic antigen in serum; aCA19–9, carbohydrate antigen 19–9 in ascites; sCA19–9, carbohydrate antigen 19–9 in serum; SAAG, serum-ascites albumin gradient; protein A/S, ascites/serum concentration ratio of protein; LDH A/S, ascites/serum concentration ratio of lactate dehydrogenase.
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