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Chen J, Fan L, Yang Z, Yang D. Comparison of results and age-related changes in establishing reference intervals for CEA, AFP, CA125, and CA199 using four indirect methods. Pract Lab Med 2024; 38:e00353. [PMID: 38221990 PMCID: PMC10787276 DOI: 10.1016/j.plabm.2023.e00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024] Open
Abstract
•The reference intervals calculated using RefineR, Kosmic, TMC, and non-parametric methods are similar.•TMC algorithm is more robust, demonstrates a high pass rate among the four methods and has the ability to automatically isolate outliers.•The reference intervals of CA125 and CA199 showed significant differences between age and sex.
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Affiliation(s)
- Juping Chen
- Department of Laboratory Medicine, Liangzhu Branch of the First Affiliated Hospital of Zhejiang University, Zhejiang, China
- School of Public Health, Zhejiang University School of Medicine, Zhejiang, China
| | - Lina Fan
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Zheng Yang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Dagan Yang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
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Lee JMY, Teo P, Lam LCW. Establishment of CA19-9 reference intervals in an apparently healthy adult population in Singapore. Ann Clin Biochem 2023:45632231224216. [PMID: 38111979 DOI: 10.1177/00045632231224216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND CA19-9 is elevated in pancreatic cancer and other malignancies, and commonly used in clinical practice. Unfortunately, CA19-9 immunoassays are not harmonized, and reference intervals may differ between assays. The aim of this study was to establish the reference interval of the ADVIA Centaur/Atellica IM CA19-9 assay in an apparently healthy Singapore adult population. METHODS This is a retrospective cross-sectional study. De-identified data from Health Screening participants were extracted from our database. Subjects with biochemical results suggesting anaemia, diabetes mellitus, viral hepatitis or abnormal liver, and renal and tumour markers were excluded. Outlier and subclass analyses by age and sex were performed. CA19-9 reference limits and 90% confidence intervals were then determined for candidate subclasses. RESULTS Data from 12,174 subjects (5846 males and 6328 females) were available after exclusion criteria were applied. CA19-9 results did not follow a normal distribution and were higher in females compared to males (P < .001). Although CA19-9 means were statistically different between certain age groups, the evaluable 99th percentile reference limits were not statistically different. The overall 99th percentile reference limits for the Centaur/Atellica CA19-9 assay was 37 U/mL for males 21-80 years, and 60 U/mL for females 21-80 years. CONCLUSIONS Our results suggest that separate CA19-9 reference intervals should be applied for males and females.
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Affiliation(s)
- Joanne Mee Yin Lee
- Parkway Laboratory Services Ltd, Parkway Pantai Ltd, Singapore, Singapore
| | - Pearline Teo
- Siemens Healthcare Pte Ltd, Singapore, Singapore
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Liu Q, Chen X, Hang H, Xu Z, Yang F. Reference interval for urinary neutrophil gelatinase-associated lipocalin in healthy adults in Jiangsu region in Eastern China: a multicenter study. Biomark Med 2021; 16:23-30. [PMID: 34856817 DOI: 10.2217/bmm-2021-0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We explored the concentrations of urinary neutrophil gelatinase-associated lipocalin (NGAL) in healthy adults in the Jiangsu region in Eastern China and established a reference interval using latex-enhanced immunoturbidimetry to provide important guidelines for the interpretation and application of urinary NGAL in clinical practice. Methods: In total, 1970 eligible subjects from four regions were included in this study. The urinary NGAL levels were measured using an AU5800 automatic biochemical analyzer with its matched reagents. The urinary NGAL reference interval was established using the one-sided percentile method (95th percentile). Results: The urinary NGAL data were non-normally distributed. The urinary NGAL levels were not significantly different by sex or age. Therefore, the urinary NGAL reference interval in healthy adults in the Jiangsu region in Eastern China was <87.5 ng/ml (95th percentile of the upper limit). Conclusion: Urinary NGAL reference interval will play an important role in promoting the clinical value of urinary NGAL.
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Affiliation(s)
- Qian Liu
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, PR China.,Department of Laboratory Medicine, Lianyungang Hospital Affiliated to Jiangsu University, Lianyungang, PR China
| | - Xiaochun Chen
- Department of Laboratory Medicine, Taizhou Second People's Hospital, Taizhou, PR China
| | - Huan Hang
- Department of Laboratory Medicine, Yancheng No.1 People's Hospital, Yancheng, PR China
| | - Zhihui Xu
- Department of Laboratory Medicine, Lanyuan Community Health Service Center of Xuanwu District, Nanjing, PR China
| | - Fumeng Yang
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, PR China.,Department of Laboratory Medicine, Lianyungang Hospital Affiliated to Jiangsu University, Lianyungang, PR China
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Lyu SC, Wang J, Huang M, Wang HX, Zhou L, He Q, Lang R. CA19-9 Level to Serum γ-Glutamyltransferase as a Potential Prognostic Biomarker in Patients with Pancreatic Head Carcinoma. Cancer Manag Res 2021; 13:4887-4898. [PMID: 34188542 PMCID: PMC8232842 DOI: 10.2147/cmar.s313517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/19/2021] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this study was to reduce the influence of biliary obstruction on carbohydrate antigen 19-9 level (CA19-9) by introducing the CA19-9 level to serum γ-glutamyltransferase (GGT) ratio as an indicator, and ultimately to reveal the correlation between CA19-9/GGT and the prognosis of patients with pancreatic head carcinoma (PHC). Methods A total of 339 enrolled patients who underwent pancreatoduodenectomy for PHC in Beijing ChaoYang Hospital from January 2010 to December 2019 were analyzed retrospectively. The optimal cut-off value, according to which patients were divided into a low-ratio group (Group 1, n=179) and a high-ratio group (Group 2, n=160), was determined by the ROC curve obtained from preoperative CA19-9/GGT and 1-year survival. Through univariate and multivariate analyses, risk factors for postoperative tumor recurrence and long-term survival were screened out among PHC patients. Results The best cut-off value of CA19-9/GGT was 2.07 (area under the curve=0.567, 95% CI 0.498-0.636). Compared with Group 2, Group 1 had lower CA19-9, and higher GGT, total bilirubin (TB) and lymph-node metastasis rate (P<0.05). The 1-, 2- and 3-year disease-free survival rates of patients in Groups 1 and 2 were 68.2%, 42.5% and 28.2%, and 42.2%, 19.3% and 18.3%, respectively (P=0.000), and the 1-, 2- and 3-year overall survival rates were 79.1%, 50.7% and 29.1%, and 56.7%, 22.2% and 17.2%, respectively (P=0.000). Multivariate analysis showed that CA19-9/GGT, portal system invasion and lymph-node metastasis were independent risk factors for postoperative tumor recurrence and long-term survival among patients with PHC. Conclusion Compared with CA19-9 level alone, CA19-9/GGT plays a more precise role in the evaluation of postoperative tumor recurrence and the long-term prognosis of PHC patients. The lower the ratio, the better the long-term prognosis. The CA19-9/GGT ratio may prove to be a useful biomarker for identifying PHC patients at high risk of early recurrence and unfavorable prognosis.
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Affiliation(s)
- Shao-Cheng Lyu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Jing Wang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Mengxiu Huang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Han-Xuan Wang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Lin Zhou
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Qiang He
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Ren Lang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
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Liu Q, Zong R, Li H, Yin X, Fu M, Yao L, Sun J, Yang F. Distribution of urinary N-acetyl-beta-D-glucosaminidase and the establishment of reference intervals in healthy adults. J Clin Lab Anal 2021; 35:e23748. [PMID: 33709460 PMCID: PMC8128320 DOI: 10.1002/jcla.23748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Urinary N-acetyl-beta-D-glucosaminidase (NAG) plays an important role in the early diagnosis and progression of diseases related to renal tubular injury. We detected the urinary NAG concentration, assessed the preliminary statistics of its distribution, and established reference intervals for healthy adults in China using the rate method. METHODS A total of 1,095 reference individuals (aged 20 to 79 years) met the requirements for inclusion in this study. Urinary NAG concentrations were detected using an AU5800 automatic biochemical analyzer with its matched reagents. The Kolmogorov-Smirnov test was used to analyze the normality of the data. According to the guidelines of C28-A3 and WS/T 402-2012, the reference intervals of urinary NAG were established using the nonparametric percentile method (unilateral 95th percentile). RESULTS The urinary NAG data showed a non-normal distribution. The distribution of urinary NAG was significantly different by sex and age. Therefore, the reference intervals of urinary NAG were established using the rate method: males (aged 20-59 years) <19.4 U/L (90% CI: 18.0-20.3 U/L); males (aged 60-79 years) <22.3 U/L (90% CI: 20.2-22.6 U/L); females (aged 20-59 years) <15.7 U/L (90% CI: 15.2-16.5 U/L); and females (aged 60-79 years) <21.4 U/L (90% CI: 20.3-22.3 U/L). CONCLUSIONS We established preliminary reference intervals of urinary NAG for healthy adults in China to provide guidance for health screening, auxiliary diagnosis, and treatment monitoring of renal tubule-related diseases.
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Affiliation(s)
- Qian Liu
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Ruyuan Zong
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Huan Li
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Xiaoxiao Yin
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Mei Fu
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Li Yao
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Jin Sun
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Fumeng Yang
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
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Xu WL, Wang J, Lyu SC, Zhou L, He Q, Lang R. Ratio of CA19-9 level to total bilirubin as a novel prognostic indicator in patients with pancreatic head carcinoma following curative resection. Gland Surg 2021; 10:980-991. [PMID: 33842242 DOI: 10.21037/gs-20-720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Ratio of carbohydrate antigen 19-9 level to total bilirubin (CA19-9/TB) is used to reduce the influence of obstructive jaundice on the concentration of CA19-9, thereby determining the correlation between CA19-9/TB and tumor recurrence or long-term prognosis of patients with pancreatic head cancer (PHC). Methods In this study, a total of 339 patients were enrolled. The optimal cut-off value of CA19-9/TB was determined by ROC curve based on preoperative CA19-9/TB and 1-year survival, and the patients were divided into low-ratio group (Group 1) and high-ratio group (Group 2) accordingly. Univariate and multivariate analyses were performed to screen out the risk factors affecting postoperative recurrence and long-term prognosis of PHC. Results The best cut-off value of CA19-9/TB was 7.7. [area under curve (AUC), 0.599, 95% CI: 0.533-0.666] Compared with Group 1, Group 2 had lower CA19-9, higher TB and lymph node metastasis rate (P<0.05). The 1-, 2- and 3-year disease-free survival (DFS) rates of patients in Group 1 and Group 2 were 70.1%, 44.3% and 30.8%, 39.9%, 17.1% and 13.6%, respectively (P=0.000), and the 1-, 2- and 3-year overall survival (OS) rates were 81.5%, 52.1% and 31.5%, 53.7%, 20.5% and 14.2%, respectively (P=0.000). Multivariate analysis showed that CA19-9/TB, portal vein invasion and lymph node metastasis were independent risk factors for postoperative tumor recurrence and long-term survival of PHC. Conclusions Compared with CA19-9 alone, CA19-9/TB is more valuable in judging postoperative tumor recurrence and long-term survival of PHC. The lower the ratio, the better the long-term prognosis.
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Affiliation(s)
- Wen-Li Xu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shao-Cheng Lyu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lin Zhou
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qiang He
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ren Lang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Liu Q, Fan J, Xu A, Yao L, Li Y, Wang W, Liang W, Yang F. Distribution of serum neuron-specific enolase and the establishment of a population reference interval in healthy adults. J Clin Lab Anal 2019; 33:e22863. [PMID: 30779465 PMCID: PMC6595301 DOI: 10.1002/jcla.22863] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/26/2019] [Accepted: 01/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Neuron-specific enolase (NSE) is an important tumor marker in the serum of patients with lung cancer. Elevated serum NSE levels are also associated with many other diseases. However, there is no unified population reference interval for serum NSE. This study aimed to investigate the distribution of serum NSE in healthy Chinese adults aged 20-79 years and to establish its reference interval in Chinese population. METHODS A total of 10 575 healthy subjects were in line with the requirements of this study. The concentration of serum NSE was detected by a fully automated Cobas e602 analyzer with matching reagents. The population reference interval for serum NSE was established using the unilateral 95th percentile (P95 ) according to standard guidelines. RESULTS The distributions of serum NSE were not significantly different between males and females (P > 0.05) and also did not differ by age (P > 0.05). Therefore, the population reference interval for serum NSE was established as upper limit 25.4 ng/mL (90% confidence interval: 24.5-26.2 ng/mL). CONCLUSIONS We established the first population reference interval for serum NSE in a large healthy Chinese adult cohort, which was higher than that recommended by Roche Diagnostics GmbH. This new reference interval is more practical and applicable in Chinese adults.
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Affiliation(s)
- Qian Liu
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Jilong Fan
- Department of Hepatobiliary Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Aiguo Xu
- Department of Oncology, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Li Yao
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Yan Li
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Wenjun Wang
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Wei Liang
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Fumeng Yang
- Department of Laboratory Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China
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Zhang GM, Bai SM, Zhang GM, Ma XB. Reference intervals of carbohydrate antigen 19-9 in the apparently healthy adult population. J Clin Lab Anal 2018; 32:e22380. [PMID: 29315815 DOI: 10.1002/jcla.22380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/12/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To establish reference intervals of carbohydrate antigen 19-9(CA 19-9) according to the CLSI CA28-A3 guideline and to evaluate age- and gender-related variations. METHODS Serum CA 19-9 values of 10 149 healthy subjects (from 20 years old to 60 years old) were measured from location health checkups. The relationship between CA 19-9 and age was analyzed using Spearman's approach. The reference intervals of CA19-9 were established using Q2.5 and Q97.5 , and the 90% confidence intervals of upper limits were calculated. RESULTS The reference intervals of CA 19-9 were 1.98-25.12 U/mL for males (1.97-25.06 U/mL for 20-50 years old and 2.31-26.13 U/mL for 50-60 years old) and 2.36-29.29 U/mL for adult (20-60 years old) females. The upper limit of reference intervals for all individuals was 26.45 U/mL; the level of CA 19-9 is higher in females than males. Carbohydrate antigen (CA) 19-9 is significantly associated with aging in adult males(r = .0930, P < .0001), but not in females (P = .4734). CONCLUSIONS Establishing reference intervals for CA19-9 and giving age-related reference intervals of CA19-9 using a big data of healthy adult, we first discovered that CA19-9 tends to increase with age in adult males but not in females.
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Affiliation(s)
- Gao-Ming Zhang
- Department of Laboratory Medicine, Shuyang People's Hospital, Shuyang, China.,Department of Laboratory Medicine, Shuyang Affiliated Hospital of Xuzhou Medical University, Shuyang, China
| | - Shu-Mei Bai
- Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guo-Ming Zhang
- Department of Laboratory Medicine, Shuyang People's Hospital, Shuyang, China.,Department of Laboratory Medicine, Shuyang Affiliated Hospital of Xuzhou Medical University, Shuyang, China
| | - Xiao-Bo Ma
- Department of Laboratory Medicine, Shuyang People's Hospital, Shuyang, China.,Department of Laboratory Medicine, Shuyang Affiliated Hospital of Xuzhou Medical University, Shuyang, China
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