Carcinoembryonic antigen-like activity in gastric juice and plasma in patients with gastric disorders

CEA Levels in Gastric Juice in Precancerous Conditions and Cancer

First described in 1965 as a specific antigen for cancer of the colon, CEA is now considered to be an antigen associated with many types of malignant neoplasia, although the CEA-Test's role in clinical routine has yet to be clearly defined.

In the present study CEA levels in gastric juice were measured in subjects with gastric carcinoma (n = 25) and with benign gastric lesions (n = 171). CEA was significantly (p < 0.05) higher in patients with gastric carcinoma (GC) than in subjects with benign gastric lesions, other than chronic atrophic gastritis (CAG) associated with intestinal metaplasia (IM). In this latter condition CEA levels were similar to those in patients with GC.

These results suggest that the assay of CEA in gastric juice could be included in the diagnostic program for gastric cancer and its precursors with the aim of assessing its utility as risk indicator in the management of precancerous conditions and lesion.

Specific detection of gastric alpha-antitrypsin by immobilized trypsin on polyHEMA films

Early diagnosis of gastric carcinoma is crucial for maximizing medical treatment efficacy. For the purpose of real time diagnosis ("virtual biopsy") of stomach malignancy we developed a polyHEMA platform capable of capturing human alpha1-antitrypsin precursor (A1AT); a model proteinaceous luminal biomarker. Its specific attachment to the polymeric platform was accomplished by immobilized trypsin, which was linked to the surface of the polyHEMA film by a series of PEG-based spacers. Recognition was enabled by adapting an ELISA-like methodology, using rabbit anti-A1AT and HRP-conjugated anti-rabbit IgG as a secondary antibody. Since this A1AT-sensing platform was designed to be detected by endoscopic means such as a video capsule, its physical stability was tested after casting on top of a polycarbonate surface. It was found that, in contrast to classical ELISA analysis performed on polystyrene plates, A1AT detection was possible only when spacer arms were used to immobilize the capturing moiety, trypsin, with a 7-fold increase in the optical signal and a saturation kinetics dependency upon the concentration of the A1AT biomarker.

An endogastric capsule for measuring tumor markers in gastric juice: an evaluation of the safety and efficacy of a new diagnostic tool

BACKGROUND

In gastric juice, high levels of the carcinoembryonic antigen (CEA) and the carbohydrate antigen 19-9 (CA 19-9) have been found to correlate with precancerous lesions and gastric cancer. So far, sampling of gastric juice has required upper endoscopy. In place of this invasive procedure, we investigated a new tool for the quantitation of tumor markers in gastric juice.

MATERIALS AND METHODS

The study population consisted of healthy controls and consecutive subjects with suspected gastric cancer or dyspepsia/epigastric distress. Patients were asked to swallow a small gelatine capsule (14 mm in length and 5 mm in diameter) containing a pierced plastic cover and surrounding a piece of absorbent paper. The capsule was left in the gastric cavity for 60 min to allow saturation of the absorbent paper with gastric juice. A 45-50 cm length of nylon thread connected to the inner capsule was used to remove the device from the gastric cavity. After processing the absorbent paper for radioimmunoassay, CEA and CA 19-9 levels were correlated to the findings of upper endoscopy and biopsies of gastric mucosa or suspected lesions.

RESULTS

The endogastric capsule did not cause any side-effects and 62 participants were fully compliant to the procedure. Assessable gastric juice samples were taken from 23 patients with gastric cancer, 15 patients with intestinal metaplasia or dysplasia, 12 patients with gastritis and 12 controls without gastric diseases. In the 12 samples of gastric juice from control patients, mean values of CEA and CA 19-9 were 1.1 +/- 0.9 ng/ml and 16 +/- 7.5 ng/ml, respectively. The mean levels of both markers were found to increase according to the severity of gastric lesions and in patients with cancer, mean CEA and CA 19-9 levels were 513 +/- 627 ng/ml and 545 +/- 510 ng/ml, respectively. Patients with precancerous lesions and cancer showed higher levels of CEA and CA 19-9 than patients with normal findings or gastritis (P <0.001).

CONCLUSIONS

The endogastric capsule is a simple, non-invasive tool for the measurement of CEA and CA 19-9 levels in gastric juice. These values may discriminate between normal or minor pathologic changes and precancerous lesions or carcinomas. Further investigations are warranted, since this may represent a new method for gastric cancer screening.

The prognostic significance of gastric juice CA 19-9 and CEA levels in gastric carcinoma patients

AIM

The usefulness of gastric juice CA 19-9 and carcinoembryonic antigen (CEA) levels in the diagnosis of gastric carcinoma is controversial. There is only one study related with their prognostic value. In this study the clinical significance of gastric juice CA 19-9 and CEA levels in patients with gastric carcinoma was investigated.

METHODS

Preoperative serum and gastric juice CA 19-9 and CEA concentrations were measured in 139 patients with gastric carcinoma, 54 patients with benign gastroduodenal disease and as the 'healthy' control group 46 patients with inguinal hernia and with no other pathology.

RESULTS

In all groups the mean gastric juice levels of CA 19-9 and CEA were significantly higher than the serum levels. The gastric juice CA 19-9 levels were not different between groups. Gastric juice CEA levels of the gastric carcinoma group were significantly higher than those of the benign gastroduodenal disease group (P=0.007) and had a tendency to increase when compared to those of the control group (P=0.064) whereas there was no significant difference between the benign gastroduodenal disease and the control group. The cut-off values of gastric juice CA 19-9 and CEA were 440U/ml and 320ng/ml and the positivity ratios of these markers in gastric carcinoma patients were 16.5 and 27.3%, respectively. There was no significant relationship between the histopathological features and the gastric juice CA 19-9 or CEA positivities. Neither univariate analysis nor the multivariate Cox proportional hazards model analysis showed prognostic value for gastric juice CA 19-9 and CEA positivities.

CONCLUSIONS

The gastric juice CA 19-9 and CEA levels have no diagnostic and prognostic significance in gastric carcinoma patients.

Association between preoperative plasma CEA levels and the prognosis of gastric cancer following curative resection. Tumor Marker Committee, Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan

A large-scale retrospective study was undertaken to evaluate the association between preoperative plasma carcinoembryonic antigen (CEA) levels and the prognosis of 2768 gastric cancer patients who underwent curative gastrectomy between 1983 and 1984 at 66 leading medical institutions in Japan Postoperative follow-up was at least 5 years. Preoperative plasma CEA levels were also analysed against other prognostic factors. Preoperative plasma CEA levels showed strong correlations to the degree of lymph node metastasis (P < 0.001), TNM stage (P = 0.004) and the histopathology of the gastric cancer (P < 0.001). Preoperative CEA levels were also evaluated against survival, after being adjusted for the effect of clinically important factors by multivariate analysis. Patients with lower preoperative plasma CEA levels survived significantly longer than patients with higher CEA levels (P = 0.0001). This analysis demonstrates that curatively resected gastric cancer patients with higher preoperative plasma CEA levels have a poorer prognosis than those with lower levels, despite the adjustment for the effects of major prognostic factors.

Marked elevation of plasma carcinoembryonic antigen and stomach carcinoma

BACKGROUND

This study was undertaken to clarify the relationship between marked elevation of plasma carcinoembryonic antigen (CEA) and signet ring cell carcinoma of the stomach.

METHODS

To elucidate the contributing factor of extreme elevation of plasma CEA value, the histologic and biochemical records for 310 cases of stomach carcinoma, including 202 advanced and 108 early, collected between 1980 to 1994 from the San-in Rosai Hospital and Tottori University Hospital were studied. Immunohistochemical localization of CEA in the stomach was performed using a peroxidase antiperoxidase (PAP) staining technique.

RESULTS

Among 310 cases of gastric carcinoma, 44 (14%) had abnormal plasma CEA values. The positivity rates of early and advanced gastric carcinoma were 3.7% (4/18) and 19% (40/202), respectively. Concerning advanced gastric carcinoma, 20 cases had more than 51 ng/mL, and 20 cases had between 5 ng/mL and 50 ng/mL. Four cases with plasma CEA values of more than 1,000 ng/mL had histological signet ring cell carcinoma (one case), and poorly differentiated adenocarcinoma with signet ring cell carcinoma (2 cases). Three cases of signet ring cell carcinoma or poorly differentiated adenocarcinoma of the stomach were massive local infiltration rather than hepatic metastasis. Among 40 cases with elevated plasma CEA, a multivariate regression analysis showed that only one variable (lymph node metastasis) was an independent factor (P < 0.05). Significantly higher rates of peritoneal metastasis (P < 0.0001) and lymph node metastasis (P < 0.05) were observed in patients with marked elevations of plasma CEA than in patients with moderate elevations of plasma CEA. No correlation was obtained between plasma CEA value and several biochemical tests.

CONCLUSIONS

Marked elevation of plasma CEA may be found in the absence of liver metastasis from signet ring or poorly differentiated gastric carcinoma. Patients with marked elevations of CEA also had lymphatic and peritoneal dissemination.

Correlation of preoperative carcinoembryonic antigen levels and prognosis of gastric cancer patients

BACKGROUND

The prognostic significance of preoperative serum carcinoembryonic antigen (CEA) determination in patients with gastric cancer has been controversial.

METHODS

The correlation between preoperative serum CEA levels and clinicopathologic factors was evaluated in 865 patients with gastric cancer who underwent gastrectomy between 1980 and 1990. The authors also investigated whether preoperative CEA levels represented a prognostic parameter using Cox's proportional hazard model.

RESULTS

Of the 865 patients, 249 (28.8%) were positive for CEA. The positivity rate was higher in the elderly, in male patients whose tumors were located in the lower third of the stomach, and in those with Borrmann types 2 and 3. It was also significantly correlated with tumor size, depth of invasion, lymph node metastasis, peritoneal and liver metastases, and cancer stage. The higher the serum CEA level, the more advanced the cancer stage, and the rate of curative resection also decreased as CEA levels were elevated. There was a significant difference between patients with CEA levels below 10 ng/ml and those with levels exceeding 10 ng/ml with regard to tumor progression and curability. Multivariate analysis showed a strong and highly significant association between preoperative serum CEA level and survival time. The prognosis was also significantly poorer when the CEA level was above 10 ng/ml, even in patients in the same stage (Stages 1, 2, and 3).

CONCLUSIONS

Preoperative serum CEA determination in patients with gastric cancer valuable for predicting tumor progression and prognosis. Further, in patients in Stages 1, 2, and 3, CEA levels exceeding 10 ng/ml are clinically significant and provide more prognostic information than that obtained by conventional staging methods.

Carcinoembryonic antigen levels in peritoneal washings can predict peritoneal recurrence after curative resection of gastric cancer

Carcinoembryonic antigen (CEA) levels were determined in the peritoneal washings from 120 patients with gastric cancer and 9 patients with benign diseases. Elevated values (greater than 100 ng/g of protein) were observed in 20 of 25 patients with gastric cancer with visible dissemination and 16 of 25 patients with serosal invasion but no dissemination. The same elevation was found in only 9 of 70 patients with no serosal invasion and none of the patients with benign disease. The 2-year survival rates after curative operation for the patients with and without elevation of CEA levels were 21% (19 patients) and 100% (66 patients), respectively (P less than 0.001). A negative correlation was found between CEA levels and survival times after noncurative operation. These results indicate that the CEA level in peritoneal washings could be a sensitive detector of invisible peritoneal dissemination and a new predictor for the postoperative prognosis of gastric cancer.

CA 50 determination in body fluids: can we screen patients at risk for gastric cancer?

CA 50 (a tumor-associated gangliosidic antigen) levels have been determined by an RIA test in serum, gastric juice and urine of patients undergoing upper gastrointestinal tract endoscopy: 22 control subjects (no macroscopic or microscopic lesions), 29 patients with chronic atrophic gastritis, 20 with epithelial dysplasia and 16 with gastric cancer entered the study. Gastric juices were also tested for pH, protein concentration and specific gravity, urines for protein concentration and osmolarity. Serum and gastric juices were also tested for CEA levels and the results obtained with the two markers compared. In patients with gastric cancer, CA 50 gastric juice levels were statistically higher than in controls; a wide overlap was however present among groups, and sensitivity and specificity were respectively 38% and 85% for serum and 69% and 82% for gastric juice. Sensitivity and specificity were respectively 23% and 89% for CA 50 determination in urines. In this case, no statistically significant difference was observed between gastric cancer and control patients. A trend toward higher median values was observed in advanced with respect to early gastric cancer. A correlation was found between gastric juice and serum CA 50 levels, as well as between serum and urine levels of the marker. A correlation was also observed between CA 50 values and protein concentration in gastric juice and with osmolarity in urines. Overall, CA 50 levels were statistically higher in patients with intestinal metaplasia than in those who did not present the lesion. Increased CA 50 gastric juice levels are also observed in patients with chronic atrophic gastritis and epithelial dysplasia. CA 50 gastric juice and urine levels appear to be dependent, at least in part, on the concentration of the fluid.

Carcinoembryonic antigen measurement in gastric juice. Discovery and elimination of an inhibitory interference

In biological fluids containing mucus an inhibitory interference on CEA measurement was found. The interference could be eliminated.

Tumor marker radioimmunoassays in gastric juice. Methodologic drawbacks due to pH variations

Conflicting data have been reported on tumor marker determination in gastric juice. In the present study the effect of pH variations on both antibody-antigen binding and the immunologic stability of the antigen were evaluated for the radioimmunoassay of carcinoembryonic antigen, CA19-9, tissue polypeptide antigen, and ferritin. A significant inhibition of antibody-antigen binding was constantly found in acidic conditions. Antigen concentration was lower in acidified than in untreated samples, possibly due to the carryover of acidity in the incubation mixture. Neutralization of acidified samples partly improved recovery of carcinoembryonic antigen and CA19-9. Tissue polypeptide antigen and ferritin were not recovered by neutralization in samples with pH less than 4.5, suggesting an irreversible damage of the immunologic characteristics of the two antigens. From the present data we conclude that an accurate validation of methods and a rigorous standardization of sample collection are mandatory for tumor marker determination by radioimmunoassay in gastric juice.

Immunohistochemical study of carcinoembryonic antigen (CEA) in gastric tumors: correlation with preoperative serum levels, histologic type, and grade of anaplasia of the tumor

The occurrence of carcinoembryonic antigen (CEA) was studied in 45 cases of gastric tumors by the immunoperoxidase technique. CEA-positive staining was found in 48.8% of tumors. A correlation was found between preoperative CEA values and tumor CEA staining. All patients with serum CEA values below 2.5 ng/ml showed CEA-negative staining of tumor. In patients with serum CEA values between 2.6 and 10 ng/ml, the tumors showed a minority of CEA-positive cells; but in patients with serum CEA values above 10 ng/ml, the tumors contained a majority of CEA-positive cells. CEA-positive staining was found in 34.4% of tumors of the diffuse type, and in 75% of tumors of the intestinal type. A high percentage of CEA positivity was seen in well-differentiated tumors (87.7%) compared to the moderately differentiated (69.2%), and to the undifferentiated (28.7%). A faint CEA-positivity was observed in intestinal metaplasia, while normal gastric mucosa was CEA-negative.

Evaluation of gastric carcinoembryonic antigen analysis as an aid during screening for gastric neoplasia in atrophic gastritis

The value of gastric juice and tissue carcinoembryonic antigen (CEA) analysis as an adjunct to endoscopic screening for gastric neoplasia was investigated in 61 patients with atrophic gastritis of whom 41 had other (superimposed) gastric lesions: six adenocarcinoma, four carcinoid, 23 regenerative polyps with or without dysplasia and eight fundic, or antral mucosal dysplasia. The gastric concentration of CEA did not differ between patient groups with different superimposed lesions. In these patients the gastric juice CEA concentrations were significantly increased in comparison with those in patients without superimposed lesions (p = 0.002). Gastric juice CEA concentrations above the upper range (+2SD) of those observed in normal controls were found in 40 (98%) of 41 patients with superimposed lesions and in 13 (65%) of 20 patients without such lesions (p = 0.001). At re-examination of 26 patients without neoplasia initially, after a mean interval of 32 months two (without polyps initially), had developed regenerative polyps, one an adenoma, and one an adenocarcinoma. These four had raised gastric juice CEA concentrations at the initial examination.

Carcinoembryonic antigen in gastric juice collected during endoscopy. Value in detecting high-risk patients and gastric cancer

In order to ascertain the role of gastric carcinoembryonic antigen (CEA) determination in detecting patients with a risk for gastric cancer, 69 subjects were studied; 23 were referred for endoscopy because of dyspepsia but without obvious macroscopic lesions, 27 with duodenal ulcer, 11 with benign gastric ulcer, 8 with gastric cancer. The following results were obtained by subdividing the material according to the histologic interpretation of the results of gastric mucosal biopsies: (1) in the presence of minor histologic abnormalities of the gastric mucosa, CEA in gastric juice was under 100 ng/ml in all but five cases; and (2) in moderate or severe chronic atrophic gastritis (associated or otherwise with intestinal metaplasia or dysplasia), and in gastric cancer, gastric CEA ranged between 224 and 3120 ng/ml in all but two cases. Although not diagnostic for gastric cancer, gastric CEA is a promising test in detecting patients at risk, including those with dysplasia of the gastric mucosa.

Serum beta 2--microglobulin and carcinoembryonic antigen in patients with gastric disorders

A comparative study of carcinoembryonic antigen (CEA) and beta 2-microglobulin in serum was made by radioimmunoassay in 121 patients with gastric disease. There was no statistical difference in serum CEA and beta 2-microglobulin in patients with benign gastric disease, early gastric carcinoma, and advanced gastric carcinoma. However, CEA levels in patients with advanced gastric carcinoma were higher than those in benign gastric disease and in early gastric carcinoma but beta 2-microglobulin did not show and differences. Furthermore, after total removal of the tumor, the elevated CEA levels decreased but beta 2-microglobulin remained unchanged. We concluded that CEA appeared to predict tumor behavior more accurately in patients with gastric carcinoma than beta 2-microglobulin.