Correlations of cancer antigen 19-9 and Carcinoembryonic antigen with histopathological and clinical features among malignant thyroid tumors
Main Article Content
Keywords
Thyroid, tumors, CEA, CA 19-9, Sulaimani city
Abstract
Background: CEA and CA19-9 are important serum tumor marker for malignant tumors especially gastrointestinal tumors. This study aimed to reveal the correlations of CA19-9 and CEA titers with malignant thyroid tumors (MTTs).
Methodology: This study enrolled patients’ with MTTs (n=50), and control group (n=50). Thyroid biopsies were taken from MTTs and examined histopathologically and the sera of the patients’ and control groups were tested for both CEA and CA19-9, the patients’ group was tested twice, preoperatively and post operatively.
Results: Papillary thyroid carcinoma (PTC) was the most common MTT [n=46, (92%)]. Neck swelling was the most frequent (89.1%) feature among PTC patients. For the patients’ group, the median serum CEA results preoperatively was 1.57 (1.08-2.30) ng/ml, then it became 1.57 (0.94-2.05) ng/ml postoperatively, while the median preoperative serum CA19-9 was 12.17 (6.50-18.68) U/ml, then it became 12.24 (6.57-20.11) U/ml postoperatively; for both tumor markers, the differences between preoperative and postoperative concentrations were statistically significant (<0.05). The differences between median CEA concentrations between patients’ group and control group were statistically significant (p=0.001); while for CA 19-9 were statistically non-significant (p=0.936). Histologically, 97.92% of the differentiated thyroid tumors were in stage I.
Conclusion: There is significant decline in CEA concentration postoperatively among papillary thyroid carcinoma patients, while CA 19-9 was significantly increased postoperatively. The CEA concentration is higher in MTTs than in normal population and there is non-significant difference in CA 19-9 concentrations in MTTs and in normal population.
References
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28. Franceschi S, Boyle P, Maisonneuve P, La Vecchia C, Burt AD, Kerr DJ, et al. The epidemiology of thyroid carcinoma. Crit Rev Oncog 1993; 4:25-52.
29. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. Jama 2006; 295:2164-2167.
30. Zhu C, Zheng T, Kilfoy BA, Han X, Ma S, Ba Y, et al. A birth cohort analysis of the incidence of papillary thyroid cancer in the United States, 1973–2004. Thyroid 2009; 19:1061-1066.
31. Howlader N, Noone A, Krapcho M, Miller D, Bishop K, Altekruse S, et al. SEER Cancer Statistics Review, 1975–2013. Bethesda, MD: National Cancer Institute; 2016. 2016.
32. Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. The Lancet 2016; 388:2783-2795.
33. Bonnefond S, Davies TF. Thyroid cancer—risks and causes. Journal-Thyroid Cancer—Risks and Causes 2014.
34. Cooper DS. American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19:1167-1214.
35. Lee K, Anastasopoulou C, Chandran C, Cassaro S. Thyroid cancer. StatPearls [Internet]: StatPearls Publishing; 2021.
36. Glikson M, Dresner Feigin R, Libson E, Rubinow A. Anaplastic thyroid carcinoma in a retrosternal goiter presenting as fever of unknown origin. The American journal of medicine 1990; 88:81-82.
37. Chang T, Liaw K, Kuo S, Chang C, Chen F. Anaplastic thyroid carcinoma: review of 24 cases, with emphasis on cytodiagnosis and leukocytosis. Taiwan yi xue hui za zhi Journal of the Formosan Medical Association 1989; 88:551-556.
38. Milman S, Arnold JL, Price M, Negassa A, Surks MI, Fleischer N, et al. Medullary thyroid cancer that stains negative for CA 19-9 has decreased metastatic potential. Endocrine Practice 2015; 21:590-594.
39. Ito Y, Miyauchi A. CA19-9 May Be a Prognostic Factor for Medullary Thyroid Carcinoma. Clinical Thyroidology 2020; 32:24-26.
40. Shvero J, Koren R, Shpitzer T, Feinmesser R, Segal K. Immunohistochemical profile and treatment of uncommon types of thyroid carcinomas. Oncology reports 2003; 10:2075-2078.
41. Fletcher RH. Carcinoembryonic antigen. Annals of internal medicine 1986; 104:66-73.
42. Oncology ASoC. Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Adopted on May 17, 1996 by the American Society of Clinical Oncology. J Clin Oncol 1996; 14:2843-2877.
43. Ballesta AM, Molina R, Filella X, Jo J, Giménez N. Carcinoembryonic antigen in staging and follow-up of patients with solid tumors. Tumor biology 1995; 16:32-41.
44. Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. American Journal of Gastroenterology (Springer Nature) 1990; 85.
45. Kim H-J, Kim M-H, Myung S-J, Lim B-C, Park E-T, Yoo K-S, et al. A new strategy for the application of CA19-9 in the differentiation of pancreaticobiliary cancer: analysis using a receiver operating characteristic curve. The American journal of gastroenterology 1999; 94:1941-1946.
46. SobRinho-SiMõES M. Poorly differentiated and undifferentiated thyroid carcinomas. Turk Patoloji Dergisi 2015:48-59.
47. Sorush N. Evaluation of Serum Tumor Markers Variation, following the Radioac-tive Iodine Therapy in Patients with Differentiated Thyroid Cancer. SOJ Pedia Clin Neonato 2020; 1:1-6.
48. Lang TA, Secic M. How to report statistics in medicine: annotated guidelines for authors, editors, and reviewers: ACP Press; 2006.
49. Habibzadeh F. Common statistical mistakes in manuscripts submitted to biomedical journals. European Science Editing 2013; 39:92-94.
50. Habibzadeh F. Statistical data editing in scientific articles. Journal of Korean medical science 2017; 32:1072-1076.
51. Karhu D, Vanzieleghem M. Significance of digits in scientific research. AMWA J 2013; 28:58-60.
52. Li C, Xu F, Huang Q, Han D, Zheng S, Wu W, et al. Nomograms for differentiated thyroid carcinoma patients based on the eighth AJCC staging and competing risks model. JNCI Cancer Spectrum 2021; 5:pkab038.
53. Kakudo K, Tang W, Ito Y, Mori I, Nakamura Y, Miyauchi A. Papillary carcinoma of the thyroid in Japan: subclassification of common type and identification of low risk group. Journal of clinical pathology 2004; 57:1041-1046.
2. Wartofsky L, Van Nostrand D. Thyroid cancer: a comprehensive guide to clinical manag{Wartofsky, 2006 #194}ement: Springer; 2006.
3. Gilliland FD, Hunt WC, Morris DM, Key CR. Prognostic factors for thyroid carcinoma: A population‐based study of 15,698 cases from the Surveillance, Epidemiology and End Results (SEER) Program 1973–1991. Cancer: Interdisciplinary International Journal of the American Cancer Society 1997; 79:564-573.
4. Junior PLU, Callegaro-Filho D, Bugano DD, Moura F, Maluf FC. Predictive value of serum carbohydrate antigen 19-9 (CA19-9) for early mortality in advanced pancreatic cancer. Journal of gastrointestinal cancer 2018; 49:481-486.
5. Galli C, Basso D, Plebani M. CA 19-9: handle with care. Clinical chemistry and laboratory medicine 2013; 51:1369-1383.
6. Ballehaninna UK, Chamberlain RS. Serum CA 19-9 as a biomarker for pancreatic cancer—a comprehensive review. Indian journal of surgical oncology 2011; 2:88-100.
7. Kim H-R, Lee C-H, Kim YW, Han SK, Shim Y-S, Yim J-J. Increased CA 19-9 level in patients without malignant disease. Clinical chemistry and laboratory medicine 2009; 47:750-754.
8. Ogawa M, Hori H, Hirayama M, Kobayashi M, Shiraishi T, Watanabe Y, et al. Anaplastic transformation from papillary thyroid carcinoma with increased serum CA19‐9. Pediatric blood & cancer 2005; 45:64-67.
9. Yokoyama S, Fukuhara S, Imazu T, Hara T, Yamaguchi S, Adachi S. Recrudescence of prostate cancer with low serum level of PSA and high serum level of CEA and CA19-9: a case
report. Hinyokika kiyo Acta urologica Japonica 2007; 53:485-487.
10. Momma T, Kimura S, Saito S, Onoda N. Prostate cancer with high serum level of CEA and CA19-9: a case report. Hinyokika kiyo Acta urologica Japonica 1998; 44:187-191.
11. Yamaguchi E, Makino Y, Sato T, Uchida M, Harada Y, Maruyama R. CA19-9-producing lung metastasis after surgery for papillary thyroid carcinoma: report of a case. Surgery today 2014; 44:2157-2161.
12. Elisei R, Lorusso L, Romei C, Bottici V, Mazzeo S, Giani C, et al. Medullary thyroid cancer secreting carbohydrate antigen 19-9 (Ca 19-9): a fatal case report. The Journal of Clinical Endocrinology & Metabolism 2013; 98:3550-3554.
13. Milman S, Whitney KD, Fleischer N. Metastatic medullary thyroid cancer presenting with elevated levels of CA 19-9 and CA 125. Thyroid 2011; 21:913-916.
14. Perkins GL, Slater ED, Sanders GK, Prichard JG. Serum tumor markers. Am Fam Physician 2003; 68:1075-1082.
15. Hammarström S, editor The carcinoembryonic antigen (CEA) family: structures, suggested functions and expression in normal and malignant tissues. Seminars in cancer biology; 1999: Elsevier.
16. Slaoui M, Fiette L. Histopathology procedures: from tissue sampling to histopathological evaluation. Drug safety evaluation: Springer; 2011. p. 69-82.
17. Jonklaas J, Nogueras-Gonzalez G, Munsell M, Litofsky D, Ain K, Bigos S, et al. The impact of age and gender on papillary thyroid cancer survival. The Journal of Clinical Endocrinology & Metabolism 2012; 97:E878-E887.
18. Rahbari R, Zhang L, Kebebew E. Thyroid cancer gender disparity. Future Oncology 2010; 6:1771-1779.
19. Yager J, Leihr J. Molecular mechanisms of estrogen carcinogenesis. Annual review of pharmacology and toxicology 1996; 36:203-232. 20. Lee M, Chen G, Vlantis A, Tse G, Leung B, Van Hasselt C. Induction of thyroid papillary carcinoma cell proliferation by estrogen is associated with an altered expression of Bcl-xL. The Cancer Journal 2005; 11:113-121.
21. Zeng Q, Chen G, Vlantis A, Van Hasselt C. Oestrogen mediates the growth of human thyroid carcinoma cells via an oestrogen receptor–ERK pathway. Cell Proliferation 2007; 40:921-935.
22. Ortega J, Sala C, Flor B, Lledo S. Efficacy and cost-effectiveness of the UltraCision® harmonic scalpel in thyroid surgery: an analysis of 200 cases in a randomized trial. Journal of Laparoendoscopic & Advanced Surgical Techniques 2004; 14:9-12.
23. Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005. Cancer: Interdisciplinary International Journal of the American Cancer Society 2009; 115:3801-3807.
24. Moysich KB, Menezes RJ, Michalek AM. Chernobyl-related ionising radiation exposure and cancer risk: an epidemiological review. The Lancet Oncology 2002; 3:269-279.
25. Scott Br, Cardis E, Kesminiene A. Re: Risk of thyroid cancer after exposure to 131I in childhood. Author's reply. Journal of the National Cancer Institute 2006; 98:561-561.
26. Parad MT, Fararouei M, Mirahmadizadeh AR, Afrashteh S. Thyroid cancer and its associated factors: A population‐based case‐control study. International Journal of Cancer 2021; 149:514-521.
27. LeClair K, Bell KJ, Furuya-Kanamori L, Doi SA, Francis DO, Davies L. Evaluation of gender inequity in thyroid cancer diagnosis: differences by sex in US thyroid cancer incidence compared with a meta-analysis of subclinical thyroid cancer rates at autopsy. JAMA internal medicine 2021; 181:1351-1358.
28. Franceschi S, Boyle P, Maisonneuve P, La Vecchia C, Burt AD, Kerr DJ, et al. The epidemiology of thyroid carcinoma. Crit Rev Oncog 1993; 4:25-52.
29. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. Jama 2006; 295:2164-2167.
30. Zhu C, Zheng T, Kilfoy BA, Han X, Ma S, Ba Y, et al. A birth cohort analysis of the incidence of papillary thyroid cancer in the United States, 1973–2004. Thyroid 2009; 19:1061-1066.
31. Howlader N, Noone A, Krapcho M, Miller D, Bishop K, Altekruse S, et al. SEER Cancer Statistics Review, 1975–2013. Bethesda, MD: National Cancer Institute; 2016. 2016.
32. Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. The Lancet 2016; 388:2783-2795.
33. Bonnefond S, Davies TF. Thyroid cancer—risks and causes. Journal-Thyroid Cancer—Risks and Causes 2014.
34. Cooper DS. American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19:1167-1214.
35. Lee K, Anastasopoulou C, Chandran C, Cassaro S. Thyroid cancer. StatPearls [Internet]: StatPearls Publishing; 2021.
36. Glikson M, Dresner Feigin R, Libson E, Rubinow A. Anaplastic thyroid carcinoma in a retrosternal goiter presenting as fever of unknown origin. The American journal of medicine 1990; 88:81-82.
37. Chang T, Liaw K, Kuo S, Chang C, Chen F. Anaplastic thyroid carcinoma: review of 24 cases, with emphasis on cytodiagnosis and leukocytosis. Taiwan yi xue hui za zhi Journal of the Formosan Medical Association 1989; 88:551-556.
38. Milman S, Arnold JL, Price M, Negassa A, Surks MI, Fleischer N, et al. Medullary thyroid cancer that stains negative for CA 19-9 has decreased metastatic potential. Endocrine Practice 2015; 21:590-594.
39. Ito Y, Miyauchi A. CA19-9 May Be a Prognostic Factor for Medullary Thyroid Carcinoma. Clinical Thyroidology 2020; 32:24-26.
40. Shvero J, Koren R, Shpitzer T, Feinmesser R, Segal K. Immunohistochemical profile and treatment of uncommon types of thyroid carcinomas. Oncology reports 2003; 10:2075-2078.
41. Fletcher RH. Carcinoembryonic antigen. Annals of internal medicine 1986; 104:66-73.
42. Oncology ASoC. Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Adopted on May 17, 1996 by the American Society of Clinical Oncology. J Clin Oncol 1996; 14:2843-2877.
43. Ballesta AM, Molina R, Filella X, Jo J, Giménez N. Carcinoembryonic antigen in staging and follow-up of patients with solid tumors. Tumor biology 1995; 16:32-41.
44. Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. American Journal of Gastroenterology (Springer Nature) 1990; 85.
45. Kim H-J, Kim M-H, Myung S-J, Lim B-C, Park E-T, Yoo K-S, et al. A new strategy for the application of CA19-9 in the differentiation of pancreaticobiliary cancer: analysis using a receiver operating characteristic curve. The American journal of gastroenterology 1999; 94:1941-1946.
46. SobRinho-SiMõES M. Poorly differentiated and undifferentiated thyroid carcinomas. Turk Patoloji Dergisi 2015:48-59.
47. Sorush N. Evaluation of Serum Tumor Markers Variation, following the Radioac-tive Iodine Therapy in Patients with Differentiated Thyroid Cancer. SOJ Pedia Clin Neonato 2020; 1:1-6.
48. Lang TA, Secic M. How to report statistics in medicine: annotated guidelines for authors, editors, and reviewers: ACP Press; 2006.
49. Habibzadeh F. Common statistical mistakes in manuscripts submitted to biomedical journals. European Science Editing 2013; 39:92-94.
50. Habibzadeh F. Statistical data editing in scientific articles. Journal of Korean medical science 2017; 32:1072-1076.
51. Karhu D, Vanzieleghem M. Significance of digits in scientific research. AMWA J 2013; 28:58-60.
52. Li C, Xu F, Huang Q, Han D, Zheng S, Wu W, et al. Nomograms for differentiated thyroid carcinoma patients based on the eighth AJCC staging and competing risks model. JNCI Cancer Spectrum 2021; 5:pkab038.
53. Kakudo K, Tang W, Ito Y, Mori I, Nakamura Y, Miyauchi A. Papillary carcinoma of the thyroid in Japan: subclassification of common type and identification of low risk group. Journal of clinical pathology 2004; 57:1041-1046.
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Apr 15, 2023
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Yadgar Aziz Abdullah, Abdulwahid Mohammed Salih, Ari Mohammed Abdullah, Mohammed Abdalkarim Hama Ali, & Ali Hattem Hussain. (2023). Correlations of cancer antigen 19-9 and Carcinoembryonic antigen with histopathological and clinical features among malignant thyroid tumors. Journal of Population Therapeutics and Clinical Pharmacology, 30(7), 56–71. https://doi.org/10.47750/jptcp.2023.30.07.008
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