Clinical and laboratory evaluation of CA 19-9 in cirrhotic patients

Abstract

Objectives: CA 19-9 is a tumour marker mainly used in the evaluation of digestive system cancers. However, abnormal values can also be found in benign hepatobiliary diseases. The purpose of this study was to evaluate the behaviour of CA 19-9 in cirrhotic patients to try to find the factors associated with increased antigen levels which could have pathogenetic implications.

Methods: Eighty-five cirrhotic patients underwent a thorough clinical and laboratory evaluation. CA 19-9 levels and a wide range of liver tests were recorded in each case and evaluated with non-parametric statistical analysis.

Results: Forty patients (47.1%) had increased levels of CA 19-9 without significant differences between the Child's classes. Several laboratory parameters, especially transaminases, showed a significant correlation with CA 19-9. Patients with increased serum aspartate aminotransferase (ASAT) had higher CA 19-9 levels than those with normal ASAT (p < 0.0001). Multivariate analysis showed that the only independent factors significantly associated to CA 19-9 were ASAT and serum alanine aminotransferase (ALAT).

Conclusions: Cirrhotic liver disease must be excluded when an abnormal CA 19-9 serum level is found in a cancer patient before attributing it to the malignancy. Although several mechanisms can be involved, cytolysis and/or regeneration seems to play a role in the increase of CA 19-9 in these patients.