Abstract
Aim and Background
Preparation of the patients for liver transplantation is a meticulous process and includes evaluation of tumor markers to rule out occult malignancy. The present study evaluated the significance of serum tumor markers in patients bound for liver transplantation due to viral and other etiologies of liver failure.
Patients and Methods
Three hundred eighty-one patients who underwent liver transplantation were included in the study. Demographic data, model for end stage liver disease (MELD) scores, and serum tumor marker levels were prospectively collected.
Results
AFP levels were significantly higher in viral etiologies when compared to other etiologies (p < 0.05). Ca 19–9 was significantly higher in viral etiologies (p < 0.05). Among the viral etiologies, HCV-related liver failure had higher carcinoembryonic antigen (CEA) and carbohydrate antigen 19–9 (Ca 19–9) levels (p < 0.05). A correlation was found between increasing MELD scores and serum levels of tumor markers (p < 0.05).
Conclusions
Tumor markers such as AFP, CEA, Ca 125, and Ca 19–9 can be elevated in end stage liver disease. Their levels vary according to etiology and severity of disease. The diagnostic capabilities of these markers are reduced in end stage liver disease setting but they contribute to the evaluation of the pathophysiology of chronic liver disease. Transplantation can be performed safely in cases with high tumor marker levels provided that any occult malignancy is ruled out by means of imaging and endoscopic techniques. Tumor markers can guide the physician in determining the severity of liver cirrhosis, and further studies are needed to validate such a relationship.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Thuluvath PJ. Evaluation of liver transplant recipients. J Clin Exp Hepatol. 2011;1:199–203.
Alqahtani SA, Larson AM. Adult liver transplantation in the USA. Curr Opin Gastroenterol. 2011;27:240–7.
Burra P, et al. Liver transplantation for alcoholic liver disease in Europe: a study from the ELTR (European liver transplant registry). Am J Transplant. 2010;10:138–48.
Oketani M, et al. Etiology and prognosis of fulminant hepatitis and late-onset hepatic failure in Japan: summary of the annual nationwide survey between 2004 and 2009. Hepatol Res. 2013;43:97–105.
Kayaalp C, Ersan V, Yilmaz S. Acute liver failure in Turkey: a systematic review. Turkish J Gastroenterol. 2014;25:35–40.
Adil B, et al. Hepatitis B virus and hepatitis D virus recurrence in patients undergoing liver transplantation for hepatitis B virus and hepatitis B virus plus hepatitis D virus. Transplant Proc. 2016;48:2119–23.
Ökten A. Türkiye’de kronik hepatit, siroz ve hepatosellüler karsinoma etiyolojisi. Güncel Gastroenteroloji. 2003;7:187–91.
Pissaia A, et al. Significance of serum tumor markers carcinoembryonic antigen, CA 19–9, CA 125, and CA 15–3 in pre-orthotopic liver transplantation evaluation. Transplant Proc. 2009;41:682–4.
Tang A, Hallouch O, Chernyak V, Kamaya A, Sirlin CB. Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis. Abdom Radiol. 2017;1–13. https://doi.org/10.1007/s00261-017-1209-1.
Assmar M, Yeganeh S, Mansourghanaei F, Amirmozafari N. Combined evaluation of AFP, CA15-3, CA125, CA19-9, and CEA tumor markers in patients with hepatitis B and C. Iran J Public Health. 2016;45:1645–51.
Jain SK, Rohatgi A, Raman KK, Sharma VK. Study of serum prealbumin and serum alpha fetoprotein in cases of fulminant hepatic failure. J Assoc Physicians India. 1995;43:462–3.
Takikawa Y, Suzuki K. Is AFP a new reliable marker of liver regeneration in acute hepatic failure? J Gastroenterol. 2002;37:681–2.
Varshney A, Gupta R, Verma SK, Ahmad S. Alpha-fetoprotein as a prognostic marker in acute liver failure: a pilot study. Trop Doct. 2016. https://doi.org/10.1177/0049475516653891.
Schiødt FV, et al. Alpha-fetoprotein and prognosis in acute liver failure. Liver Transpl. 2006;12:1776–81.
Maestranzi S, Przemioslo R, Mitchell H, Sherwood RA. The effect of benign and malignant liver disease on the tumour markers CA19-9 and CEA. Ann Clin Biochem. 1998;35:99–103.
Kitagawa Y, et al. Immunohistochemical localization of CEA, CA19-9 and DU-PAN-2 in hepatitis C virus-infected liver tissues. Histopathology. 2002;40:472–9.
Singhal A, et al. Elevation of CA 125 and CA 19–9 in patients with end-stage liver disease. Int J Biol Markers. 2012;27:e147–51.
Bertino G, et al. Carbohydrate 19.9 antigen serum levels in liver disease. Biomed Res Int. 2013;2013.
Author information
Authors and Affiliations
Contributions
All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Deniz Yavuz Baskiran, Talha Sarigoz, and Adil Baskiran. The first draft of the manuscript was written by Deniz Yavuz Baskiran, and all the authors commented on the previous versions of the manuscript. All the authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics Approval
This retrospective study was conducted at Inonu University Institute of Liver Transplantation after obtaining institutional review board approval (2020/766).
Competing Interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Baskiran, D.Y., Sarigoz, T., Baskiran, A. et al. The Significance of Serum Tumor Markers CEA, Ca 19–9, Ca 125, Ca 15–3, and AFP in Patients Scheduled for Orthotopic Liver Transplantation: Do Elevated Levels Really Mean Malignancy?. J Gastrointest Canc 54, 442–446 (2023). https://doi.org/10.1007/s12029-021-00798-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12029-021-00798-5