Serum tumor markers used for predicting esophagogastric junction adenocarcinoma in esophageal malignancy

Background/aims: To evaluate a panel of complementary biomarkers for differential prediction of esophagogastric junction adenocarcinoma (EGAC) from other esophageal malignancy. Methods: Preoperative CA199, CEA, SCC and CA72-4 were evaluated among 410 patients (164 EGAC, 192 esophageal squamous cell carcinoma (ESCC) and 54 benign esophageal diseases). Kruskal-Wallis test, Wilcoxon rank-sum test, receiver operating characteristic curve and logistic regression analysis were applied. Results: The median CA19-9, CEA and CA72-4 levels were statistically higher in patients with EGAC than in those with ESCC (Wilcoxon rank sum test; P<0.001, respectively). Being adjusted to optimal cut-off value, positive CA19-9, positive CEA, negative SCC and positive CA72-4 were significantly correlated with high risk of EGAC (Logistics regression; CA19-9 OR=9.600 P<0.001; CEA OR=7.368 P<0.001; SCC OR=2.754 P<0.001; CA72-4 OR=2.487 P=0.001). When applied as a markers panel, serum tumor markers show a medium sensitivity (65.2%) and a high specificity (79.7%) (AUC=0.791 P<0.001) in EGAC prediction. Conclusions: Synchronous exertion of CA72-4, CEA, SCC, and CA19-9 could be a valuable method to distinguish esophagogastric junction adenocarcinoma from esophageal squamous cell carcinoma.