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Digestive Diseases and Sciences, Vol. 51, No. 2 (February 2006), pp. 338345 ( CMAXIMILIAN SCH ONIGER-HEKELE, MD, and CHRISTIAN M ULLER, MDIncreased tumor markers in patients with liver cirrhosis are often considered to be unspecific. The
use of this unspecific elevation to discriminate minimal fibrosis from severe fibrosis has never been
explored. We aimed to answer the question, Do tumor markers predict severe liver fibrosis? The
study group consisted of 125 patients with alcoholic liver disease, hepatitis B, or hepatitis C with
available liver biopsy. Tumor markers CA 19-9, CA 15-3, and CA 125 were determined using
routine laboratory methods and correlated with the extent of liver fibrosis. Fibrosis stages 1 and 2
were classified as minimal fibrosis; stages 3 and 4, as severe fibrosis.Tumor markers CA 19-9, CA 125, and CA 15-3 increased with stage of fibrosis. For separating
patients with mild fibrosis (F1+F2) from patients with severe fibrosis (F3+F4), CA 19-9 had a
sensitivity of 70.5% and a specificity of 88.6, CA 125 had 38.1% and 89.7%, and CA 15-3 had19.0% and 93.0%, respectively. Logistic regression of a combined score of CA19-9 and CA 125
values revealed that an increase of 1 point of the CA 19-9/CA125 score resulted in a 1.6 times
increase in likelihood of the presence of severe fibrosis. The CA 19-9/CA 125 score achieved a
similar specificity (97.1% vs. 100%) but a higher sensitivity (42.9% vs. 33.3%) than the widely used
cirrhosis discriminant score of Bonacini. A specificity (98.5%) similar to that of the CA 19-9/CA 125
score was reached by the easier determination of the combined elevation of CA 19-9 and CA 125,
which had the best positive predictive value, 92.9%. The excellent predictive ability of the combined
elevation of CA 19-9 and CA 125 for severe liver fibrosis (F3+F4) was confirmed in an independent
group of patients with liver disease. The combined elevation of CA 19-9 and CA 125 is useful
for identifying patients with advanced fibrosis or cirrhosis with high specificity. Patients without a
combined elevation of CA 19-9 and CA 125 still require histological examination to identify severe
fibrosis or cirrhosis.KEY WORDS: CA 19-9; CA 125; tumor marker; liver fibrosis.The gold standard for the diagnosis of cirrhosis is the histological examination of liver tissue,...