Objective: To verify the significance of prospective serum cancer markers clearance program for primary Venous thromboembolism(VTE) cases.
Methods: During 1 July 2010 within 31 Dec 2012, data from two Chinese vascular centers was prospective registry. All the cases diagnosed as primary VTE by first vascular physicians were underwent serum cancer markers clearance. Long term follow up was required to confirm real cancer occurrence and long term survival rate. A total of 167 cases (106 male and 61 female) were enrolled in this study. Mean age was 52 ± 15 years old.
Results: Eighteen cases (10.78%) were finally scanned as malignant. The sensitive of markers: Carcino-embryonic antigen (CEA) 0.67, carbohydrate antigen (CA)199 0.44, CA242 0.33, CA153 0.44, CA125 0.78, CA724 0.17, combined markers 0.94. The specificity of above markers was 0.97,0.98, 0.98, 0.97, 0.93, 0.97 and 0.86. CA 125 showed best sensitive and specificity as a sole marker. The positive likelihood ratio for markers: CEA 24.83 ((95%CI 8.95-68.90), CA199 22.07 (95%CI 6.43-75.78), CA242 16.56 (95%CI 4.53-60.55), CA153 13.24 (95%CI 4.85-36.17), CA125 10.54 (95%CI 5.67-19.58), CA 724 4.97(95%CI 1.29-19.07), combined of markers 6.70 (95%CI 4.44-10.12). The negative likelihood ratio for markers: CEA 0.34 ((95%CI 0.18-0.66), CA199 0.57 (95%CI 0.37-0.86), CA242 0.68 (95%CI 0.49-0.94), CA153 0.57 (95%CI 0.38-0.87), CA125 0.24 (95%CI 0.10-0.57), CA 724 0.86 (95%CI 0.76-1.06), combined of markers 0.66 (95%CI 0.01-0.44). CEA+CA125 showed better positive and negative likelihood ratio. 6 months, 12 months and 24 months survival rate for malignant (18cases) and non-malignant(149cases) were 61.1%, 50.0%, 31.3% and 99.3%, 98.6%, 98.6% respectively.
Conclusion: It is reasonable to screening malignant for "unprovoked" VTE cases. Combined multiple serum cancer markers showed best result. CA125 plus CEA showed acceptable result for some limited condition. CA50 was useless for cancer screening.