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Advances in dermatology and venereology Acta Dermato-Venereologica
Serum Carcinoembryonic Antigen Level as a Marker for Advanced Stage and Chemotherapeutic Response in Extramammary Paget’ s Disease
Hiroshi UMEMURA 1, Osamu YAMASAKI 1, Tatsuya KAJI 1, Masaki OTSUKA 2, Kenji ASAGOE 3 and Keiji IWATSUKI 1
1
Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, 2 Division of Dermatology, Shizuoka Cancer Center Hospital, Shizuoka, and 3 Department of Dermatology, National Hospital Organization Okayama Medical Center, Okayama, Japan. E-mail: ugn11252 @ nifty. com Accepted Apr 24, 2018; Epub ahead of print Apr 24, 2018
Extramammary Paget’ s disease( EMPD) is a rare cutaneous adenocarcinoma that primarily affects the genital area in elderly patients. In general, the prognosis of EMPD in patients with carcinoma in situ is good. However, when EMPD becomes invasive, it has the potential to cause distant metastases after regional lymph node metastasis( 1, 2). EMPD has non-specific visual features and is frequently misdiagnosed as other common skin diseases( e. g. eczema, psoriasis, and tinea). In such cases, inappropriate treatment may result in progression to advanced stages of the disease( 3). Therefore, a cancer biomarker that properly reflects disease progression is required for early diagnosis of the disease.
Serum carcinoembryonic antigen( CEA) is a widely used biomarker for various adenocarcinomas, especially for colorectal cancer( 4 – 6). Serum CEA has been reported to be useful in the management of EMPD( 7 – 9). However, the significance of serum CEA levels in patients with EMPD remains to be established.
The present study retrospectively analysed 72 cases of EMPD at a Japanese institute for analysing the use of serum CEA levels in disease management.
METHODS
Serum CEA levels were measured in 72 patients with EMPD( 42 men and 30 women) from April 2004 to January 2017 at the Department of Dermatology, Okayama University Hospital, Okayama, Japan. No patient had other forms of adenocarcinoma, such as colorectal cancer. Mean patient age was 72 years( range 44 – 88). Clinical staging was performed according to a recently reported classification( 1). However, we lacked information regarding the tumour thickness and thus could not distinguish stage I from II. Therefore, EMPD was classified as stage I – II( without metastasis; n = 55), stage III( with regional lymph node metastasis; n = 7), or stage IV( with distant metastasis; n = 10).
The effects of chemotherapy were evaluated by measuring the size of the metastatic lesion in accordance with the Response Evaluation Criteria in Solid Tumors version 1.1 guidelines. The evaluation results were recorded as complete response( CR) and partial response( PR), stable disease( SD) and progressive disease( PD). All metastatic lesions were evaluated using enhanced computed tomography( CT) except for the left inguinal lymph node in case 3, which was evaluated using ultrasonography( Table SI 1).
Mean serum CEA levels were compared between the EMPD stage groups using the Mann – Whitney U test. The Wilcoxon signed-rank sum test was used to compare pre- and post-chemotherapeutic serum CEA levels. p < 0.05 was considered statistically significant.
1 https:// www. medicaljournals. se / acta / content / abstract / 10.2340 / 00015555-2948
The study was approved by the ethics committee of Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital( number 1704-005).
RESULTS
Serum CEA levels, obtained during the initial hospital visit, were significantly elevated in patients with stage IV( p < 0.0001) compared with those in patients with stage I – II EMPD. The levels were not significantly different in patients with stages III and I – II of the disease( p = 0.6867; Fig. 1). The cut-off value was set to 5.0 ng / ml; the calculated sensitivities of the serum CEA level were 1.8 %, 14.3 %, and 90.0 % for patients with stages I – II( 1 of 55), III( 1 of 7) and IV( 9 of 10), respectively. These findings suggest that serum CEA level is a useful marker in patients with EMPD and distant metastases.
Among the 72 patients with EMPD, 9 underwent 16 courses of chemotherapy for treatment of metastatic lesions. A summary of changes in serum CEA levels is shown in Table SI 1. Among 19 patients undergoing imaging tests, none had a CR, 3 had a PR, one had SD, and 15 had PD. Three patients( cases 4, 7 and 8) had PR at some
Stage
( ng / ml) 3200
3150
3100
3050
3000 ~ ~ 70 60 50 40 30 20 10 0 p = 0.6867
p < 0.0001
I-II |
III |
IV |
( n = 55) |
( n = 7) |
( n = 10) |
Fig. 1. Compared with patients without metastases( stage I – II; n = 55), serum carcinoembryonic antigen( CEA) levels significantly elevated in patients with distant metastases( stage IV; n = 10, p < 0.0001). Serum CEA levels did not differ significantly between patients with( stage III) and those without regional lymph node metastasis( n = 7, p = 0.6867). doi: 10.2340 / 00015555-2948 Acta Derm Venereol 2018; 98: 706 – 707
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2018 Acta Dermato-Venereologica.