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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 .