CLINICAL-VALUE OF TUMOR-MARKERS AND SERUM-ASCITES ALBUMIN GRADIENT INTHE DIAGNOSIS OF MALIGNANCY-RELATED ASCITES

To determine the clinical value of tumour markers in the diagnosis of malignancy-related ascites (not including hepatocellular carcinoma), s erum and ascitic fluid levels of carcinoembryonic antigen, cancer anti gen 125, carbohydrate antigen 19-9, tissue polypeptide antigen and ser um-ascites albumin gradient were determined in 66 patients with cirrho tic ascites, 28 patients with hepatocellular carcinoma and ascites, an d 29 patients with malignancy-related ascites. Three tumour markers an d serum-ascites albumin gradient showed significant difference between patients with malignancy-related ascites and those without: serum car cinoembryonic antigen (26.4 +/- 31.5 vs 4.8 +/- 4.6 ng/mL, P < 0.01), ascitic fluid carcinoembryonic antigen (118.4 +/- 196.5 vs 2.0 +/- 1.4 ng/mL, P < 0.01), ascitic fluid carbohydrate antigen 19-9 (12933 +/- 25496 vs 23 +/- 67 U/mL, P < 0.01) and serum-ascites albumin gradient (1.1 +/- 0.4 vs 2.0 +/- 0.4 g/dL, P < 0.01). At the best cut-off level s chosen from near 95% of the data in those without malignancy-related ascites, the sensitivity, specificity and accuracy to diagnose malign ancy-related ascites were, respectively, 65.5%, 93.6%, 87.0% using ser um carcinoembryonic antigen greater-than-or-equal-to 10 ng/mL; 69.0%, 94.7%, 88.6% using ascitic fluid carcinoembryonic antigen greater-than -or-equal-to 5 ng/mL; 65.5%, 93.6%, 87.0% using ascitic fluid carbohyd rate antigen 19-9 greater-than-or-equal-to 50 U/mL; 62.1%, 98.9%, 90.2 % using serum-ascites albumin gradient < 1.1 g/dL. Although serum-asci tes albumin gradient offered the best diagnostic accuracy and specific ity, its sensitivity was not good enough. Our study indicates that ser um-ascites albumin gradient and tumour markers are not sensitive param eters in the diagnosis of malignancy-related ascites.