title: Use of Tumor Markers in Gastrointestinal Cancers: Surgeon Perceptions and Cost-Benefit Trade-Off Analysis.
abstract: BACKGROUND
  Gastrointestinal cancers constitute the third most common cancers worldwide. Tumor markers have long since been used in the postoperative surveillance of these malignancies; however, the true value in clinical practice remains undetermined.
  
  
  OBJECTIVE
  This study aimed to evaluate the clinical utility of three tumor markers in colorectal and esophagogastric cancer.
  
  
  METHODS
  A systematic review of the literature was undertaken to elicit the sensitivity, specificity, statistical heterogeneity and ability to predict recurrence and metastases for carcinoembryonic antigen (CEA), cancer antigen (CA) 19-9 and CA125. European surgeons were surveyed to assess their current practice and the characteristics of tumor markers they most valued. Data from the included studies and survey were combined in a cost-benefit trade-off analysis to assess which tumor markers are of most use in clinical practice.
  
  
  RESULTS
  Diagnostic sensitivity and specificity were ranked the most desirable characteristics of a tumor marker by those surveyed. Overall, 156 studies were included to inform the cost-benefit trade-off. The cost-benefit trade-off showed that CEA outperformed both CA19-9 and CA125, with lower financial cost and a higher sensitivity, and diagnostic accuracy for metastases at presentation (area under the curve [AUC] 0.70 vs. 0.61 vs. 0.46), as well as similar diagnostic accuracy for recurrence (AUC 0.46 vs. 0.48).
  
  
  CONCLUSIONS
  Cost-benefit trade-off analysis identified CEA to be the best performing tumor marker. Further studies should seek to evaluate new tumor markers, with investigation tailored to factors that meet the requirements of practicing clinicians.
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, 10th Floor QEQM Building, South Wharf Road, London, W2 1NY, UK.
authors.forename: Amish
authors.initials: A
authors.lastname: Acharya
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, 10th Floor QEQM Building, South Wharf Road, London, W2 1NY, UK.
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, 10th Floor QEQM Building, South Wharf Road, London, W2 1NY, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Matar
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, 10th Floor QEQM Building, South Wharf Road, London, W2 1NY, UK.
authors.forename: Melody
authors.initials: M
authors.lastname: Ni
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, 10th Floor QEQM Building, South Wharf Road, London, W2 1NY, UK. g.hanna@imperial.ac.uk.
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
mesh_terms: D001291:Attitude of Health Personnel; D014408:Biomarkers, Tumor / Q000097:blood / Q000191:economics; D018394:CA-125 Antigen / Q000097:blood* / Q000191:economics; D018395:CA-19-9 Antigen / Q000097:blood* / Q000191:economics; D002272:Carcinoembryonic Antigen / Q000097:blood* / Q000191:economics; D015179:Colorectal Neoplasms / Q000097:blood* / Q000175:diagnosis; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008565:Membrane Proteins / Q000097:blood* / Q000191:economics; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000097:blood* / Q000175:diagnosis; D011795:Surveys and Questionnaires
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins