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Purpose <p>Tumor markers are widely used for the diagnosis of malignancies in clinical settings; however, their utility in postmortem specimens remains insufficiently explored. In this study, we aimed to evaluate the diagnostic value of six major serum tumor markers—carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), cancer antigen 125 (CA125), cancer antigen 15–3 (CA15-3), cancer antigen 19–9 (CA19-9), and squamous cell carcinoma antigen (SCC)—in postmortem blood samples.</p> Methods <p>We retrospectively reviewed 178 forensic autopsy cases performed at our institution between July 1, 2015, and March 31, 2024. The control group comprised 103 cases in which the patients died from non-neoplastic causes. The presence of malignancy, primary tumor sites, and histological subtypes were analyzed in relation to tumor marker levels.</p> Results <p>Among the six markers, CA15-3, CA19-9, CEA, and CA125 demonstrated high diagnostic performance for specific cancers. CA15-3 showed excellent discriminatory ability for breast cancer, including invasive ductal carcinoma (area under the curve [AUC] &gt; 0.99). CEA was effective in detecting colorectal cancer, CA125 in detecting pancreatic and colorectal cancers, and CA19-9 in detecting cholangiocarcinoma and pancreatic cancer, all with AUC values exceeding 0.9. In contrast, AFP and SCC showed limited diagnostic value for malignancy detection. Notably, the optimal cutoff values for postmortem samples were substantially higher than conventional clinical reference values, underscoring the necessity for postmortem-specific diagnostic thresholds.</p> Conclusions <p>Our findings suggest that tumor markers retain organ-specific diagnostic utility even in postmortem serum and may serve as useful adjunctive tools in forensic pathology. Further validation through larger multicenter studies is warranted.</p>

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Diagnostic utility of postmortem serum tumor markers for identifying primary malignancies: A forensic evaluation of six markers

  • 期刊论文

  • 发表日期：

    2026年3月2日

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  • Sari Matsumoto,
  • Shojiro Takasu

摘要

Purpose

Tumor markers are widely used for the diagnosis of malignancies in clinical settings; however, their utility in postmortem specimens remains insufficiently explored. In this study, we aimed to evaluate the diagnostic value of six major serum tumor markers—carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), cancer antigen 125 (CA125), cancer antigen 15–3 (CA15-3), cancer antigen 19–9 (CA19-9), and squamous cell carcinoma antigen (SCC)—in postmortem blood samples.

Methods

We retrospectively reviewed 178 forensic autopsy cases performed at our institution between July 1, 2015, and March 31, 2024. The control group comprised 103 cases in which the patients died from non-neoplastic causes. The presence of malignancy, primary tumor sites, and histological subtypes were analyzed in relation to tumor marker levels.

Results

Among the six markers, CA15-3, CA19-9, CEA, and CA125 demonstrated high diagnostic performance for specific cancers. CA15-3 showed excellent discriminatory ability for breast cancer, including invasive ductal carcinoma (area under the curve [AUC] > 0.99). CEA was effective in detecting colorectal cancer, CA125 in detecting pancreatic and colorectal cancers, and CA19-9 in detecting cholangiocarcinoma and pancreatic cancer, all with AUC values exceeding 0.9. In contrast, AFP and SCC showed limited diagnostic value for malignancy detection. Notably, the optimal cutoff values for postmortem samples were substantially higher than conventional clinical reference values, underscoring the necessity for postmortem-specific diagnostic thresholds.

Conclusions

Our findings suggest that tumor markers retain organ-specific diagnostic utility even in postmortem serum and may serve as useful adjunctive tools in forensic pathology. Further validation through larger multicenter studies is warranted.