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Updated: May 6, 2026

Intraoperative Ultrasound in Spinal Surgery

Intraoperative Ultrasound in Spinal Surgery

Published on: August 17, 2022

Value of serum tumor markers in early differential diagnosis of spinal tumors and spinal infections.

Bo Tang^1,2, Xiaojiang Hu^3,4, Dongcheng Xu^3,4

¹Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008. 424406721@qq.com.

Zhong Nan Da Xue Xue Bao. Yi Xue Ban = Journal of Central South University. Medical Sciences

|February 11, 2025

Summary

This study found that alpha-fetoprotein (AFP), cytokeratin 19 fragment antigen 21-1 (cyfra21-1), and pepsinogen I/II ratio (PGR) can help differentiate early spinal tumors from infections. A diagnostic model using these markers showed promising predictive performance.

Keywords:

early differential diagnosis optimal cut-off value serum tumor markers spinal infection spinal tumors

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Area of Science:

Oncology
Infectious Diseases
Diagnostic Imaging

Background:

Early diagnosis of spinal tumors is challenging due to overlapping imaging features with spinal infections.
Serum tumor markers are used for cancer screening but lack specificity for spinal tumors, which are often metastatic.
The utility of tumor markers in distinguishing early spinal tumors from infections requires further investigation.

Purpose of the Study:

To evaluate the effectiveness of serum tumor markers in the early differential diagnosis between spinal tumors and spinal infections.
To identify specific tumor markers that can aid in distinguishing these two conditions.

Main Methods:

Retrospective analysis of clinical data from 221 patients with spinal bone destruction.
Measurement of 10 serum tumor markers, including carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), neuron-specific enolase (NSE), cytokeratin 19 fragment antigen 21-1 (cyfra21-1), carbohydrate antigens (CA199, CA125, CA72-4), and pepsinogen levels (PGI, PGII, PGR).
Statistical analyses including univariate and multivariate logistic regression, correlation analysis, and receiver operating characteristic (ROC) curve analysis to develop a diagnostic model.

Main Results:

Spinal tumor patients showed significantly higher levels of AFP, cyfra21-1, and lower PGR compared to spinal infection patients.
Multivariate analysis identified AFP and cyfra21-1 as risk factors and PGR as a protective factor for spinal tumors.
A diagnostic model using optimal cut-off values for AFP, cyfra21-1, and PGR achieved an area under the curve (AUC) of 0.772.

Conclusions:

Serum markers AFP, cyfra21-1, and PGR are significantly associated with spinal tumors.
A diagnostic model incorporating these three markers demonstrates effective predictive performance for differentiating early spinal tumors from spinal infections.