Abstract. The sensitivity of three biomarkers, carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9 and CA72-4, in combination has been identified to be greater than that of any of the biomarkers considered in isolation in cases of gastric cancer (GC). However, the fundamental cause underlying this phenomenon remains to be fully elucidated. In the present study, the differences and correlation of these three biomarkers were investigated in patients with GC in order to determine how the three biomarkers in combination work more effectively compared with any of the biomarkers considered alone. The serum levels of CEA, CA19-9 and CA72-4 of 216 patients with gastric adenocarcinoma were analyzed on admission to hospital. The differences in positive rates and the serum levels of CEA, CA19-9 and CA72-4 were analyzed using the χ 2 test and the non-parametric Wilcoxon two-sample test. Phi (f) correlation analysis was used to study the correlation among the expression (positive or not) levels of CEA, CA19-9 and CA72-4. The correlation among the serum levels of biomarkers was analyzed using Spearman's test. The results demonstrated that the combined positive rate of CEA, CA19-9 and CA72-4 was significantly higher compared with the individual CEA, CA19-9 and CA72-4 positive rates (44.91% vs. 22.69, 18.98 and 22.69%, respectively; all P<0.05). The positive rate of CA19-9 and CA72-4 in the extent of the primary tumor/involvement of regional lymph node/distant metastases (TNM)-III/IV stage subgroup was higher compared with that in the TNM-I/II subgroup (χ 2 =5.902, P=0.015; χ 2 =8.009, P=0.005), although not the positive rate of CEA (χ 2 =0.302, P= 0.583). A significant correlation was identified between the expression level of CEA and CA72-4 (f correlation coefficient=0.182; P=0.008) and between that of CA19-9 and CA72-4 (f correlation coefficient= 0.189; P= 0.006), although not between that of CEA and CA19-9 (f correlation coefficient=0.048; P=0.482) in the total number of patients with GC. A significant correlation was also identified between the serum levels of CEA and CA19-9, of CEA and CA72-4 and of CA19-9 and CA72-4 (Spearman's correlation coefficient=0.231, -0.271 and 0.167; P=0.001, P<0.0001 and P=0.014, respectively). The present study indicated that there was only a weak correlation between the positive rate of CEA and CA72-4 and between that of CA19-9 and CA72-4, and no correlation was identified between the positive rate of CEA and CA19-9, even if a correlation was identified between the serum levels of the biomarkers. The present study suggested that the evidence that the sensitivity of the three biomarkers in combination is greater than that of any of the biomarkers taken in isolation is due to less co-presentation of CEA, CA19-9 and CA72-4 in patients with GC.

BACKGROUND Nonoperative management (NOM) is a promising therapeutic modality for patients with perforated peptic ulcer (PPU). However, the risk factors for poor efficacy and adverse events of NOM are a concern. AIM To investigate the factors predictive of poor efficacy and adverse events in patients with PPU treated by NOM. METHODS This retrospective case-control study enrolled 272 patients who were diagnosed with PPU and initially managed nonoperatively from January 2014 to December 2018. Of these 272 patients, 50 converted to emergency surgery due to a lack of improvement (surgical group) and 222 patients were included in the NOM group. The clinical data of these patients were collected. Baseline patient characteristics and adverse outcomes were compared between the two groups. Logistic regression analysis and receiver operating characteristic curve analyses were conducted to investigate the factors predictive of poor efficacy of NOM and adverse outcomes in patients with PPU. RESULTS Adverse outcomes were observed in 71 patients (32.0%). Multivariate analyses revealed that low serum albumin level was an independent predictor for poor efficacy of NOM and adverse outcomes in patients with PPU. CONCLUSION Low serum albumin level may be used as an indicator to help predict the poor efficacy of NOM and adverse outcomes, and can be used for risk stratification in patients with PPU.

Correlation of p16 and cyclin D1 expression with the incidence and prognosis of cardiac carcinoma was investigated. Thirty-six patients with cardiac carcinoma treated in The Second Affiliated Hospital of Zhengzhou University were selected. After the radical operation of cardiac carcinoma, carcinoma tissues were taken, and the corresponding para-carcinoma tissues were used as controls. p16 and cyclin D1 messenger ribonucleic acid (mRNA) and protein expression in cardiac carcinoma tissues and para-carcinoma tissues were detected via quantitative polymerase chain reaction (qPCR) and western blot analysis. The survival time and pathological conditions of patients with cardiac carcinoma were recorded in detail, and correlation of p16 and cyclin D1 with incidence and prognosis of cardiac carcinoma was studied. In cardiac carcinoma tissues, the p16 mRNA and protein expression levels were significantly lower than those in para-carcinoma tissues (P<0.01), but the cyclin D1 mRNA and protein expression levels were significantly higher than those in para-carcinoma tissues (P<0.01). The expression of p16 and cyclin D1 protein had correlation with the tumor size, lymph node metastasis and tumor-node-metastasis stage of cardiac carcinoma (P<0.01). There was a negative correlation between expression of p16 and cyclin D1 in cardiac carcinoma (P<0.01). According to Kaplan-Meier survival analysis, the survival rate of patients with high expression of p16 was obviously higher than that of patients with low expression of p16 (P<0.01), while the survival rate of patients with high expression of cyclin D1 was obviously lower than that of patients with low expression of cyclin D1 (P<0.01). Both p16 and cyclin D1 are closely related to the incidence and prognosis of cardiac carcinoma, which may become indexes for the incidence and prognosis of cardiac carcinoma.