Clinical Significance of Serum CA125, CA19-9, CA72-4, and Fibrinogen-to-Lymphocyte Ratio in Gastric Cancer With Peritoneal Dissemination

Abstract

Background: Relevant serum tumor markers have been indicated to be associated with peritoneal dissemination (PD) of gastric cancer (GC). Fibrinogen has been shown to play an important role in the systemic inflammatory response (SIR) and in tumor progression. However, the clinical significance of the fibrinogen-to-lymphocyte ratio (FLR) in GC with PD has not been studied.Methods: The clinical data of 391 patients with GC were collected, including 86 cases of PD. Then, 1:3 matching was performed by propensity score matching (PSM), and the clinical data of the matched 344 patients were analyzed by univariate and multivariate conditional logistic regression. Classification tree analysis was used to obtain the decision rules and a random forest algorithm to extract the important risk factors of PD in GC. A nomogram model for risk assessment of PD in GC was established by using the rms package of R software.Results: Univariate analysis showed that the factors related to PD in GC were: carbohydrate antigen (CA) 125 (P < 0.0001), CA19-9 (P < 0.0001), CA72-4 (P < 0.0001), FLR (P < 0.0001), neutrophil-to-lymphocyte ratio (NLR) (P < 0.0001), albumin-to- lymphocyte ratio (ALR) (P < 0.0001), platelet-to-lymphocyte ratio (PLR) (P = 0.013), and carcinoembryonic antigen (CEA) (P = 0.031). Conditional logistic regression found that CA125 (OR: 1.046; P < 0.0001), CA19-9 (OR: 1.002; P < 0.0001), and FLR (OR: 1.266; P = 0.024) were independent risk factors for GC with PD. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the decision rules for detecting PD of GC were 89.5, 77.4, 94.0, 82.8, and 91.8%, respectively. According to the important variables identified by the classification tree and random forest algorithm, the risk assessment model of PD in GC was established. The accuracy, sensitivity, and specificity of the model were 91, 89.5, and 79.5%, respectively.Conclusion: CA125 > 17.3 U/ml, CA19-9 > 27.315 U/ml, and FLR > 2.555 were the risk factors for GC with PD. The decision rules and nomogram model constructed by CA125, CA19-9, CA72-4, and FLR can correctly predict the risk of PD in GC.

Establishment of Decision Rules and Risk Assessment Model for Preoperative Prediction of Lymph Node Metastasis in Gastric Cancer

“…Duraker and Celik ( 62 ) showed that CEA has value in the diagnosis of LNM in GC. Previous studies demonstrated that elevated levels of CA125 are associated with GC peritoneal dissemination and a poor prognosis ( 64 , 65 ). In this study, univariate analysis found that CEA, CA19-9, CA125, and CA72-4 were associated with LNM in GC, and multivariate analysis showed that CEA and CA19-9 were independent risk factors for LNM in GC.…”

Clinical Significance of Systemic Inflammation Response Index and Platelet–lymphocyte Ratio in Patients with Adenocarcinoma of The Esophagogastric Junction and Upper Gastric Cancer

“…With the development of Real World Study and Big Data for Cancer Research, the mode combining clinicopathological features and serum immunity markers to predicting the prognosis of GC is widely used in clinical. Fanotto found that the patients with higher ECOG score and lower lactate dehydrogenase (LDH) NLR had better prognosis after chemotherapy [54] Huang et al found that CA125, CA19-9, CA72-4 and Fibrinogen-to-Lymphocyte are risk factors for peritoneal dissemination among patients with GC, and used these indicators to constructe the Nomogram model [55]. We analyzed the clinical signi cance of the SIRI-PLR score through the The Gastric Cancer Information Management System v1.2 of Harbin Medical University Cancer Hospital database.…”

Predicting Peritoneal Dissemination of Gastric Cancer in the Era of Precision Medicine: Molecular Characterization and Biomarkers

“…Serum tumor markers, particularly CEA, CA19-9 and CA72-4, are established biomarkers for diagnosis and disease-progress monitoring in GC patients [88]. Accumulating evidence has shown significant association between elevated CEA [89], CA19-9 [89,90,99,102], CA72-4 [88,99,102] and CA12-5 [90,[99][100][101] levels and synchronous and/or metachronous peritoneal metastasis. Specifically, CA12-5 level has shown a higher predictive performance for PD and a correlation with the degree of PD as well as the presence of malignant ascites [90,100].…”