Prognostic Value of Early Postoperative Tumor Marker Response in Gastric Cancer

Nam, Dong Hyuk; Lee, Yong Kang; Park, Jun Chul; Lee, Hyuk; Shin, Sung Kwan; Lee, Sang Kil; Cheong, Jae‐Ho; Hyung, Woo Jin; Noh, Sung Hoon; Kim, Choong Bai

doi:10.1245/s10434-013-3066-7

Cited by 41 publications

(34 citation statements)

References 22 publications

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“…Indeed, patients with a low TNM stage but a high CTM score may benefit from closer monitoring or more aggressive adjuvant therapy. We agree with others that it might be worth exploring the use of GC tumor markers and CTM score in the early postoperative period to help guide clinical decision-making [27]. …”

Section: Discussionsupporting

confidence: 76%

Combined preoperative concentrations of CEA, CA 19-9, and 72-4 for predicting outcomes in patients with gastric cancer after curative resection

Liu

Qiu

et al. 2016

Oncotarget

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In many cancers, prognostic factors are useful for identifying high-risk patients and in individualizing treatment. We sought to determine whether a combination of tumor markers (CTM) would improve prognostic accuracy in patients with gastric cancer (GC). The CTM score, which is derived from serum concentrations of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), and carbohydrate antigen 72-4 (CA 72-4), was tested retrospectively in 1134 patients with GC undergoing curative resection between October 2000 and December 2012. The CTM score was 2 for patients with two or three elevated markers, 1 for those with one elevated marker, and 0 for those no elevated markers. Overall survival (OS) in patients with CTM scores 0, 1, and 2 was 61.8%, 31.4%, and 15.1%, respectively (P<.001). The CTM score independently predicted OS on multivariate analysis (HR, 1.95; 95% CI, 1.73 to 2.21; P<.001). Moreover, the area under the receiver operating characteristics curve of the CTM score (0.67; 95% CI, 0.64 to 0.70) was higher than the values of any individual marker (0.63, 0.57, 0.57; P<.001 for all comparisons). The CTM score independently predicted postoperative survival in GC, and it may have better clinical utility than individual tumor markers for identifying high-risk patients with GC.

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Section: Discussionsupporting

confidence: 76%

Combined preoperative concentrations of CEA, CA 19-9, and 72-4 for predicting outcomes in patients with gastric cancer after curative resection

Liu

Qiu

et al. 2016

Oncotarget

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“…However, when we analyzed the CEA levels before and after gastrectomy, the survival curves for the overall and disease-free survival were stratified by the patterns of changes in CEA levels, indicating that the risk of adverse prognosis can be stratified more precisely than using a single measurement. Normalization of postoperative level of CEA or CA19-9 after curative gastrectomy is a strong prognostic factor for GC, suggesting that preoperative levels as well as the time course of changes of serum CEA levels can help physicians to more precisely stratify patients at risk and then implement a management strategy that includes postoperative surveillance and adjuvant therapy [36]. Although physicians have to consider that serum CEA levels can be influenced by other factors including smoking and diabetes mellitus [6,12], patients with persistent elevation of CEA levels before and after gastrectomy may be candidates for intensive examinations and combination chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Serum Carcinoembryonic Antigen Levels Predict Recurrence and Survival of Patients with Pathological T2-4 Gastric Cancer Treated with Curative Gastrectomy

et al. 2017

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Background/Aims: Do serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels serve as prognostic indicators in patients with gastric cancer (GC)? This is a question that has long been disputed. The aim of this study was to evaluate the significance of perioperative serum levels of CEA and CA19-9 for predicting the recurrence and long-term survival after patients with pT2-4 GC undergo curative gastrectomy. Methods: This study included 251 patients with radically resected pT2-4 GC without preoperative treatment. Associations between the preoperative and postoperative serum levels of CEA or CA19-9 and postoperative long-term outcomes and recurrence patterns were evaluated. Results: Preoperative CEA >5.0 ng/mL was an independent prognostic factor of overall survival. Elevation of both preoperative CEA and CA19-9 levels showed no synergistic adverse effects on prognosis. Preoperative levels of these markers achieved superior predictive performance compared with the postoperative values. Adverse prognosis is significantly associated with persistent elevation of CEA levels before and after gastrectomy. Elevation of CEA levels, particularly at postoperative measurement, was significantly associated with hematogenous recurrence. Conclusion: Determination of perioperative CEA levels facilitated predictions of recurrence patterns and prognosis among patients with pT2-4 GC who underwent curative gastrectomy.

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“…The survival rate of patients with GC remains relatively poor, since the majority of cases are already in the late stage at diagnosis, and surgery and chemotherapy result in an unsatisfactory prognosis. Serum tumor markers are useful for diagnosis, for predicting survival rates and for monitoring recurrence following surgery (2,3). Carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9 and CA72-4 are the most frequently used clinical markers.…”

Section: Introductionmentioning

confidence: 99%

Differences and correlation of serum CEA, CA19-9 and CA72-4 in gastric cancer

Zhang

Zhao

2015

Molecular and Clinical Oncology

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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.

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Prognostic Value of Early Postoperative Tumor Marker Response in Gastric Cancer

Abstract: Early CEA or CA19-9 normalization after radical gastrectomy is a strong prognostic factor for gastric cancer, especially in patients with high preoperative levels of tumor markers.

Cited by 41 publications

References 22 publications

Combined preoperative concentrations of CEA, CA 19-9, and 72-4 for predicting outcomes in patients with gastric cancer after curative resection

Combined preoperative concentrations of CEA, CA 19-9, and 72-4 for predicting outcomes in patients with gastric cancer after curative resection

Perioperative Serum Carcinoembryonic Antigen Levels Predict Recurrence and Survival of Patients with Pathological T2-4 Gastric Cancer Treated with Curative Gastrectomy

Differences and correlation of serum CEA, CA19-9 and CA72-4 in gastric cancer

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