Brief Article
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World J Gastroenterol. Aug 28, 2013; 19(32): 5302-5308
Published online Aug 28, 2013. doi: 10.3748/wjg.v19.i32.5302
High level of preoperative carbohydrate antigen 19-9 is a poor survival predictor in gastric cancer
A Ra Choi, Jun Chul Park, Jie-Hyun Kim, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jae Bock Chung
A Ra Choi, Jun Chul Park, Jie-Hyun Kim, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jae Bock Chung, Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea
Author contributions: Choi AR and Park JC contributed equally to this work; Choi AR, Park JC and Chung JB designed the study and performed the majority of experiments; Kim JH, Shin SK, Lee SK and Lee YC identified and recruited patients for the study and undertook the experiments; Kim JH and Shin SK were responsible for data collection, data extraction, data interpretation and manuscript drafting; Lee SK and Lee YC performed bioinformatic analysis of the sequencing data and performed statistical analyses; Choi AR and Park JC co-wrote the manuscript and were also involved in editing the manuscript; all authors reviewed and agreed on the final version.
Correspondence to: Jae Bock Chung, MD, PhD, Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. jbchung@yuhs.ac
Telephone: +82-2-22281945 Fax: +82-2-3936884
Received: May 16, 2013
Revised: July 10, 2013
Accepted: July 17, 2013
Published online: August 28, 2013
Processing time: 102 Days and 23.8 Hours
Abstract

AIM: To assess the clinical significance and the prognostic value of preoperative serum carbohydrate antigen 19-9 (CA 19-9) level in gastric cancer.

METHODS: Between January 2005 and December 2006, 1960 patients underwent surgery for histologically confirmed gastric cancer. Of these, 163 patients had elevated serum levels of CA 19-9 preoperatively, and 1628 patients had normal serum levels of CA 19-9 preoperatively. For this study, 325 patients were selected from the group of 1628 patients by age, sex, and cancer stage to serve as controls. Statistically significant differences in survival rates were calculated using the log-rank test. A P value less than 0.05 was considered statistically significant and was determined using SAS software.

RESULTS: The baseline characteristics showed some differences between the two groups with regard to histology. Overall survival (OS) in the elevated and non-elevated group was 37.90 and 68.67 mo, respectively (P < 0.001). N stage (P = 0.001) was a significant predictor of disease-free survival by multivariate analysis. Also, N stage (P < 0.001), and the presence of peritoneal metastasis (P < 0.001) remained independent factors in predicting OS by multivariate analysis. Additionally, preoperative serum CA 19-9 levels were significantly associated with OS in univariate (P = 0.009) and multivariate (P = 0.021) analyses.

CONCLUSION: Serum CA 19-9 can be considered an independent prognostic factor in predicting OS in patients anticipating surgery for gastric cancer.

Keywords: Gastric cancer; Carbohydrate antigen 19-9; Disease-free survival; Overall survival

Core tip: The exact functions of preoperative carbohydrate antigen (CA) 19-9 in stomach cancer have yet to be uncovered. We sought to assess the clinical significance of preoperatively high levels of CA 19-9 in patients with gastric cancer and aimed to investigate the relationship between serum levels of CA 19-9 and disease-free survival and overall survival (OS). We conclude that OS in gastric cancer patients with elevated CA 19-9 levels was lower than that in patients with non-elevated levels. Serum CA 19-9 can be considered an independent prognostic factor in predicting OS in patients anticipating surgery for gastric cancer.