Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8562
Peer-review started: August 2, 2017
First decision: August 10, 2017
Revised: August 19, 2017
Accepted: November 22, 2017
Article in press: November 22, 2017
Published online: December 28, 2017
Processing time: 309 Days and 16 Hours
To assess whether elevated serum carcinoembryonic antigen (CEA) is in the inferior prognosis for pathological lymph node-negative (pN0) gastric cancer (GC) patients who underwent D2 gastrectomy.
About 469 pN0 GC patients, who received D2 radical gastrectomy were retrospectively analyzed. The X-tile plots cut-off point for CEA were 30.02 ng/mL using minimum P-value from log-rank χ2 statistics, and pN0 GC patients were assigned to two groups: those more than 30.02 ng/mL (n = 48; CEA-high group) and those less than 30.02 ng/mL (n = 421; CEA-low group). Clinicopathologic characteristics were compared using Pearson's χ2 or Fisher’s exact tests, and survival curves were so manufactured using the Kaplan-Meier method. Univariate and multivariate analysis were carried out using the logistic regression method.
The percentage of vessel carcinoma embolus (31.35% vs 17.1%) and advanced GC (T2-4b) (81.25% vs 65.32%) were higher in CEA-high group than CEA-low group. The CEA-positive patients had a significantly poorer prognosis than the CEA-nagetive patients in terms of overall survival (57.74% vs 90.69%, P < 0.05), and no different was found between subgroup of T category, differentiation, nerve invasion, and vessel carcinoma embolus (all P > 0.05). Multivariate survival analysis showed that CEA (OR = 4.924), and T category (OR = 2.214) were significant prognostic factors for stage pN0 GC (all P < 0.05). Besides, only T category (OR = 1.962) was an independent hazard factor in the CEA-high group (P < 0.05).
Those pretreatment serum CEA levels over 30.02 ng/mL on behalf of worse characteristics and unfavourable tumor behavior, and a poor prognosis for a nearly doubled risk of mortality in GC patients.
Core tip: Currently, the survival rate for gastric cancer (GC) is still unsatisfactory. Reliable biomarker such as carcinoembryonic antigen (CEA) is necessary to improve the management of GC and pathological lymph node-negative (pN0) represents a group of reliable biological status. About 469 pN0 GC patients, who received D2 radical gastrectomy were retrospectively analyzed, and an optimal cut-off value of CEA was reset, and we found that pretreatment serum CEA levels over 30.02 ng/mL on behalf of worse characteristics and unfavourable tumor behavior, and a poor prognosis for a nearly doubled risk of mortality in staging pN0 GC patients.