Normal carcinoembryonic antigen indicates benefit from perioperative chemotherapy to gastric carcinoma patients

Table 1 Clinicopathologic characterization of patients with gastric adenocarcinoma treated by surgery in combination with chemotherapy

	Normal serum CEA(median 52 yr, range: 22-74 yr)	Elevated serum CEA(median 54 yr, range: 32-73 yr)
Data	n (%)	n (%)	P
Sex			0.090
Male	116 (67.1)	44 (80.0)
Female	57 (32.9)	11 (20.0)
Tumor location			0.115
Upper	52 (30.0)	26 (47.3)
Middle	42 (24.3)	12 (21.8)
Lower	68 (39.3)	15 (27.3)
Total	11 (6.4)	2 (3.6)
Histological grade			0.128
G1	1 (0.6)	0 (0)
G2	31 (17.9)	18 (32.7)
G3	112 (64.7)	29 (52.7)
G4	29 (16.8)	8 (14.6)
Tumor size			0.053
≤ 2 cm	23 (13.3)	1 (1.8)
2 cm < diameter ≤ 5 cm	98 (56.6)	36 (65.5)
> 5 cm	52 (30.1)	18 (32.7)
Boarrman type			0.093
I	3 (1.7)	0 (0)
II	90 (52.0)	20 (36.4)
III	69 (39.9)	28 (50.9)
IV	11 (6.4)	7 (12.7)
Pathological T staging1			0.664
T0	6 (3.5)	1 (1.8)
T3	156 (90.2)	49 (89.1)
T4	11 (6.4)	5 (9.1)
Lymph node metastasis rate			0.951
0	12 (6.9)	3 (5.5)
0 < r ≤ 0.1	29 (16.8)	8 (14.5)
0.1 < r ≤ 0.3	50 (28.9)	17 (30.9)
r > 0.3	82 (47.4)	27 (49.1)
Surgery			0.313
Radical	165 (95.4)	50 (90.9)
Palliative	8 (4.6)	5 (9.1)
Chemotherapy			0.384
Adjuvant	130 (75.1)	38 (69.1)
Perioperative	43 (24.9)	17 (30.9)

¹Pathological T staging was based on the 6th Union for International Cancer Control’s staging systems for gastric cancer. CEA: Carcinoembryonic antigen.

Table 2 The efficacy of preoperative chemotherapy on locally advanced gastric cancer patients n (%)

	Response to preoperative chemotherapy
Pretreatment serum CEA	Complete response	Partial response	Stable disease	Progressive disease
Normal	3 (7.0)	15 (34.9)	21 (48.8)	4 (9.3)
Elevated	1 (5.9)	4 (23.5)	10 (58.8)	2 (11.8)

CEA: Carcinoembryonic antigen.

Table 3 Univariate analysis of overall survival in all patients and in patients with normal pretreatment serum carcinoembryonic antigen

Variable	No. of patients	2-yr survival rate (%)	Median survival (mo)	P value
All patients
Pathological T staging				0.001
T0	7	86	52
T3	205	52	37
T4	16	36	27
Lymph node metastasis				0.001
0	15	79	48
0 < r ≤ 0.1	37	68	31
0.1 < r ≤ 0.3	67	42	32
r > 0.3	109	50	33
Chemotherapy				0.029
Adjuvant	168	50	35
Perioperative	60	58	41
Normal-CEA patients
Pathological T staging				0.001
T0	6	83	50
T3	156	50	35
T4	11	39	17
Lymph node metastasis				0.002
0	12	74	44
0 < r ≤ 0.1	29	70	45
0.1 < r ≤ 0.3	50	38	26
r > 0.3	82	49	33
Chemotherapy				0.024
Adjuvant	130	48	34
Perioperative	43	59	43

CEA: Carcinoembryonic antigen.

Table 4 Multivariate analyses (Cox regression model) of overall survival of all patients and of patients having a normal pretreatment serum carcinoembryonic antigen

Variable	Hazard ratio	95% CI	P value
All patients
Perioperative chemotherapy	0.723	0.501–1.044	0.084
T staging	1.422	1.067–1.896	0.016
Lymph node metastasis rate	1.302	1.101–1.539	0.002
Normal-CEA patients
Perioperative chemotherapy	0.670	0.434–1.033	0.070
T staging	1.443	1.041–2.000	0.028
Lymph node metastasis rate	1.274	1.053–1.542	0.013

CEA: Carcinoembryonic antigen.