High level of preoperative carbohydrate antigen 19-9 is a poor survival predictor in gastric cancer

Table 1 Baseline characteristics with a comparison of patients with elevated serum carbohydrate antigen 19-9 levels and normal serum carbohydrate antigen 19-9 levels

Characteristic	Elevated group (n = 163)	Non-elevated group (n = 325 )	P value
Sex			0.963
Male	111 (68.1)	222 (68.3)
Female	52 (31.9)	103 (31.7)
Mean age, yr (range)	60.70 ± 12.00 (29-84)	59.71 ± 12.40 (27-85)	0.295
Number of lesions			0.436
Single	145 (89.0)	281 (86.5)
Multiple	18 (11.0)	44 (13.5)
Size (cm)
Horizontal	6.38 ± 3.51	5.78 ± 3.16	0.060
Vertical	5.15 ± 2.79	4.66 ± 2.60	0.053
Endoscopic findings			0.135
EGC
Elevated	10 (6.1)	23 (7.1)
Flat	3 (1.8)	15 (1.6)
Depressed	10 (6.1)	18 (5.5)
AGC
Borrmann I	9 (5.5)	8 (2.5)
Borrmann II	25 (15.3)	38 (11.7)
Borrmann III	89 (54.6)	203 (62.5)
Borrmann IV	17 (10.4)	20 (6.2)
Histology			0.033
Well differentiated	19 (11.7)	23 (7.1)
Moderately differentiated	57 (35.0)	86 (26.5)
Poorly differentiated	54 (33.1)	145 (44.6)
Signet ring cell cancer	33 (20.3)	71 (21.9)
Location			0.404
Lower	108 (66.3)	210 (61.6)
Middle	16 (9.8)	49 (15.1)
Upper	31 (19.0)	52 (16.0)
Diffuse	8 (1.9)	14 (4.3)
T stage			0.843
T0-2	55 (36.7)	117 (37.6)
T3, 4	95 (63.3)	194 (62.4)
N stage			0.908
N0, 1	79 (52.7)	162 (52.1)
N2, 3	71 (47.3)	149 (47.9)
Mean metastatic			0.893
Lymph nodes (N)	9.88 ± 13.03	10.09 ± 11.94
TNM stage			> 0.999
0	1 (0.6)	2 (0.6)
I	26 (16.0)	52 (16.0)
II	21 (12.9)	42 (12.9)
III	57 (35.0)	114 (35.1)
IV	58 (35.6)	115 (35.4)
Operation			0.114
For radical	139 (85.3)	293 (90.2)
For palliative	24 (14.7)	32 (0.8)
Lymphovascular invasion			0.225
Positive	98 (76.0)	190 (70.1)
Negative	31 (24.0)	81 (29.9)
Peritoneal metastasis			0.899
Positive	10 (6.1)	19 (5.8)
Negative	153 (93.9)	306 (94.2)
Hepatic metastasis			0.853
Positive	5 (3.1)	11 (3.4)
Negative	158 (96.9)	314 (96.6)
Neoadjuvant chemotherapy			0.217
Positive	6 (3.7)	6 (1.8)
Negative	157 (96.3)	319 (98.2)
Mean serum CA 19-9 (range)	575.74 ± 518.09 (37.4-12800)	8.45 ± 8.42 (0-36.8)	< 0.001
Mean serum CEA (range)	6.00 ± 21.86 (0.01-260.27)	5.49 ± 17.30 (0.01-189.21)	0.777
Mean serum CA 72-4 (range)	9.31 ± 20.52 (0.33-164)	14.42 ± 68.61 (0.2-600)	0.376

Data are expressed as mean ± SD or n (%). AGC: Advanced gastric cancer; CA: Carbohydrate antigen; CEA: Carcinoembryonic antigen; EGC: Early gastric cancer; TNM: Tumor-node-metastasis.

Table 2 Univariate and multivariate analysis of factors associated with disease-free survival

Variable	Univariate analysis		Multivariate analysis
	Hazard ratio (95%CI)	P value	Hazard ratio (95%CI)	P value
Disease-free survival
Age (< 60 vs≥ 60 yr)	0.737 (0.475-1.143)	0.737	0.620 (0.379-1.015)	0.053
Sex (male vs female )	1.140 (0.720-1.806)	0.575	0.777 (0.454-1.331)	0.359
Lesions (single vs multiple)	1.350 (0.746-2.446)	0.322	0.930 (0.458-1.892)	0.842
T staging (T 0-2 vs T 3, 4)	2.469 (1.442-4.228)	0.001	1.841 (0.961-3.527)	0.066
N staging (N 0, 1 vs N 2, 3)	4.069 (2.445-6.772)	< 0.001	2.993 (1.587-5.646)	0.001
Differentiation (well vs poorly)	1.378 (0.863-2.201)	0.179	1.419 (0.786-2.563)	0.246
Histology (adenocarcinoma vs signet ring cell cancer)	0.979 (0.573-1.674)	0.940	0.599 (0.315-1.142)	0.119
Lymphovascular invasion (negative vs positive )	3.054 (1.514-6.161)	0.002	1.15 (0.495-2.674)	0.745
Peritoneal metastasis (negative vs positive )	0.956 (0.301-3.034)	0.939	0.507 (0.069-3.704)	0.503
Hepatic metastasis (negative vs positive )	0.048 (0.000-29.505)	0.354	0.000 (0.000-1.254)	0.962
CA19-9 (< 37.0 U/mL vs≥ 37.0 U/mL)	1.385 (0.883-2.172)	0.156	1.179 (0.710-1.958)	0.525
Overall survival
Age (< 60 vs≥ 60 yr)	1.047 (0.816-1.342)	0.719	1.218 (0.905-1.639)	0.193
Sex (male vs female )	0.979 (0.755-1.269)	0.874	0.995 (0.732-1.355)	0.977
Lesions (single vs multiple)	1.144 (0.804-1.626)	0.455	1.163 (0.769-1.761)	0.474
T staging (T 0-2 vs T 3, 4)	2.498 (1.846-3.382)	< 0.001	1.437 (0.986-2.094)	0.059
N staging (N 0, 1 vs N 2, 3)	3.577 (2.713-4.715)	< 0.001	2.817 (1.984-4.001)	< 0.001
Differentiation (well vs poorly)	1.595 (1.227-2.073)	< 0.001	1.408 (0.990-2.002)	0.057
Histology (adenocarcinoma vs signet ring cell cancer)	1.171 (0.880-1.560)	0.279	1.000 (0.702-1.424)	0.999
Lymphovascular invasion (negative vs positive )	2.527 (1.739-3.673)	< 0.001	1.004 (0.643-1.569)	0.985
Peritoneal metastasis (negative vs positive )	4.620 (3.098-6.6887)	< 0.001	3.213 (1.792-5.762)	< 0.001
Hepatic metastasis (negative vs positive )	2.294 (1.285-4.097)	0.005	2.114 (0.916-4.880)	0.079
CA19-9 (< 37.0 U/mL vs≥ 37.0 U/mL)	1.395 (1.087-1.791)	0.009	1.414 (1.053-1.898)	0.021

CA: Carbohydrate antigen.