Published online Jan 15, 2019. doi: 10.4251/wjgo.v11.i1.17
Peer-review started: August 17, 2018
First decision: October 5, 2018
Revised: October 28, 2018
Accepted: December 5, 2018
Article in press: December 5, 2018
Published online: January 15, 2019
Processing time: 152 Days and 7.2 Hours
There certainly remains a patient population with disease recurrence after curative gastrectomy for advanced gastric cancer. The accurate prediction of patient prognosis is an important task in optimizing management for each individual patient. Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are have long been widely used for the diagnosis and monitoring of gastric cancer. However, their performance remains unsatisfactory and further improvement is needed.
In our previous paper, we reported that the risk of recurrences can be stratified by examining both the preoperative and postoperative levels of serum CEA and CA19-9. However, our previous study suffered from caveats such as being a single institution study with a small sample size and variabilities in the adjuvant treatments given due to the change in standard of care during the acquisition of data. Our data should be verified by a larger and modern cohort and the influence of adjuvant chemotherapy implementation should be considered in evaluating the prognostic ability of tumor markers.
To reappraise the prognostic significance of perioperative serum CEA and CA 19-9 levels in patients with stage II/III gastric cancer, we designed a large-scale multi-institutional retrospective database and analyzed patients who underwent resection of gastric cancer between 2010 and 2014.
Data of 998 patients who underwent curative resection for stage II/III gastric cancer between 2010 and 2014 at the nine participating institutions was analyzed. Prognostic impact of the preoperative and postoperative levels and chronological changes in CEA, CA19-9 and their combination were evaluated. The hazard ratios for mortality were compared between patients who underwent surgery alone and patients who underwent surgery followed by adjuvant chemotherapy.
Postoperative levels had better prognostic values compared to preoperative levels. Disease-free survival rates gradually reduced according to postoperative CEA and CA19-9 levels, and patients with high levels of both markers had the worst prognosis. Patients with normalized CEA levels after surgery had a significantly lower disease-free survival rate than those with normal perioperative levels, whereas patients with normalized CA19-9 levels after surgery had equivalent survival to those with normal perioperative levels. The prognostic impact of high CA19-9 was greater in patients who underwent adjuvant chemotherapy.
We herein showed the combination and preoperative measurement of serum CEA and CA 19-9 levels can be a promising tool to predict prognosis of patients with stage II/III gastric cancer. Using a multi-institutional large-size database, our data was successfully refined and more convincing than the previous one.
Serum CEA and CA 19-9 levels have distinct dynamics and prognostic significance. Intensive postoperative management should be considered. The appropriate timing of measurement and optimal cutoff values of perioperative tumor markers for maximal risk stratification are unresolved issues. In the future, novel biomarkers for gastric cancer with high sensitivity and specificity are expected to be available after validation in large-size clinical trials.