Significance of Preoperative Serum CEA, CA19-9 Levels in Postoperative Recurrence and Metastasis and Prognosis for Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENJing , ZHANGDe-wei , ZHANGChun-dong , TANGYuan-xin ,  DAIDong-qiu

Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital, China Medical University, Shenyang 110032, Liaoning Province, China;

Corresponding author：

DAIDong-qiu, Email: daidq63@163.com

Keywords：

Gastric cancer; CEA; CA19-9; Recurrence and metastasis; Prognosis

DOI：

10.7507/1007-9424.20150053

Video：

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Objective To investigate the values of serum CEA and CA19-9 in predicting postoperative recurrence and metastasis and prognosis for gastric cancer. Methods Preoperative serum levels of CEA and CA19-9 were measured by electrochemiluminescence assay in 136 patients with gastric cancer. The relationships of serum CEA level, CA19-9 level to clinicopathologic features, postoperative recurrence and metastasis, and prognosis of gastric cancer were analyzed. Kaplan-Meier method (log-rank test) was used to survival analysis. Results There were 67 patients with postoperative recurrence and metastasis in 136 patients with gastric cancer. The positive rate was 48.5% (66/136) for CEA and 43.4% (59/136) for CA19-9. There was a significant correlation between CEA level and T stage, TNM stage, lymph node metastasis, or vascular invasion (P=0.011, P=0.018, P=0.021, P=0.024). There was a significant correlation between CA19-9 level and T stage or lymph node metastasis (P=0.018, P=0.045). The rate of postoperative recurrence and metastasis was 60.6% (40/66) in positive CEA, 61.0% (36/59) in positive CA19-9, 38.6% (27/70) in negative CEA, and 40.3% (31/77) in negative CA19-9, respectively. The rate of postoperative recurrence and metastasis in the positive CEA or positive CA19-9 was significantly higher than those in the negative CEA or negative CA19-9 (P=0.010, P=0.016). Kaplan-Meier analysis showed that patients with positive CEA or positive CA19-9 had worse survival than those with negative CEA or CA19-9 (P=0.003, P=0.007). Conclusions CEA and CA19-9 have important values in detecting recurrence and metastasis, predicting patient survival after gastric cancer surgery. Combined analysis of these markers is considered to be helpful for improving the prediction of the postoperative recurrence and metastasis and prognosis of gastric cancer.

Citation： CHENJing, ZHANGDe-wei, ZHANGChun-dong, TANGYuan-xin, DAIDong-qiu. Significance of Preoperative Serum CEA, CA19-9 Levels in Postoperative Recurrence and Metastasis and Prognosis for Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(2): 195-199. doi: 10.7507/1007-9424.20150053 Copy

1.	张思维, 雷正龙, 李光琳, 等.中国肿瘤登记地区2006年肿瘤发病和死亡资料分析.中国肿瘤, 2010, 19(6): 356-365.
2.	Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin, 2005, 55(2): 74-108.
3.	Byrne DJ, Browning MC, Cuschieri A. CA72-4: a new tumour marker for gastric cancer. Br J Surg, 1990, 77(9): 1010-1013.
4.	Whiting J, Sano T, Saka M, et al. Follow-up of gastric cancer: a review. Gastric Cancer, 2006, 9(2): 74-81.
5.	Takahashi Y, Takeuchi T, Sakamoto J, et al. The usefulness of CEA and/or CA19-9 in monitoring for recurrence in gastric cancer patients: a prospective clinical study. Gastric Cancer, 2003, 6(3): 142-145.
6.	Zhou G, Niu L, Chiu D, et al. Changes in the expression of serum markers CA242, CA199, CA125, CEA, TNF-αand TSGF after cryosurgery in pancreatic cancer patients. Biotechnol Lett, 2012, 34(7): 1235-1241.
7.	Nakai Y, Kawabe T, Isayama H, et al. CA19-9 response as an early indicator of the effectiveness of gemcitabine in patients with advanced pancreatic cancer. Oncology, 2008, 75(1/2): 120-126.
8.	Nakai Y, Isayama H, Sasaki T, et al. A retrospective analysis of early CA199 change in salvage chemotherapy for refractory pancreatic cancer. Cancer Chemother Pharmacol, 2013, 72(6): 1291-1297.
9.	Sougioultzis S, Syrios J, Xynos ID, et al. Palliative gastrectomy and other factors affecting overall survival in stageⅣgastric adenocarci-noma patients receiving chemotherapy: A retrospective analysis. EJSO, 2011, 37(4): 312-318.
10.	Kim DH, Oh SJ, Oh CA, et al. The relationships between perioperative CEA, CA 19-9, and CA 72-4 and recurrence in gastric cancer patients after curative radical gastrectomy. J Surg Oncol, 2011, 104(6): 585-591.
11.	Shimada H, Noie T, Ohashi M, et al. Clinical significance of serum tumor markers for gastric cancer: a systematic review of literature by the Task Force of the Japanese Gastric Cancer Association. Gastric Cancer, 2014, 17(1): 26-33.
12.	Li F, Li S, Wei L, et al. The correlation between pre-operative serum tumor markers and lymph node metastasis in gastric cancer patients undergoing curative treatment. Biomarkers, 2013, 18(7): 632-637.
13.	刘羽, 范立侨, 李勇, 等.胃癌患者外周血CEA表达与临床病理特征相关性分析.中华肿瘤防治杂志, 2011, 18(24): 1946-1947, 1952.
14.	Duraker N, Celik AN. The prognostic significance of preoperative serum CA19-9 in patients with resectable gastric carcinoma: com-parison with CEA. J Surg Oncol, 2001, 76(4): 266-271.
15.	Ucar E, Semerci E, Ustun H, et al. Prognostic value of preoperative CEA, CA 19-9, CA 72-4, and AFP levels in gastric cancer. Adv Ther, 2008, 25(10): 1075-1084.
16.	吴兴平, 陈跃琼, 赖长春, 等.胃癌患者外周血CEA和TSGF及糖类抗原联合检测诊断价值的探讨.中华肿瘤防治杂志, 2011, 18(21): 1688-1690, 1707.
17.	朱昱冰, 葛少华, 张连海, 等.肿瘤标志物在胃癌患者中的诊断及预后价值.中华胃肠外科杂志, 2012, 15(2): 161-164.
18.	Ikeda Y, Oomori H, Koyanagi N, et al. Prognostic value of combination assays for CEA and CA 19-9 in gastric cancer. Oncology, 1995, 52(6): 483-486.
19.	Fan B, Xiong B. Investigation of serum tumor markers in the diagnosis of gastric cancer. Hepatogastroenterology, 2011, 58(105): 239-245.
20.	Sisik A, Kaya M, Bas G, et al. CEA and CA 19-9 are still valuable markers for the prognosis of colorectal and gastric cancer patients. Asian Pac J Cancer Prev, 2013, 14(7): 4289-4294.
21.	Mroczko B, Lukaszewicz-Zając M, Gryko M, et al. Clinical significance of serum levels of matrix metalloproteinase 2 (MMP-2) and its tissue inhibitor (TIMP-2) in gastric cancer. Folia Histochem Cytobiol, 2011, 49(1): 125-131.
22.	Mittal A, Gupta SP, Jha DK, et al. Impact of various tumor markers in prognosis of gastric cancer. A hospital based study from tertiary care hospital of Kathmandu valley. Asian Pac J Cancer Prev, 2013, 14(3): 1965-1967.
23.	Park JC, Lee YC, Kim JH, et al. Clinicopathological aspects and prognostic value with respect to age: an analysis of 3 362 consecutive gastric cancer patients. J Surg Oncol, 2009, 99(7): 395-401.
24.	Ikeda Y, Mori M, Kajiyama K, et al. Indicative value of carcinoembr-yonic antigen (CEA) for liver recurrence following curative resec-tion of stageⅡandⅢgastric cancer. Hepatogastroenterology, 1996, 43(11): 1281-1287.
25.	Marrelli D, Pinto E, De Stefano A, et al. Preoperative positivity of serum tumor markers is a strong predictor of hematogenous recurrence of gastric cancer. J Surg Oncol, 2001, 78(4): 253-258.

1. 张思维, 雷正龙, 李光琳, 等.中国肿瘤登记地区2006年肿瘤发病和死亡资料分析.中国肿瘤, 2010, 19(6): 356-365.
2. Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin, 2005, 55(2): 74-108.
3. Byrne DJ, Browning MC, Cuschieri A. CA72-4: a new tumour marker for gastric cancer. Br J Surg, 1990, 77(9): 1010-1013.
4. Whiting J, Sano T, Saka M, et al. Follow-up of gastric cancer: a review. Gastric Cancer, 2006, 9(2): 74-81.
5. Takahashi Y, Takeuchi T, Sakamoto J, et al. The usefulness of CEA and/or CA19-9 in monitoring for recurrence in gastric cancer patients: a prospective clinical study. Gastric Cancer, 2003, 6(3): 142-145.
6. Zhou G, Niu L, Chiu D, et al. Changes in the expression of serum markers CA242, CA199, CA125, CEA, TNF-αand TSGF after cryosurgery in pancreatic cancer patients. Biotechnol Lett, 2012, 34(7): 1235-1241.
7. Nakai Y, Kawabe T, Isayama H, et al. CA19-9 response as an early indicator of the effectiveness of gemcitabine in patients with advanced pancreatic cancer. Oncology, 2008, 75(1/2): 120-126.
8. Nakai Y, Isayama H, Sasaki T, et al. A retrospective analysis of early CA199 change in salvage chemotherapy for refractory pancreatic cancer. Cancer Chemother Pharmacol, 2013, 72(6): 1291-1297.
9. Sougioultzis S, Syrios J, Xynos ID, et al. Palliative gastrectomy and other factors affecting overall survival in stageⅣgastric adenocarci-noma patients receiving chemotherapy: A retrospective analysis. EJSO, 2011, 37(4): 312-318.
10. Kim DH, Oh SJ, Oh CA, et al. The relationships between perioperative CEA, CA 19-9, and CA 72-4 and recurrence in gastric cancer patients after curative radical gastrectomy. J Surg Oncol, 2011, 104(6): 585-591.
11. Shimada H, Noie T, Ohashi M, et al. Clinical significance of serum tumor markers for gastric cancer: a systematic review of literature by the Task Force of the Japanese Gastric Cancer Association. Gastric Cancer, 2014, 17(1): 26-33.
12. Li F, Li S, Wei L, et al. The correlation between pre-operative serum tumor markers and lymph node metastasis in gastric cancer patients undergoing curative treatment. Biomarkers, 2013, 18(7): 632-637.
13. 刘羽, 范立侨, 李勇, 等.胃癌患者外周血CEA表达与临床病理特征相关性分析.中华肿瘤防治杂志, 2011, 18(24): 1946-1947, 1952.
14. Duraker N, Celik AN. The prognostic significance of preoperative serum CA19-9 in patients with resectable gastric carcinoma: com-parison with CEA. J Surg Oncol, 2001, 76(4): 266-271.
15. Ucar E, Semerci E, Ustun H, et al. Prognostic value of preoperative CEA, CA 19-9, CA 72-4, and AFP levels in gastric cancer. Adv Ther, 2008, 25(10): 1075-1084.
16. 吴兴平, 陈跃琼, 赖长春, 等.胃癌患者外周血CEA和TSGF及糖类抗原联合检测诊断价值的探讨.中华肿瘤防治杂志, 2011, 18(21): 1688-1690, 1707.
17. 朱昱冰, 葛少华, 张连海, 等.肿瘤标志物在胃癌患者中的诊断及预后价值.中华胃肠外科杂志, 2012, 15(2): 161-164.
18. Ikeda Y, Oomori H, Koyanagi N, et al. Prognostic value of combination assays for CEA and CA 19-9 in gastric cancer. Oncology, 1995, 52(6): 483-486.
19. Fan B, Xiong B. Investigation of serum tumor markers in the diagnosis of gastric cancer. Hepatogastroenterology, 2011, 58(105): 239-245.
20. Sisik A, Kaya M, Bas G, et al. CEA and CA 19-9 are still valuable markers for the prognosis of colorectal and gastric cancer patients. Asian Pac J Cancer Prev, 2013, 14(7): 4289-4294.
21. Mroczko B, Lukaszewicz-Zając M, Gryko M, et al. Clinical significance of serum levels of matrix metalloproteinase 2 (MMP-2) and its tissue inhibitor (TIMP-2) in gastric cancer. Folia Histochem Cytobiol, 2011, 49(1): 125-131.
22. Mittal A, Gupta SP, Jha DK, et al. Impact of various tumor markers in prognosis of gastric cancer. A hospital based study from tertiary care hospital of Kathmandu valley. Asian Pac J Cancer Prev, 2013, 14(3): 1965-1967.
23. Park JC, Lee YC, Kim JH, et al. Clinicopathological aspects and prognostic value with respect to age: an analysis of 3 362 consecutive gastric cancer patients. J Surg Oncol, 2009, 99(7): 395-401.
24. Ikeda Y, Mori M, Kajiyama K, et al. Indicative value of carcinoembr-yonic antigen (CEA) for liver recurrence following curative resec-tion of stageⅡandⅢgastric cancer. Hepatogastroenterology, 1996, 43(11): 1281-1287.
25. Marrelli D, Pinto E, De Stefano A, et al. Preoperative positivity of serum tumor markers is a strong predictor of hematogenous recurrence of gastric cancer. J Surg Oncol, 2001, 78(4): 253-258.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Significance of Preoperative Serum CEA, CA19-9 Levels in Postoperative Recurrence and Metastasis and Prognosis for Gastric Cancer

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