Abstract
BackgroundSerum tumor markers including AFU, AFP, CEA, CA199, CA125 and CA724, are of great importance in the diagnosis, prognostic prediction and recurrence monitoring of gastrointestinal malignancies. However, their significance in gastric cancer (GC) patients with neoadjuvant therapy (NCT) is still uncertain. The aim of this study was to evaluate the predictive value of these six tumor markers in locally advanced GC patients who underwent NCT and curative surgery.MethodsIn total, 290 locally advanced GC patients who underwent NCT and D2 radical gastrectomy were retrospectively analyzed. Data on their tumor markers before (pre-) and after (post-) NCT and pathological characteristics were extracted from the database of our hospital. The optimal cutoff values of the six tumor markers were calculated by the ROC curve and Youden index. Their predictive significance was analyzed and survival curves for overall survival (OS) were obtained by the Kaplan-Meier method. Associations between categorical variables were explored by the chi-square test or Fisher’s exact test. Multivariate analyses were performed by the Cox regression model.ResultsPre- and post-CA199, −CA125 and -CA724 could predict overall survival (all P < 0.05), but only the change (diff-) of CA199 was related to prognosis (P = 0.05). In the multivariable analysis, pre- (P = 0.014) and post-CA724 (P = 0.036) remained significant, though diff-CA724 was not an independent prognostic factor (P = 0.581). In addition, pre- and post-CA199, −CA125 and -CA724 were associated with lymph node metastasis (N- vs N+) and pathological stage (I-II vs III) (all P < 0.05). Moreover, post-CA724 was related to the vascular or lymphatic invasion (P = 0.019), while pre-CA724 was not (P = 0.082). However, AFU, AFP and CEA showed no association with survival (P > 0.05).ConclusionsCA724 is an independent factor for prognosis and could be used to predict ypN and ypTNM stage in locally advanced GC patients undergoing NCT and curative resection.
Highlights
Serum tumor markers including AFU, AFP, Carcinoembryonic antigen (CEA), Carbohydrate antigen 19–9 (CA199), Cancer antigen 125 (CA125) and Carbohydrate antigen 72–4 (CA724), are of great importance in the diagnosis, prognostic prediction and recurrence monitoring of gastrointestinal malignancies
AFU was considered to be related to liver metastasis in colorectal cancer [4]; AFP was associated with prognosis in gastric cancer patients undergoing surgery alone [5]; preoperative CEA could predict the prognosis of GC patients with no lymph node metastasis [6]; CA199 was an independent prognostic factor in gastroesophageal junction (GEJ) cancer patients who experienced surgery alone [7]; the CA125 level was related to the degree of peritoneal dissemination and the existence of malignant ascites in GC patients with peritoneal metastasis [8]; and CA724 was correlated with pathological TNM stage (pTNM) stage in gastric carcinoma patients [9]
We investigated the prognostic significance of the six serum tumor markers before and after Neoadjuvant chemotherapy (NCT), the predictive value of changes of tumor markers due to treatment, the innerrelationships among those markers and the connections between markers and other pathological factors in locally advanced GC patients
Summary
Serum tumor markers including AFU, AFP, CEA, CA199, CA125 and CA724, are of great importance in the diagnosis, prognostic prediction and recurrence monitoring of gastrointestinal malignancies. Their significance in gastric cancer (GC) patients with neoadjuvant therapy (NCT) is still uncertain. AFU was considered to be related to liver metastasis in colorectal cancer [4]; AFP was associated with prognosis in gastric cancer patients undergoing surgery alone [5]; preoperative CEA could predict the prognosis of GC patients with no lymph node metastasis [6]; CA199 was an independent prognostic factor in gastroesophageal junction (GEJ) cancer patients who experienced surgery alone [7]; the CA125 level was related to the degree of peritoneal dissemination and the existence of malignant ascites in GC patients with peritoneal metastasis [8]; and CA724 was correlated with pTNM stage in gastric carcinoma patients [9]. For GC patients who underwent NCT, the evidence of these markers is still insufficient
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