Abstract
BackgroundGrowing evidence has indicated that tumor biomarkers, including cytokeratin 19 fragment antigen 21–1 (Cyfra21–1), carbohydrate antigen 19–9 (CA19–9), carbohydrate antigen 72–4 (CA72–4), carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag) were reported to be commonly used in diagnosis and prognosis in esophageal squamous cell carcinoma (ESCC). However, which is the best marker for predicting prognosis remains unknown. Few papers focused on the relationship between tumor biomarkers and postoperative treatment in ESCC.MethodsA total of 416 ESCC patients were enrolled in this study. The association between tumor markers and overall survival (OS) was analyzed using Kaplan-Meier method with log-rank test, followed by multivariate Cox regression models.ResultsThe results of Cox multivariate analysis indicated that among these tumor biomarkers, CA19–9 (≥ 37 vs. < 37) [hazard ratio (HR) = 2.130, 95% confidence interval (CI) = 1.138–3.986, p = 0.018] and CEA (≥ 5 vs. < 5) (HR = 1.827, 95% CI = 1.089–3.064, p = 0.022) were the independent prognostic factors of poor OS. For the ESCC patients with CA19–9 < 37, CEA < 5 or SCC-Ag < 1.5, the surgery plus postoperative chemotherapy group had a significantly longer OS than the surgery group alone (p < 0.05), but this significant difference of OS between these two groups cannot be found in patients with CA19–9 ≥ 37, CEA ≥ 5 or SCC-Ag ≥ 1.5 (p > 0.05).ConclusionsCEA and CA19–9 maybe are superior to other tumor biomarkers as prognostic indicators in ESCC. CA19–9, CEA, SCC-Ag may be useful in predicting the therapeutic effect of postoperative chemotherapy in ESCC.
Highlights
Growing evidence has indicated that tumor biomarkers, including cytokeratin 19 fragment antigen 21–1 (Cyfra21–1), carbohydrate antigen 19–9 (CA19–9), carbohydrate antigen 72–4 (CA72–4), carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag) were reported to be commonly used in diagnosis and prognosis in esophageal squamous cell carcinoma (ESCC)
Our result indicated that male patients, larger tumor size, advanced pT stage, advanced pN stage, advanced TNM stage, patients who did not receive postoperative chemotherapy and elevated CA19–9, CEA, Cyfra21–1 and SCC-Ag were significantly related to poor overall survival (OS) (p < 0.05, Fig. 1a-e, Table 2)
Some studies indicated that Cyfra21–1 was better than CEA as a predictor of OS for prognosis in ESCC [12, 18], Cao et al found that Cyfra21–1 and SCC-Ag were both independently significant poor predictors of prognosis in patients with stage II ESCC [5]
Summary
Growing evidence has indicated that tumor biomarkers, including cytokeratin 19 fragment antigen 21–1 (Cyfra21–1), carbohydrate antigen 19–9 (CA19–9), carbohydrate antigen 72–4 (CA72–4), carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag) were reported to be commonly used in diagnosis and prognosis in esophageal squamous cell carcinoma (ESCC). Few papers focused on the relationship between tumor biomarkers and postoperative treatment in ESCC. Despite the development of multidisciplinary treatment in ESCC, the prognosis of patients still remains poor [4]. TNM staging system has been regarded as the primary factor in predicting prognosis for ESCC. ESCC patients with the same TNM stage often have different clinical outcomes. It is very important to explore dependable prognostic factors to accurately predict the prognosis of patients with ESCC and even guide a personalized treatment
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