Abstract
BackgroundIn clinical practice, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are the most common markers measured before and after surgery for gastric cancer (GC). However, which pre- or post-operative combined tumour markers (CEA and CA19-9) have more prognostic value remains unclear.MethodsConsecutive patients undergoing a resection for GC at the Fujian Medical University Union Hospital were included as a discovery database between January 2011 and December 2014. The prognostic impact of pre- and post-operative tumour markers was evaluated using Kaplan–Meier log-rank survival analysis and multivariable Cox regression analysis. The results were then externally validated.ResultsA total of 735 and 400 patients were identified in the discovery cohort and in the validation cohort, respectively. Overall survival rates decreased in a stepwise manner in association with the number of pre- and post-operative positive tumour markers (both P < 0.001). Multivariable analysis revealed that the number of pre-operative positive tumour markers was an independent prognostic factor (P < 0.05). For patients with abnormal pre-operative tumour markers, normalisation of tumour markers after surgery is an independent prognostic protective factor (hazard ratio (HR) = 0.618; 95% confidence interval (CI) = 0.414–0.921), and patients with both positive post-operative tumour markers had double the risk of overall death (HR = 2.338; 95% CI = 1.071–5.101). Similar results were observed in the internal validation and external validation cohorts.ConclusionPre-operative tumour markers have a better discriminatory ability for post-operative survival in GC patients than post-operative tumour markers, and the normalisation of tumour markers after surgery was associated with better survival.
Highlights
In clinical practice, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are the most common markers measured before and after surgery for gastric cancer (GC)
Compared with the discovery cohort, patients in the validation cohort were significantly associated with younger age, increased body mass index (BMI), smaller tumour size and pathological findings, such as differentiated histological type, an earlier TNM stage, and vascular and perineural invasion
Our study assessed the prognostic value of the combination of CEA and
Summary
Carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are the most common markers measured before and after surgery for gastric cancer (GC). By integrating other significant prognostic factors, such as tumour markers, the individual prognosis of patients can be better assessed.[3] In clinical practice, carcinoembryonic antigen (CEA). Carbohydrate antigen (CA) 19-9 are the most commonly used markers for the early diagnosis and monitoring of GC These markers have been confirmed to be associated with prognosis and recurrence of GC after surgery.[4,5] previous studies mainly focused on the pre-operative level of CEA and CA19-9.6–8 There are rare and conflicting studies evaluating the prognostic value of post-operative tumour markers.[9,10] the purpose of this study was to determine whether pre- or post-operative combined tumour markers (CEA and CA19-9) are more prognostic. We asked whether patients with pre-operative positive tumour markers that normalise after gastrectomy had a better survival than patients with post-operative positive tumour markers
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