Abstract
Objective: The prognostic significance of serum CA19-9 levels in gastric cancer patients remains a matter debate. The aim of this study was to determine the prognostic value of changes in preoperative and postoperative serum CA19-9 levels in patients with gastric cancer.Methods: A total of 1,046 gastric cancer patients who underwent curative gastrectomy in West China Hospital of Sichuan University from January 2011 to December 2016 were analyzed retrospectively. Patients were categorized by minimum P-value using X-tile, while the baseline confounders for CA19-9 changes were balanced through propensity score matching (PSM). The relationships between CA19-9 changes and other clinicopathologic features were measured. Univariate and multivariate analysis were performed to explore the risk factors associated with survival outcomes.Results: We included 653 patients. Changes in CA19-9 levels significantly correlated with age, tumor size, macroscopic type, histological grade, T stage and TNM stage. Kaplan–Meier curves revealed that patients with CA19-9 changes <20% had significant better overall survival than those with changes more than 20% (p < 0.001); Cox regression analysis revealed the CA19-9 change (p = 0.010), gender (p = 0.031), histological grade (p = 0.036) and TNM stage (p < 0.001) were independent risk factors for survival after PSM. Stratification analysis indicated that patients with CA19-9 change more than 20% had worse prognosis that those with CA19-9 change no more than 20% in male (p = 0.002), poorly differentiated or undifferentiated type (p = 0.031) and TNM stage III (p = 0.006).Conclusion: Changes in preoperative and postoperative serum CA19-9 levels were closely associated with clinicopathological traits and was an independent prognostic factor in gastric cancer patients. This parameter may be a reliable marker for prediction of survival.
Highlights
Gastric cancer is one of the most common form of malignancy in China, and it is the second leading cause of cancer deaths, following lung cancer [1, 2]
There were 165 patients with CA19-9 decreasing more than 20% (α < −0.2), 125 patients with CA19-9 decreasing no more than 20% (−0.2 ≤α ≤ 0), 187 patients with CA19-9 increasing no more than 20% (0 < α ≤ 0.2) and 176 patients with CA19-9 increasing more than 20% (α > 0.2); There were 341 patients with CA19-9 changing more than 20% (α < −0.2 and α > 0.2) and 312 patients with CA19-9 changing
We compared the clinicopathological features between patients with CA19-9 decreasing no more than 20% (−0.2 ≤ α ≤ 0) and those with carbohydrate antigen (CA) 19-9 increasing no more than 20% (0 < α ≤ 0.2) and we found that there were no significant differences between the two groups in terms of tumor location, tumor size, macroscopic type, histological grade, T stage, N stage, and TNM stage (Supplementary Table 1)
Summary
Gastric cancer is one of the most common form of malignancy in China, and it is the second leading cause of cancer deaths, following lung cancer [1, 2]. In China, most patients have already evolved into advanced gastric cancer by the time of diagnosis [3, 4]. The most common causes of death for gastric cancer patients after radical surgery are local recurrence and distant metastasis. It is essential to determine the prognostic factors and perform appropriate therapeutic strategies for patients with advanced gastric cancer. The depth of tumor invasion and lymph node metastasis have been identified as the most important prognostic factors in gastric cancer [7, 8]
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