Abstract
BackgroundIn this study, we aimed to investigate the preoperative serum carcinoembryonic antigen (CEA) in the diagnosis of positive lymph node metastasis (LNM), and to evaluated the relationship between CEA and survival in patients with locally advanced gastric cancer (LAGC).MethodsThe significance of the preoperative serum CEA level for the diagnose of LAGC and prediction of LNM was determined using the receiver operating characteristic (ROC) curve. The areas under the ROC of CEA were compared with those of other tumor markers or imaging examination including CT and MRI. Logistic regression was utilized to identify the risk factors predicting positive LNM. Independent prognosis factors were evaluated using univariate and multivariate COX regression analyses.ResultsThe ROC curves showed that the AUCs of CEA, CA199, and CA125 for diagnosing LAGC were 0.727, 0.594, and 0.566. When used to predict LNM, the AUC of CEA, CA199 and CA125 were 0.696, 0.531, and 0.588. Logistic regression analysis demonstrated that preoperative serum CEA were significantly associated with positive LNM. On combining imaging examination with CEA, the sensitivity and specificity were 85.3 and 79.4%, respectively, with the AUC equal to 0.853. The combination of CEA and imaging examination preformed the highest levels of AUC and sensitivity for diagnosing LNM, which is significantly higher than using either of them alone. Although patients with abnormal CEA have a poor prognosis, two models of multivariate analysis showed that CEA was not the independent prognosis factor for survival.ConclusionsCEA can be used to diagnose gastric cancer and determine whether it has LNM. Moreover, combined with CEA could improve the diagnostic sensitivity of imaging examination for lymph node involvement.
Highlights
In this study, we aimed to investigate the preoperative serum carcinoembryonic antigen (CEA) in the diagnosis of positive lymph node metastasis (LNM), and to evaluated the relationship between CEA and survival in patients with locally advanced gastric cancer (LAGC)
To estimate the ability of the three tumour markers to distinguish Gastric cancer (GC) from benign gastric disease, receiver operating characteristic (ROC) curves were generated, and the results showed that the area under the curve (AUC) values for CEA, Carbohydrate antigen 199 (CA199), and CA 125 were 0.727(0.681–0.773), 0.594(0.54–0.648), and 0.566(0.513
When using the common cut-off value of 3.4 ng/ml for CEA, 27 U/ml for CA199, and 35 U/ml for Carbohydrate antigen 125 (CA125), the AUC values were 0.614, 0.484, and 0.4, respectively (Table 2). This finding indicated that serum CEA, CA199, and CA125 values have the ability to diagnose GC
Summary
We aimed to investigate the preoperative serum carcinoembryonic antigen (CEA) in the diagnosis of positive lymph node metastasis (LNM), and to evaluated the relationship between CEA and survival in patients with locally advanced gastric cancer (LAGC). Because most of patients are in an advanced stage at the time of diagnosis, the mortality rates for GC have continued to increase in the past decade, especially in China [2] The reason for this may be tumour invasion or, lymph node metastasis (LNM), in addition to other factors such as differentiation, genetic mutation and patient behaviour, and postoperative recurrence and metastasis [3]. Previous studies have found that several factors have been associated with the prognosis of patients with GC, including tumour size, differentiation, lymph node metastasis (LNM) and selection of treatment. Among these factors, lymph node status may be the most reliable prognostic factor accessible [4,5,6,7]. Additional methods are necessary to detect LNM before operation when imaging studies are unavailable or the results are not accurate
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