Association between preoperative plasma CEA levels and the prognosis of gastric cancer following curative resection. Tumor Marker Committee, Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan

Prognostic value of Serum and Tumor Tissue CA 72-4 Content in Gastric Cancer

To date no general agreement has been reached regarding the prognostic significance of CEA, CA 19-9 and CA 72-4 as serum markers in gastric cancer, and only scattered information is available on the predictive value of marker expression in tumor tissue. Therefore, a longitudinal study was designed to analyze the presurgical serum and tumor tissue content of CA 72-4, CEA and CA 19-9 in 166 patients at different stages of gastric cancer, and to evaluate the possible correlation with clinicopathological features in respect to prognostic information on relapse-free survival. The results obtained showed that 48.4% of patients with tumor recurrence had positive presurgical CA 72-4 levels compared to approximately 24% of patients who remained free of disease. Furthermore, the median presurgical serum CA 72-4 levels were significantly elevated in relapsing patients. Serosa and lymph node involvement as well as positive presurgical serum CA 72-4 levels had independent prognostic value in predicting recurrence. A significant association between disease-free survival and lymph node involvement, depth of invasion and tumor tissue content of CA 72-4 was also demonstrated. We may therefore conclude that CA 72-4 antigen can be considered the marker of choice in the follow-up of gastric cancer patients and may be used as a prognostic indicator of relapse.

Cutoff value of carcinoembryonic antigen and carbohydrate antigen 19-9 elevation levels for monitoring recurrence in patients with resectable gastric adenocarcinoma

Background

The aim of this longitudinal study was to try and improve the specificity of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 in monitoring tumor recurrence in patients with resectable gastric adenocarcinoma by setting suitable elevation levels.

Methods

One hundred eighty-one patients with resectable gastric adenocarcinoma were considered. Serum samples were obtained preoperatively and every 3 months postoperatively.

Results

Preoperative CEA and CA19-9 positivity rates were 19.9% and 18.2%. The specificity and sensitivity of CEA elevation to monitor recurrence were 92.9% and 23.4% versus 76.5% and 78.9% in CEA-negative versus CEA-positive patients, respectively. For CA19-9 the specificity and sensitivity were 95.0% and 18.8% versus 60.0% and 83.3% in CA19-9-negative versus CA19-9-positive patients, respectively. When we set the elevation level of CEA at 5 ng/mL, the specificity of CEA elevation to monitor recurrence increased to 94.1% for CEA-positive patients. The specificity increased to 93.3% for CA19-9-positive patients when the CA19-9 elevation level was set at 100 U/mL.

Conclusions

For CEA- or CA19-9-positive patients with resectable gastric adenocarcinoma we can increase the specificity of CEA and CA19-9 by setting the elevation level of CEA at 5 ng/mL and CA19-9 at 100 U/mL.

The characteristics of the serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels in gastric cancer cases

PURPOSE

Although carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are the most commonly used tumor markers in gastric cancer, the differences in the characteristics of these two markers remain unclear, because most previous studies have included many patients who were positive for both markers.

METHODS

We analyzed the available data on 1050 patients with gastric cancer who underwent R0 resection. The background characteristics and recurrence-free survivals (RFS) were compared between the single-positive patients for CEA or CA 19-9 and double-negative patients.

RESULTS

Among these 1050 patients, 86 patients (8.2 %) were positive for CEA only, 77 patients (7.3 %) were positive for CA 19-9 only, and 867 patients (82.6 %) were double negative for both markers. Patients who were elderly, male and had a differentiated histology were more commonly observed in the CEA-positive group than in the double-negative group (P = 0.004, P = 0.009, and P = 0.001). The patients who were positive for either CEA or CA 19-9 had a significantly worse RFS than the patients who were negative for both (P < 0.001 and P < 0.001). The most frequent site of recurrence was the liver (9.3 %) in the CEA-positive group and the peritoneum (11.7 %) in the CA 19-9-positive group.

CONCLUSION

Age, sex, and histological type were thus found to be associated with CEA positivity. CEA is, therefore, considered to be a sensitive marker for liver recurrence, while CA 19-9 is a sensitive marker for peritoneal recurrence.

Preoperative serum CEA and CA19-9 in gastric cancer--a single tertiary hospital study of 1,075 cases

To evaluate the clinical impact of preoperative serum CEA and CA19-9 on resectable gastric cancer (GC), a total of 1,075 consecutive cases with gastric adenocarcinoma were obtained retrospectively from January 2012 and December 2013 in a single tertiary hospital, and the relationships between serum CEA, CA19-9 and clinicopathologic features were investigated. Positive preoperative serum rates of CEA and CA19-9 were 22.4% and 12.3% respectively, levels significantly correlating with each other and depth of invasion, lymph node involvement, pTNM and stage. The CEA level also presented a remarkable association with lymphovascular invasion. Both CEA and CA19-9 positivity significantly and positively correlated with depth of invasion, nodal involvement, pTNM stage, lymphovascular invasion, tumor size and tumor location. Stratified analyses according to gender or tumor location showed preoperative CEA or CA19-9 had different associations with clinicopathologic features in different gender subgroups or location subgroups. Preoperative serum CA19-9 positivity may be more meaningful for tumor size rather than CEA. In conclusion, preoperative serum CEA and CA19-9 correlate with disease progression of GC, and may have applications in aiding more accurate estimation of tumor stage, decision of treatment choice and prognosis evaluation.

Preoperative serum tumor marker levels in gastric cancer

OBJECTIVE

Tumor markers have shown little benefit as a method for screening. However, they can be used clinically for the monitoring of tumor recurrence and used as prognostic factors because higher levels have been observed in advanced disease. This study aimed to investigate the relationship between the preoperative tumor marker levels and different clinical aspects of gastric cancer.

METHODS

One hundred and six consecutive patients with confirmed diagnosis of gastric cancer and 106 subjects (age and sex matched) with no malignancy as control group were included prospectively in this study in 3 years. The relationships between tumor markers CEA, CA 19-9 and stage of disease, tumor differentiation, presence of ringlet cell type, presence of peritoneal carcinomatozis were investigated.

RESULTS

The serum CEA and CA 125 levels were found to be significantly elevated in gastric cancer patients than in controls. The serum level of CEA had showed a significant elevation with the presence of distant metastasis. The CA 19-9 and CA 125 levels had showed significant elevations with the presence of peritoneal carcinomatozis. Conclusions : This study showed that there is a limited clinical benefit of preoperative tumor marker measurements in gastric cancer such as estimation of peritoneal dissemination.

Gastric cancer: tumor markers as predictive factors for preoperative staging

INTRODUCTION

CEA, CA 19-9, and CA 72-4 are tumor markers commonly used for gastric neoplasms. The clinical importance of the preoperative serum levels of these tumor markers in gastric cancer (GC) is not well known. Even less is known about the predictive value of the preoperative serum levels of the β-subunit of human chorionic gonadotropin (hCGβ).

AIMS AND METHODS

We designed a prospective study to evaluate the significance of the preoperative values of these tumor markers in GC. The serum levels that we considered as positive are as follows: CA 72-4, >4 U/ml; CEA, >5 ng/ml; CA 19-9, >37 U/ml; hCGβ-free subunit, <5 mUI/ml. These levels were correlated by pathological stage, lymph node status, and histology.

RESULTS

We studied 66 (42 male and 24 female) patients prospectively. Twenty-seven patients had stage I and stage II GCs, while 39 patients had stage III and stage IV GCs. Two patients tested positive for hCGβ. The preoperative positivity rates of CA 72-4 in patients at the early stages (stages I and II) and in patients with advanced disease (stages III and IV) were 0 and 28 patients, respectively. The preoperative positivity rates of CEA/CA 19.9 were 0/5 and 7/12 patients in early stages and advanced disease, respectively. The serum levels of these markers were not correlated with the histological type or tumoral grade of GC.

CONCLUSION

The preoperative serum level of CA 72-4 has the best predictive value in indicating advanced disease in patients diagnosed with GC. A combination of these four markers is better in predicting this situation.

The relationships between perioperative CEA, CA 19-9, and CA 72-4 and recurrence in gastric cancer patients after curative radical gastrectomy

BACKGROUND AND OBJECTIVES

The correlation between perioperative CEA, CA 19-9, and CA 72-4 and recurrence of gastric cancer has not been clarified. The aim of this study was to investigate the relationships between perioperative CEA, CA 19-9, and CA 72-4 and recurrence of gastric cancer.

METHODS

We retrospectively analyzed the relationships between the tumor markers CEA, CA 19-9, and CA 72-4 and recurrence of gastric cancer.

RESULTS

In patients with early gastric cancer, the recurrence sensitivity of postoperative CEA, CA 19-9, and CA 72-4 was 40.0, 5.6, and 2.8%, respectively. And in patients with advanced gastric cancer, the recurrence sensitivity of postoperative CEA, CA 19-9, and CA 72-4 was 100.0, 68.2, and 51.3%, respectively. Multivariate analyses showed that an increase in postoperative CEA in early gastric cancer was an independent prognostic factor of recurrence. In patients with advanced gastric cancer, age >60 years, stage III, and postoperative CEA increase and CA 72-4 increase were independent prognostic factors of recurrence.

CONCLUSIONS

For patients with advanced gastric cancer, CEA, CA 19-9, and CA 72-4 are considered useful for follow-up tests. Although, CEA is considered useful for follow-up test for patients with early gastric cancer, but CA19-9 and CA72-4 are less useful due to their low sensitivity.

Detection of survivin-expressing circulating cancer cells (CCCs) in peripheral blood of patients with gastric and colorectal cancer reveals high risks of relapse

BACKGROUND

We previously demonstrated that the detection of circulating cancer cells (CCCs) expressing survivin mRNA could provide valuable information for predicting metastasis and recurrence in breast cancer. The objective of this study was to investigate whether or not the detection of survivin expression in the peripheral blood could also have significant effects on the clinical outcomes of patients with gastric and colorectal cancer.

METHODS

Survivin-expressing CCCs in peripheral blood samples obtained from 55 gastric cancer patients, 86 colorectal cancer patients, and 87 healthy volunteers were quantitatively examined by using a RT-PCR ELISA. Its clinical significance was statistically evaluated.

RESULTS

The CCCs in the peripheral blood samples were detected in 45.4% and 44.0% of gastric and colorectal cancer patients, respectively. The presence of survivin-expressing CCCs was found to be significantly associated with the degree of tumor penetration, nodal status, and disease stages for both types of cancers. During a follow-up period of 36 months, patients who had a positive detection at the time of the initial assay test had a higher relapse rate than those who had a negative detection. As well, survivin-expressing CCCs were statistically shown to be a significant and independent predictor for cancer recurrence. The detection of survivin-expressing CCCs was also demonstrated to be more accurate in terms of predicting recurrence than traditional detection methods such as plasma carcinoembryonic antigen (CEA) measurements.

CONCLUSION

The detection of CCCs expressing survivin mRNA could be used to accurately identify gastric and colorectal cancer patients with high risks of relapse.

Different roles of tumor marker monitoring after curative resections of gastric and colorectal cancers

We previously demonstrated that false-positive findings for tumor markers are frequently observed, and that the sensitivity of marker monitoring for early detection of the recurrence is low after curative resection of gastric cancer. The aim of this study was to investigate whether such characters are specific to gastric cancer. Serum carcinoembryonic antigen and/or carbohydrate antigen 19-9 were periodically assessed in 258 patients who underwent curative gastrectomy for gastric cancer (n = 161) or curative resection for colorectal cancer (n = 97). The frequency of false-positive findings for the tumor markers, the sensitivity of the marker monitoring for detection of the recurrence, and the characteristics of such cases were compared between these two cancer groups. During the median follow-up period of 30 months, recurrence developed in 14% of gastric cancer and 23% of colorectal cancer patients. A false positive with the tumor marker was frequently observed in patients after gastrectomy compared with after colorectal surgery. The sensitivity of the marker monitoring regarding early detection of recurrence was higher in patients with colorectal cancer than those with gastric cancer, especially in cases of advanced stage. As a result, the accuracy of marker monitoring for the detection of recurrence was higher in patients after the resection of colorectal cancer than that of gastric cancer. Surgeons and oncologists should thus be aware that the role of the tumor marker monitoring after a curative operation differs between patients with gastric and colorectal cancers.

Prognostic significance of serum and tissue carcinoembryonic antigen in patients with gastric adenocarcinomas

PURPOSE

Carcinoembryonic antigen (CEA) is known to be elevated in nearly all solid malignancies. The prognostic role of CEA in gastric cancers however, is still controversial. We evaluated preoperative serum CEA levels and CEA expression from the resected tumor tissues to determine whether they have prognostic significance in gastric cancer patients.

MATERIALS AND METHODS

Medical records of 810 patients who underwent surgery for gastric adenocarcinoma from June, 1998 to February, 2002 in Kyungpook National University Hospital were reviewed. Serum CEA level was evaluated by radioimmunoassay preoperatively, and the cut-off level for positivity was 7.0 ng/ml. Labeled streptavidin-biotin peroxidase method was used to determine CEA expression from the gastric cancer tissues.

RESULTS

Serum and tissue CEA were positive in 9.3% and 91.1% of the patients, respectively. They had no correlation with each other. The positivity rate of serum CEA had positive correlation with invasion depth (p<0.001), lymph node metastasis (p<0.001), distant metastasis (p=0.006), and final stage (p<0.001). Well differentiated tumors showed higher serum CEA positivity (p=0.002). Patients with positive serum CEA had higher recurrence rate (p<0.001). Multivariate analysis showed significantly lower survival rate in patients with preoperative CEA levels over 7 ng/ml than those with lower levels (48.0% vs. 80.7%; p<0.001). The positivity rates of tissue CEA were higher in advanced cancers (p=0.033) and in more advanced stages (p=0.029). Tissue CEA positivity showed no correlation with recurrence or survival.

CONCLUSIONS

Preoperative serum CEA level had correlation with disease progression and survival in gastric cancer patients, and proved to be an independent prognostic factor. Tissue CEA expression in gastric cancers had no prognostic information.

False-positive findings for tumor markers after curative gastrectomy for gastric cancer

The objective of this study was to assess the frequency and characteristics of false-positive results for tumor markers after curative gastrectomy for gastric cancer. Carcinoembryonic antigen and/or carbohydrate antigen 19-9 were periodically assessed for 168 patients who underwent curative gastrectomy. Cancer recurrence was observed for 17 (10.1%) patients and 151 (89.9%) were disease-free during the mean follow-up period of 23.1 months after the operation. The frequency of false-positive findings for tumor markers after gastrectomy was 14.3% (24/168) for all followed-up patients. Three different patterns of marker elevation were observed in the false-positive group. A false-positive finding for these markers was observed for patients with early-stage cancer and for those with chronic benign diseases, for example bronchitis, liver dysfunction, diabetes mellitus, and renal dysfunction. For most patients with false-positive findings for a marker a spontaneous decrease in the tumor marker was observed 1-2 months after the marker was first observed at a high level after the operation. Surgeons and oncologists should therefore keep in mind the high frequency of false-positive findings for tumor markers after curative gastrectomy for gastric cancer.

Gastric cancer

Gastric cancer is one of the most common cancers and one of the most frequent causes of cancer-related deaths. The incidence, diagnostic studies, and therapeutic options have undergone important changes in the last decades, but the prognosis for gastric cancer patients remains poor, especially in more advanced stages. Surgery is the mainstay of treatment of this disease, even if it is associated with a high rate of locoregional and distant recurrence. There is ongoing debate regarding the role of adjuvant treatment In advanced disease, palliation of symptoms, rather than cure, is the primary goal of patient management. Several combination therapies have been developed and have been examined in phase III trials; however, in most cases, they have failed to demonstrate a survival advantage over the reference arm. This review summarizes the most important recommendations for the management of patients with gastric cancer.

Serum carcinoembryonic antigen as a prognostic factor in resectable gastric cancer

BACKGROUND

Carcinoembryonic antigen (CEA) has been widely accepted as a tumor marker useful in the diagnosis and management of colorectal cancer. When CEA levels are positive in gastric cancer patients, they could be useful prognostic indicators. However, the value of CEA as a tumor marker for gastric cancer remains a matter of controversy.

STUDY DESIGN

We measured preoperative serum CEA levels in 196 patients with resectable gastric cancer between May 1986 and April 1996 and then evaluated the correlation between serum CEA levels, clinicopathologic features, and prognostic information.

RESULTS

Serum levels of CEA were above the normal range in 29 of 196 (14.8%) surgically resected patients (range, 5.2-570 ng/mL). Among 100 early gastric cancers confined to the submucosal layer, only 7 patients (7.0%) had positive CEA levels, but among 96 advanced cancers, 22 patients (22.9%) had high CEA levels. The CEA positive patients had more macroscopically infiltrative tumors, a more prominent serosal invasion, more frequent lymph nodes involvement, and a more advanced stage than did the CEA negative patients. The 3- and 5-year cumulative disease-specific survival rates of patients positive for serum CEA were 39.6% and 31.7%, respectively; these rates for patients negative for CEA were 83.0% and 77.3%, respectively (p < 0.0001 for comparison of survival curves). In various clinicopathologic parameters, nine parameters (tumor size, macroscopic type, type and time of operation, Laurén classification, depth of invasion, lymph node involvement, CEA, alpha-fetoprotein [AFP], and carbohydrate antigen [CA] 19-9) showed statistically significant differences in the cumulative survival rates. Of these nine parameters, independent prognostic factors by multivariate analysis were depth of invasion (T1, 2 versus T3, 4, p < 0.0001), serum CEA levels (negative versus positive, p = 0.0003), and lymph node metastasis (negative versus positive, p = 0.0005).

CONCLUSIONS

Preoperative serum CEA levels provide a predictive value in determining tumor stage and prognostic information for patients with potentially resectable gastric cancer during the preoperative period.