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Sun AH, Zhang XY, Huang YY, Chen L, Wang Q, Jiang XC. Prognostic value and predictive model of tumor markers in stage I to III gastric cancer patients. World J Clin Oncol 2024; 15:1033-1047. [PMID: 39193154 PMCID: PMC11346068 DOI: 10.5306/wjco.v15.i8.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/03/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Preoperative serum tumor markers have been widely used in the diagnosis and treatment of gastric cancer patients. However, few studies have evaluated the prognosis of gastric cancer patients by establishing statistical models with multiple serum tumor indicators. AIM To explore the prognostic value and predictive model of tumor markers in stage I and III gastric cancer patients. METHODS From October 2018 to April 2020, a total of 1236 patients with stage I to III gastric cancer after surgery were included in our study. The relationship between serum tumor markers and clinical and pathological data were analyzed. We established a statistical model to predict the prognosis of gastric cancer based on the results of COX regression analysis. Overall survival (OS) was also compared across different stages of gastric cancer. RESULTS The deadline for follow-up was May 31, 2023. A total of 1236 patients were included in our study. Univariate analysis found that age, clinical stage, T and N stage, tumor location, differentiation, Borrmann type, size, and four serum tumor markers were prognostic factors of OS (P < 0.05). It was shown that clinical stage, tumor size, alpha foetoprotein, carcinoembryonic antigen, CA125 and CA19-9 (P < 0.05) were independent prognostic factors for OS. According to the scoring results obtained from the statistical model, we found that patients with high scores had poorer survival time (P < 0.05). Furthermore, in stage I patients, the 3-year OS for scores 0-3 ranged from 96.85%, 95%, 85%, and 80%. In stage II patients, the 3-year OS for scores 0-4 were 88.6%, 76.5%, 90.5%, 65.5% and 60%. For stage III patients, 3-year OS for scores 0-6 were 70.9%, 68.3%, 64.1%, 50.9%, 38.4%, 18.5% and 5.2%. We also analyzed the mean survival of patients with different scores. For stage I patients, the mean OS was 55.980 months. In stage II, the mean OS was 51.550 months. The mean OS for stage III was 39.422 months. CONCLUSION Our statistical model can effectively predict the prognosis of gastric cancer patients.
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Affiliation(s)
- Ai-Hua Sun
- Department of Radiotherapy Oncology, Huizhou Municipal Central Hospital, Huizhou 516001, Guangdong Province, China
| | - Xin-Yu Zhang
- Department of Radiotherapy Oncology, Huizhou Municipal Central Hospital, Huizhou 516001, Guangdong Province, China
| | - Yang-Yang Huang
- Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Lei Chen
- Department of General Surgery, Xiang'an Hospital of Xiamen University, Xiamen 361102, Fujian Province, China
| | - Qing Wang
- Department of General Surgery, Xiang'an Hospital of Xiamen University, Xiamen 361102, Fujian Province, China
| | - Xiao-Cong Jiang
- Department of Radiotherapy Oncology, Huizhou Municipal Central Hospital, Huizhou 516001, Guangdong Province, China
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Zhang J, Yin X, Wang H, Fang T, Gao J, Zhu Z, Li C, Wang Y, Wang X, Lu Z, Wu J, Wang Y, Zhang Y, Xue Y. Development and Validation of Tumor Marker Indices in Advanced Gastric Cancer Patients. Cancer Control 2023; 30:10732748231202466. [PMID: 37728233 PMCID: PMC10515535 DOI: 10.1177/10732748231202466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Tumor markers (TMs) are important for the prognosis of gastric cancer (GC). However, the prognostic importance of the tumor marker index (TMI) based on GC-specific TMs for advanced gastric cancer (AGC) still needs to be further explored. METHODS We retrospectively examined patients who underwent radical gastric cancer surgery between February 2014 and June 2016 at the Department of Gastroenterological Surgery, Affiliated Cancer Hospital, Harbin Medical University. The patients were divided into training and validation groups. TMI was determined as the geometric mean of the standard cancer antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) levels. Patient overall survival was assessed using the Kaplan-Meier method. Independent prognosis-associated risk factors were identified using Cox hazard regression models. A nomogram model incorporating TMI and clinicopathological factors was developed, and its performance was evaluated using a decision curve analysis, concordance index, and calibration plots. RESULTS In the TMI training cohort, the cutoff value was set at .439, categorizing patients into TMI-High and TMI-Low groups. The 5-year survival rate in the TMI-Low group significantly surpassed that in the TMI-High group (78.2% vs 58.1% and 49.7 vs 41.6, P < .001). TMI emerged as an independent prognostic factor. The nomogram accurately predicted patient prognosis by using TMI and clinicopathological characteristics. Validation of the TMI in the independent cohort yielded satisfactory results. CONCLUSION The TMI constructed based on specific TMs associated with gastric cancer can offer a precise prognostic prediction for patients.
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Affiliation(s)
- Jiaqi Zhang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xin Yin
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hao Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Tianyi Fang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jialiang Gao
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ziyu Zhu
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Chunfeng Li
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yufei Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xibo Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Zhanfei Lu
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Junpeng Wu
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yimin Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yao Zhang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yingwei Xue
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
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The Modified Glasgow Prognostic Score Predicts Survival in Gastric Cancer Patients with Normal CEA and CA19-9. Can J Gastroenterol Hepatol 2022; 2022:3953004. [PMID: 35734015 PMCID: PMC9208994 DOI: 10.1155/2022/3953004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Traditionally, serum CEA and CA19-9 levels are good prognostic factors for gastric cancer. Many gastric cancer patients do not have elevated CEA or CA19-9 levels even at a very advanced stage. This study investigates the significance of the modified Glasgow prognostic score (mGPS) for the survival of gastric cancer patients with normal CEA and CA19-9. METHODS We retrospectively examined 488 curatively resected gastric cancer patients with normal preoperative serum levels of CEA and CA19-9 to evaluate the prognostic ability of mGPS for overall survival. The prognostic significance was analyzed by univariate and multivariate analyses. RESULTS Age, hemoglobin, white cell count, and neutrophils were each significantly correlated with the mGPS. Multivariate analyses showed that tumor location (HR, 0.803; 95% CI, 0.667-0.966; P=0.020), TNM stage (HR, 2.714; 95% CI, 2.250-3.275; P < 0.001), and mGPS (HR, 1.042; 95% CI, 1.105-1.772; P=0.023) were significantly associated with overall survival. Significant correlations were found between overall survival and mGPS. The Kaplan-Meier analysis demonstrated significant differences among patients with mGPS of 0, 1, and 2 (P < 0.001), with the mortality rate being higher for patients with a higher mGPS. CONCLUSION The mGPS can predict survival in gastric cancer patients with normal CEA and CA19-9.
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Liao PW, Cheng SB, Chou CW, Lin HC, Lin CH, Chen TC, Hsu CY, Jerry Teng CL, Shih YH. Chemotherapy for Metastatic Gastric Cancer: Does Age Matter? A Single-Center, Retrospective, Real-World Study. CLINICAL MEDICINE INSIGHTS: ONCOLOGY 2022; 16:11795549221123617. [PMID: 36134036 PMCID: PMC9483662 DOI: 10.1177/11795549221123617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Palliative chemotherapy is the preferred standard of care for patients with metastatic gastric cancer (mGC). It remains uncertain whether older patients with mGC would benefit from palliative chemotherapy. This study aimed to investigate the clinical impact of palliative chemotherapy in older patients with mGC. Methods: This single-institute, retrospective, and real-world study included 428 patients with mGC between January 2009 and December 2019. Among them, 306 who received palliative chemotherapy were further stratified into 2 groups according to age: ≤70 (n = 236) and >70 (n = 70) years. The clinical demographics, outcomes, and hematologic toxicities of chemotherapy were compared between the 2 groups. Prognostic factors were determined using the Cox proportional hazards model. Results: Of the screened 428 patients, older patients had worse overall survival (OS) than younger patients. Among patients who received chemotherapy (n = 306), patients aged >70 and ⩽70 years had comparable progression-free survival (PFS) and OS. The incidence of severe hematologic toxicity was similar between the 2 groups. The Eastern Cooperative Oncology Group performance status of 2 or more metastatic sites, elevated carbohydrate antigen 19-9 level, high neutrophil-to-lymphocyte ratio (NLR), and undergoing palliative gastrectomy were independent prognostic factors for OS. Notably, age >70 years was not a significant factor for poor OS. Conclusions: Older age of >70 years might not be considered an obstacle to administering palliative chemotherapy to patients with mGC.
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Affiliation(s)
- Po-Wei Liao
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung
| | - Shao-Bin Cheng
- Division of General Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung
- School of Medicine, Chung Shan Medical University, Taichung
| | - Cheng-Wei Chou
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung
| | - Hsin-Chen Lin
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung
| | - Cheng-Hsien Lin
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung
| | - Tsung-Chih Chen
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei
| | - Chiann-Yi Hsu
- Biostatistics Task Force, Taichung Veterans General Hospital, Taichung
| | - Chieh-Lin Jerry Teng
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung
- School of Medicine, Chung Shan Medical University, Taichung
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung
- Department of Life Science, Tunghai University, Taichung
| | - Yu-Hsuan Shih
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung
- School of Medicine, Chung Shan Medical University, Taichung
- Institute of Medicine, Chung Shan Medical University, Taichung
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Zhang W, Gong W, He X, Wu C, Tu X. A systematic review and meta-analysis on the efficacy of Compound Kushen Injection in 3 kinds of digestive tract tumor. J Gastrointest Oncol 2021; 12:2919-2929. [PMID: 35070418 PMCID: PMC8748064 DOI: 10.21037/jgo-21-774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/14/2021] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Chemotherapy has become the main means to prolong the life of patients with advanced digestive tract cancer; however, it is associated with serious toxicity and side effects. Compound Kushen Injection (CKI) is a pure Chinese herbal preparation, which can assist chemotherapy, inhibit tumor cell proliferation, and reduce adverse reactions of chemotherapy. In this study, we systematically evaluated reports of CKI as an adjuvant to chemotherapeutic treatment of digestive tract cancer in recent years and provided evidence for clinical diagnosis and treatment. METHODS The databases of PubMed, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI) and Web Of Science were searched for clinical randomized controlled trials (RCTs) related to adjuvant chemotherapy with CKI in the treatment of advanced gastrointestinal tumors published from January 2000 to September 2021. After screening the qualified literatures, RevMan 5.4 software was used to evaluate the bias of the included literatures and perform meta-analysis. RESULTS A total of 12 articles were included in the selection, incorporating 1080 study participants in all; meta-analysis results showed that application of the CKI in the process of chemotherapy for digestive tract tumors could improve the efficacy [odds ratio (OR) =3.11; 95% confidence interval (CI): 2.26 to 4.47, Z=7.00, P<0.00001], increase the patients' median survival time (months) (OR =3.00; 95% CI: 1.47 to 4.52, Z=3.84, P=0.0001), increase the level of CD3+ [mean difference (MD) =4.11; 95% CI: 3.24 to 4.98], CD4+ level (MD =8.24; 95% CI: 3.72 to 12.76), reduce the CD8+ level (MD =-5.42; 95% CI: -8.09 to -2.76), reduce the tumor markers carcinoembryonic antigen (CEA; MD =-14.26; 95% CI: -14.81 to -13.71), CA199 (MD =-138.87; 95% CI: -143.21 to -132.52), and reduce the adverse reactions of chemotherapy: leukopenia (OR =0.28; 95% CI: 0.19 to 0.43), thrombocytopenia (OR =0.38; 95% CI: 0.24 to 061), decreased hemoglobin (OR =0.55; 95% CI: 0.31 to 0.98), and nausea and vomiting symptoms (OR =0.35; 95% CI: 0.24 to 0.53). DISCUSSION Adjuvant chemotherapy with CKI in the treatment of digestive tract tumors can effectively improve the symptoms of patients, improve immunity, reduce the level of serum tumor markers, improve efficacy, and reduce toxic and side effects.
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Affiliation(s)
- Wuguang Zhang
- Oncology Department of Integrated Traditional Chinese and Western Medicine, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Wenqian Gong
- Department of Traditional Chinese Medicine, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Xiansong He
- Department of Traditional Chinese Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Changhai Wu
- Department of Acupuncture, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Xiaolong Tu
- Department of Oncology, Ningbo Hospital of traditional Chinese Medicine, Ningbo, China
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Hu Y, Jin D, Zhou Y, Cheng Y, Cao H, Ma Y, Zhang W. Multiple roles of THY1 in gastric cancer based on data mining. Transl Cancer Res 2020; 9:2748-2757. [PMID: 35117633 PMCID: PMC8798632 DOI: 10.21037/tcr.2020.02.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND THY1 (CD90) is a heavily N-glycosylated, glycophosphatidylinositol (GPI) anchored cell surface protein, which has been implicated in several cancers. But, the specific mechanism and function of the THY1 gene remains unclear in gastric cancer (GC). METHODS To investigate the function of THY1 in GC and illustrate the potential mechanism, TCGA and FIREBROWSE were used to detect the THY1expression. GEPIA2 and Kaplan-Meier Plotter showed significant correlation among THY1 mRNA level, TNM stage and survival probability of GC patients. RESULTS THY1 was up-regulated apparently in GC in contrast to normal tissues and linked to TNM stage. GC patients with higher THY1 expression displayed lower overall survival (OS), first progression (FP) and post-progression survival (PPS). In vitro experiments showed that knockdown of THY1 suppressed proliferation, migration while increased autophagy level in GC cells. Immune factors may interact with THY1mRNA in GC and THY1 was found significantly linked with Tregs. CONCLUSIONS Our findings indicate that higher THY1 level is link to poor prognosis of GC patients. THY1may as well be used as a marker molecule for evaluating the tumor microenvironment status of GC patients and a target for immunotherapy.
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Affiliation(s)
- Yun Hu
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
- Department of General Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 2310442, China
| | - Dongmei Jin
- Department of Respiratory Medicine, Lianyungang Oriental Hospital, Lianyungang 222042, China
| | - Yichan Zhou
- Department of Geriatrics Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ye Cheng
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Hongyong Cao
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yong Ma
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Wenling Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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