J Gastric Cancer.  2014 Jun;14(2):123-128.

At Which Stage of Gastric Cancer Progression Do Levels of Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 Increase? Application in Advanced Gastric Cancer Treatment

Affiliations
  • 1Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. painkiller9@catholic.ac.kr

Abstract

PURPOSE
Since there are no proven tumor markers that reflect the course of gastric cancer, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are commonly used alternatives. However, the degree of progression that corresponds to an increase in these markers, and the values of these markers at different cancer stages, remains unclear.
MATERIALS AND METHODS
This study enrolled 1,733 gastric cancer patients who underwent surgery and whose pre-operative CEA and CA19-9 levels were known. Survival curves and mean values of the two markers were compared according to the degree of cancer progression: serosa-unexposed (SU), serosa-exposed (SE), direct invasion (DI), localized seeding (P1), and extensive seeding (P2).
RESULTS
The 5-year overall survival rates at each stage differed significantly, except between DI and P1 patients (17.1% vs. 10.5%, P=0.344). The mean CEA values in SU, SE, DI, P1, and P2 patients were 5.80, 5.48, 13.36, 8.06, and 22.82, respectively. The CA19-9 values for these patients were 49.40, 38.97, 101.67, 73.77, and 98.57, respectively. The increase in CEA in P2 patients was statistically significant (P=0.002), and the increases in CA19-9 in DI and P2 patients were significant (P=0.025, 0.007, respectively). There was a fair correlation between the two markers in P2 patients (r=0.494, P<0.001).
CONCLUSIONS
CA19-9 can be used to assess DI of gastric cancer into adjacent organs. Both markers are useful for predicting the presence of extensive peritoneal seeding.

Keyword

Carcinomatosis; Disease progression; Neoplasm invasiveness; Stomach neoplasms; Tumor markers, biological

MeSH Terms

Carcinoembryonic Antigen*
Carcinoma
Disease Progression
Humans
Neoplasm Invasiveness
Stomach Neoplasms*
Survival Rate
Biomarkers, Tumor
Carcinoembryonic Antigen

Figure

  • Fig. 1 Overall survival rates of the five groups: serosa-unexposed (SU), serosa-exposed (SE), direct invasion (DI), localized seeding (P1), and extensive seeding (P2). SU vs. SE, P<0.001; SE vs. DI, P<0.001; DI vs. P1, P=0.344; P1 vs. P2, P=0.042.

  • Fig. 2 Comparison of the mean CEA levels among the five groups. The P2 group had a significantly higher CEA value (22.82±106.7 µg/ml; P=0.002). Error bar is ±2 standard error. CEA = carcinoembryonic antigen; SU = serosa-unexposed; SE = serosa-exposed; DI = direct invasion; P1 = localized seeding; P2 = extensive seeding.

  • Fig. 3 Comparison of the mean CA19-9 levels among the five groups. The DI and P2 groups had significantly higher CA19-9 values (DI, 101.67±193.2 U/ml, P=0.025; P2, 98.57±212.4 U/ml, P=0.007). Error bar is ±2 standard error. CA19-9 = carbohydrate antigen 19-9; SU = serosa-unexposed; SE = serosa-exposed; DI = direct invasion; P1 = localized seeding; P2 = extensive seeding.

  • Fig. 4 Correlations between CEA and CA19-9 levels in: (A) all patients (P=0.025); (B) SU group (P=0.032); (C) SE group (P=0.311); (D) DI group (P=0.633); (E) P1 group (P=0.084); (F) P2 group (P<0.001). CA19-9 = carbohydrate antigen 19-9; CEA = carcinoembryonic antigen; SU = serosa-unexposed; SE = serosa-exposed; DI = direct invasion; P1 = localized seeding; P2 = extensive seeding.


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