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Preoperative Tumor Markers Independently Predict Survival in Stage III Gastric Cancer Patients: Should We Include Tumor Markers in AJCC Staging?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to determine the prognostic significance of preoperative carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels in patients with resectable gastric cancer (GC).

Patients and Methods

Patients who underwent a radical resection for GC at the Fujian Medical University Union Hospital between 2007 and 2014 were included in this study. The estimated area under the curve (AUC) was compared to evaluate the discriminatory ability of tumor makers. Additional external validation was performed using a dataset from Sun Yat-sen University Cancer Center.

Results

Preoperative CEA/CA19-9 levels were identified as an independent predictor of overall survival (OS) and disease-specific survival (DSS) (both p < 0.05) in the development group. In a subgroup analysis based on TNM stage, preoperative CEA/CA19-9 levels clearly stratified the survival rates for stage III GC (p < 0.05). A multivariate analysis revealed that preoperative CEA/CA19-9 levels were an independent prognostic factor (p < 0.05) in stage III; the AUC of the preoperative CEA/CA19-9 was equivalent to that of T stage. A prediction model (TNMC) for stage III GC was developed by incorporating preoperative CEA/CA19-9 levels into the American Joint Committee on Cancer (AJCC) staging system. The AUC of the TNMC was significantly higher than that of the TNM staging system at 1, 3, and 5 years postoperatively (all p < 0.05), with similar results also being obtained in the external validation set.

Conclusion

Preoperative CEA/CA19-9 levels are an independent predictor of OS and DSS in stage III GC patients. The inclusion of preoperative CEA/CA19-9 levels in AJCC TNM staging provided an optimal prognosis in stage III GC.

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Acknowledgement

This study was supported by Scientific and Technological Innovation Joint Capital Projects of Fujian Province, China (No.2016Y9031); Minimally Invasive Medical Center of Fujian Province (No. [2017]171); and Startup Fund for Scientific Research, Fujian Medical University (No. 2016QH024).

Author information

Author notes

  1. Jian-Xian Lin, Wei Wang, and Jun-Peng Lin contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Jian-Xian Lin MD, Jun-Peng Lin MD, Jian-Wei Xie PhD, Jia-bin Wang PhD, Jun Lu MD, Qi-Yue Chen MD, Long-long Cao MD, Mi Lin MD, Ruhong Tu MD, Chao-Hui Zheng PhD, Chang-Ming Huang MD & Ping Li PhD

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Jian-Xian Lin MD, Jun-Peng Lin MD, Jian-Wei Xie PhD, Jia-bin Wang PhD, Jun Lu MD, Qi-Yue Chen MD, Long-long Cao MD, Mi Lin MD, Ruhong Tu MD, Chao-Hui Zheng PhD, Chang-Ming Huang MD & Ping Li PhD

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China

    Jian-Xian Lin MD, Jian-Wei Xie PhD, Jia-bin Wang PhD, Chao-Hui Zheng PhD, Chang-Ming Huang MD & Ping Li PhD

  4. Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China

    Wei Wang MD & Zhi-wei Zhou MD

Authors
  1. Jian-Xian Lin MD
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Corresponding authors

Correspondence to Chang-Ming Huang MD, Zhi-wei Zhou MD or Ping Li PhD.

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Disclosure

Jian-Xian Lin, Wei Wang, Jun-Peng Lin, Jian-Wei Xie, Jia-bin Wang, Jun Lu, Qi-Yue Chen, Long-long Cao, Mi Lin, Ruhong Tu, Chao-Hui Zheng, Chang-Ming Huang, Zhi-wei Zhou, and Ping Li have no conflicts of interest or financial ties to disclose.

Electronic Supplementary Material

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10434_2018_6634_MOESM1_ESM.tif

ROC curves of CEA, CA19-9 and CEA/CA19-9 for the prediction of 5-year overall survival (a) and disease-specific survival (b). AUC of ROC curves and p-values of CEA and CA19-9 were compared with the AUC of CEA/CA19-9. AUC area under the curve, CEA carcinoembryonic antigen, CA carbohydrate, ROC receiver operating characteristic. (TIFF 1119 kb)

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Lin, JX., Wang, W., Lin, JP. et al. Preoperative Tumor Markers Independently Predict Survival in Stage III Gastric Cancer Patients: Should We Include Tumor Markers in AJCC Staging?. Ann Surg Oncol 25, 2703–2712 (2018). https://doi.org/10.1245/s10434-018-6634-z

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