Takahashi Yutaka, Takeuchi Tetsuo, Sakamoto Junichi, Touge Tetsuya, Mai Masayoshi, Ohkura Hisanao, Kodaira Susumu, Okajima Kunio, Nakazato Hiroaki
Japanese Foundation for Multidisciplinary Treatment of Cancer, Ichigaya MS Bldg., 1-9, 4-Chome, Kudankita, Chiyoda-ku, Tokyo 102-0073, Japan.
Gastric Cancer. 2003;6(3):142-5. doi: 10.1007/s10120-003-0240-9.
Many studies on postoperative carcinoembryonic antigen (CEA) and/or carbohydrate antigen (CA)19-9 monitoring after operation for gastric cancer have been reported, but most have been retrospective.
A nationwide observational study was implemented in 135 leading institutions in Japan to evaluate the significance of CEA and/or CA19-9 in postoperative monitoring for recurrence in patients with advanced gastric cancer. Three hundred and twenty-one patients examined in this analysis underwent radical gastrectomy at one of Japan's leading institutions between November 1993 and March 1996 and had been followed up for at least 5 years. Serum levels of CEA and CA19-9 were examined preoperatively and every 3 months postoperatively, with diagnostic imagings, such as chest X-ray, computed tomography (CT), and ultrasonography also being performed every 3 months.
Recurrence was observed in 120 patients (peritoneum, 48; liver 16; lymph node, 16; multiple sites, 25; and others, 12). Sensitivities of CEA and either CEA or CA19-9, or both, for recurrence were 65.8% and 85.0%, respectively, both of which values were significantly higher than the preoperative positivities (28.3% and 45.0%, respectively). In most patients with high preoperative levels CEA and/or CA19-9, these tumor markers increased again at recurrence. Recurrent diseases were detected between 5 months after detection by diagnostic imagings and 12 months before detection by diagnostic imagings (mean of 3.1 +/- 3.6 months before detection by diagnostic imagings) and between 10 months after detection by diagnostic imagings and 13 months before detection by diagnostic imagings (mean of 2.2 +/- 3.9 months before detection by diagnostic imagings) by CEA and CA19-9 monitorings, respectively.
These results suggest that CEA and/or CA19-9 monitoring after operation was useful to predict the recurrence of gastric cancer, especially in almost all the patients with high preoperative levels of these markers.
已有许多关于胃癌手术后癌胚抗原（CEA）和/或糖类抗原（CA）19-9监测的研究报道，但大多数为回顾性研究。
在日本135家主要机构开展了一项全国性观察性研究，以评估CEA和/或CA19-9在晚期胃癌患者术后复发监测中的意义。本分析中纳入的321例患者于1993年11月至1996年3月期间在日本一家主要机构接受了根治性胃切除术，并至少随访了5年。术前及术后每3个月检测血清CEA和CA19-9水平，同时每3个月进行胸部X线、计算机断层扫描（CT）和超声检查等诊断性影像学检查。
120例患者出现复发（腹膜，48例；肝脏，16例；淋巴结，16例；多部位，25例；其他，12例）。CEA以及CEA和/或CA19-9对复发的敏感性分别为65.8%和85.0%，这两个值均显著高于术前阳性率（分别为28.3%和45.0%）。在大多数术前CEA和/或CA19-9水平较高的患者中，这些肿瘤标志物在复发时再次升高。通过CEA和CA19-9监测分别在诊断性影像学检查发现前5个月至12个月（诊断性影像学检查发现前平均3.1±3.6个月）以及诊断性影像学检查发现前10个月至13个月（诊断性影像学检查发现前平均2.2±3.9个月）检测到复发性疾病。
这些结果表明，术后CEA和/或CA19-9监测有助于预测胃癌复发，尤其是在几乎所有术前这些标志物水平较高的患者中。
