Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Gastric Cancer. 2012 Apr;15(2):154-61. doi: 10.1007/s10120-011-0091-8. Epub 2011 Sep 3.
Serum tumor markers have been shown to correlate with the clinical status of patients with advanced gastric cancer. However, the clinical significance of each tumor marker in patients with peritoneal dissemination has not been fully verified.
Four serum markers, carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, CA125, and CA72-4, were periodically measured in 102 patients with peritoneal dissemination who received combination intravenous and intraperitoneal chemotherapy. The initial values at diagnosis and after treatment were analyzed in association with clinicopathological factors, response to chemotherapy, and overall survival.
The sensitivities of CEA, CA19-9, CA125, and CA72-4 for peritoneal metastasis at the initial diagnosis were 19, 36, 46, and 45%, respectively. The CA125 level was significantly correlated with the degree of peritoneal dissemination and the existence of malignant ascites. Patients with ovarian metastasis showed significantly higher levels of CA72-4. The median survival time of patients with an elevated CA125 level was significantly shorter than that of patients with a normal CA125 level (36.7 vs. 16.6 months, p < 0.001). Multivariate analysis showed that the degree of peritoneal metastasis and an elevated CA125 level were independent prognostic factors. Normalization of the CA125 level after 3 courses of chemotherapy was correlated with reduced ascites and improved survival.
Serum CA125 and CA72-4 are clinically useful markers in diagnosis, evaluating the efficacy of chemotherapy, and predicting the prognosis of patients with peritoneal dissemination. From an academic point of view, periodic measurements of these markers are warranted in gastric cancer patients with possible peritoneal dissemination.
血清肿瘤标志物已被证明与晚期胃癌患者的临床状态相关。然而，每种肿瘤标志物在腹膜转移患者中的临床意义尚未得到充分验证。
对 102 例接受静脉联合腹腔化疗的腹膜转移患者定期检测 4 种血清标志物，癌胚抗原（CEA）、糖类抗原（CA）19-9、CA125 和 CA72-4。分析初始诊断和治疗后的指标值与临床病理因素、化疗反应和总生存期的关系。
CEA、CA19-9、CA125 和 CA72-4 对初始诊断腹膜转移的敏感性分别为 19%、36%、46%和 45%。CA125 水平与腹膜扩散程度和恶性腹水的存在显著相关。卵巢转移患者 CA72-4 水平显著升高。CA125 水平升高患者的中位生存时间明显短于 CA125 水平正常患者（36.7 对 16.6 个月，p<0.001）。多因素分析显示，腹膜转移程度和 CA125 水平升高是独立的预后因素。3 个疗程化疗后 CA125 水平正常与腹水减少和生存改善相关。
血清 CA125 和 CA72-4 是诊断、评估化疗疗效和预测腹膜转移患者预后的临床有用标志物。从学术角度来看，在有腹膜转移可能的胃癌患者中定期检测这些标志物是有必要的。
