Kwon Oh Kyoung, Yu Wansik, Chung Hoyoung
Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea.
Hepatogastroenterology. 2013 Mar-Apr;60(122):240-3. doi: 10.5754/hge12585.
BACKGROUND/AIMS: CA19-9 is known to have positive correlation with depth of invasion, nodal involvement, and peritoneal metastasis in gastric adenocarcinoma. In patients with high preoperative CA19-9 serum levels who underwent curative gastrectomy, we evaluated the prognostic impact of postoperative normalization of CA 19-9.
Among 1,439 patients who underwent curative gastrectomy for advanced gastric adenocarcinoma, data of 102 patients with advanced gastric adenocarcinoma whose preoperative serum CA19-9 level was higher than cutoff value (37 U/mL) were reviewed. If serum CA19-9 level had fallen below 37 U/mL at 6 months after surgery, the CA19-9 level was considered normalized.
CA19-9 levels were normalized in 79 patients but not in 23 patients. There were statistically significant differences in prognosis according to depth of invasion, presence of lymph node metastasis, extent of gastric resection, and postoperative CA19-9 normalization on univariate analyses. Multivariate analysis revealed that pathological lymph node metastasis (p<0.001) and postoperative CA19-9 normalization were independent prognostic factors (p=0.001).
In patients with advanced gastric adenocarcinoma who underwent curative gastric resection, postoperative normalization of CA19-9 can be a surrogate for potentially curative surgical treatment and can be used as a good prognostic factor.
背景/目的：已知CA19-9与胃腺癌的浸润深度、淋巴结受累情况及腹膜转移呈正相关。在接受根治性胃切除术且术前CA19-9血清水平较高的患者中，我们评估了术后CA19-9恢复正常对预后的影响。
在1439例行根治性胃切除术治疗进展期胃腺癌的患者中，回顾了102例术前血清CA19-9水平高于临界值（37 U/mL）的进展期胃腺癌患者的数据。如果术后6个月血清CA19-9水平降至37 U/mL以下，则认为CA19-9水平恢复正常。
79例患者的CA19-9水平恢复正常，23例未恢复正常。单因素分析显示，根据浸润深度、淋巴结转移情况、胃切除范围及术后CA19-9是否恢复正常，预后存在统计学显著差异。多因素分析显示，病理淋巴结转移（p<0.001）和术后CA19-9恢复正常是独立的预后因素（p=0.001）。
在接受根治性胃切除术的进展期胃腺癌患者中，术后CA19-9恢复正常可作为潜在根治性手术治疗的替代指标，并可作为良好的预后因素。
