Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Int J Clin Oncol. 2017 Oct;22(5):897-904. doi: 10.1007/s10147-017-1132-z. Epub 2017 May 9.
There is no evidence that monitoring tumor dynamics using sensitive tumor markers contributes to treatment decision-making and prognosis in gastric cancer patients with tumor recurrence. This study was designed to investigate the significance of tumor markers in monitoring peritoneal recurrence of gastric cancer.
We retrospectively analysed 102 consecutive patients who developed recurrence after curative gastrectomy for gastric cancer at our institute between 2002 and 2011. They were followed intensively using tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen.
Of 102 patients who exhibited recurrence, 51 had peritoneal recurrence. These patients were divided into three groups according to the status of tumor markers at the time of recurrence. Each tumor marker was re-elevated in 28 patients (58%) (re-elevation group; REG), was continuously elevated since initial surgery in 13 patients (22%) (continuous elevation group; CEG) and was not elevated in 10 patients (20%) (non-elevation group; NEG). With regard to survival after recurrence and total postoperative survival, patients in the REG were significantly better than those in the other groups ( p = 0.001, p = 0.018, respectively). REG patients received more different types of chemotherapy regimens than NEG patients because of monitoring (p = 0.018). Multivariate analysis revealed that re-elevation of tumor markers at the time of recurrence was an independent and better prognostic factor for peritoneal recurrence (p = 0.003, hazard ratio 0.29).
Monitoring of tumor dynamics with sensitive tumor markers may contribute to the decision-making process for more promising chemotherapeutic regimens by avoiding subsequent ileus and lead to better prognosis in gastric cancer patients with peritoneal recurrence.
目前尚无证据表明监测肿瘤标志物的动态变化有助于指导胃癌复发患者的治疗决策和预后。本研究旨在探讨肿瘤标志物在监测胃癌腹膜复发中的意义。
我们回顾性分析了 2002 年至 2011 年期间在我院接受根治性胃切除术治疗后复发的 102 例连续胃癌患者。采用肿瘤标志物（如癌抗原 19-9 和癌胚抗原）对患者进行密切监测。
在 102 例复发患者中，有 51 例发生腹膜复发。这些患者根据复发时肿瘤标志物的状态分为三组。28 例患者（58%）（再次升高组；REG）的每个肿瘤标志物均再次升高，13 例患者（22%）（持续升高组；CEG）自初始手术以来持续升高，10 例患者（20%）（未升高组；NEG）未升高。REG 患者的复发后生存和总术后生存均明显优于其他两组（p=0.001，p=0.018）。由于监测，REG 患者接受了更多不同类型的化疗方案（p=0.018）。多因素分析显示，复发时肿瘤标志物的再次升高是腹膜复发的独立且更好的预后因素（p=0.003，风险比 0.29）。
通过避免后续肠梗阻，监测肿瘤标志物的动态变化可能有助于为腹膜复发的胃癌患者制定更有希望的化疗方案，并改善患者预后。
