Suenaga Yasuhito, Kanda Mitsuro, Ito Seiji, Mochizuki Yoshinari, Teramoto Hitoshi, Ishigure Kiyoshi, Murai Toshifumi, Asada Takahiro, Ishiyama Akiharu, Matsushita Hidenobu, Tanaka Chie, Kobayashi Daisuke, Fujiwara Michitaka, Murotani Kenta, Kodera Yasuhiro
Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi 510-8567, Japan.
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
World J Gastrointest Oncol. 2019 Jan 15;11(1):17-27. doi: 10.4251/wjgo.v11.i1.17.
To evaluate the prognostic significance of perioperative carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels in stage II/III gastric cancer.
From a multi-institutional retrospective database compiled by integrating clinical data from nine institutions, data of 998 patients who underwent curative resection for stage II/III gastric cancer between 2010 and 2014 were retrieved and analyzed. The prognostic impact of the preoperative and postoperative levels and chronological changes in CEA, CA19-9 and their combination were evaluated. To test whether postoperative adjuvant chemotherapy alters the prognostic impact of perioperative CEA and CA19-9 levels, the hazard ratios for mortality were compared between patients who underwent surgery alone and patients who underwent surgery followed by adjuvant chemotherapy.
The prognostic impact of postoperative CEA and CA19-9 was superior to that of the preoperative levels. Multivariable analysis identified high postoperative CEA and CA19-9 levels as independent prognostic factors for overall survival. Disease-free survival rates clearly decreased in a stepwise manner in association with postoperative CEA and CA19-9 levels, and patients with high levels of both markers showed significantly poorer prognosis than other patient groups. When we analyzed perioperative changes in serum CEA and CA19-9 levels, patients with high levels before and after surgery had the worst disease-free survival rates among all patient groups. Patients with normalized CEA levels after surgery had a significantly lower disease-free survival rate than those with normal perioperative levels, whereas patients with normalized CA19-9 levels after surgery had equivalent survival to those with normal perioperative levels. The prognostic impact of high CEA levels was observably smaller in patients who underwent adjuvant chemotherapy than in patients who underwent surgery alone, whereas that of high CA19-9 was greater in patients who underwent adjuvant chemotherapy. High postoperative CEA levels were significantly associated with an increased prevalence of liver, lung and bone recurrences, and high postoperative CA19-9 levels were significantly associated with increased frequencies of lymph node and liver recurrences.
The evaluation of serum CEA and CA 19-9 levels both before and after surgery provides useful information for precise risk stratification after curative gastrectomy.
评估围手术期癌胚抗原（CEA）和糖类抗原19-9（CA19-9）水平在Ⅱ/Ⅲ期胃癌中的预后意义。
从整合了9家机构临床数据的多机构回顾性数据库中，检索并分析了2010年至2014年间接受Ⅱ/Ⅲ期胃癌根治性切除术的998例患者的数据。评估术前和术后CEA、CA19-9水平及其组合的时间变化对预后的影响。为了检验术后辅助化疗是否会改变围手术期CEA和CA19-9水平对预后的影响，比较了单纯接受手术的患者和接受手术加辅助化疗的患者的死亡风险比。
术后CEA和CA19-9对预后的影响优于术前水平。多变量分析确定术后CEA和CA19-9高水平是总生存的独立预后因素。无病生存率与术后CEA和CA19-9水平呈明显的逐步下降，两种标志物水平均高的患者预后明显比其他患者组差。当我们分析血清CEA和CA19-9水平的围手术期变化时，手术前后水平均高的患者在所有患者组中无病生存率最差。术后CEA水平恢复正常的患者无病生存率明显低于围手术期水平正常的患者，而术后CA19-9水平恢复正常的患者生存率与围手术期水平正常的患者相当。接受辅助化疗的患者中，CEA高水平对预后的影响明显小于单纯接受手术的患者，而CA19-9高水平对预后的影响在接受辅助化疗的患者中更大。术后CEA高水平与肝、肺和骨转移发生率增加显著相关，术后CA19-9高水平与淋巴结和肝转移频率增加显著相关。
手术前后血清CEA和CA19-9水平的评估为根治性胃切除术后的精确风险分层提供了有用信息。
