Department of Pathology, the First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
Medicine (Baltimore). 2021 Dec 10;100(49):e28017. doi: 10.1097/MD.0000000000028017.
Gastric cancer (GC) is very common in China, posing a threat to public health, with high morbidity and mortality ranks. Tumor-node-metastasis (TNM) staging system is routinely used to predict prognosis for patients with GC but only available after surgery. Therefore, searching for markers that can predict prognosis of GC patients before surgery is desirable to assist management decisions preoperatively. Among 322 GC patients followed-up for 128 months, the tumor markers alpha fetoprotein, carcinoembryonic antigen, carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 15-3 and carbohydrate antigen 72-4 of 168 patients were detected before surgery, and their impact on survival was analyzed. Four major findings were revealed: (1) Preoperative examined CA19-9 levels and cell differentiation using endoscopic biopsies were positively correlated with lymphatic metastases and TNM stages obtained after surgery. (2) Kaplan-Meier analyses demonstrated that poor survival of patients with GC was associated with higher CA19-9 levels, poor cell differentiation, and older age. (3) Cox multi-factorial regression analyses indicated that, in terms of predicting overall survival for GC patients, preoperative CA19-9 level, cell differentiation and age were independent factors, respectively, comparable to postoperative TNM staging system. (4) Using receiver operating characteristic curve analysis, we first revealed that preoperative CA19-9 levels and cell differentiation had the impact weights (IW) on survival comparable to postoperative TNM components. These findings suggest that preoperative CA19-9 levels, cell differentiation and age are useful prognostic related markers for GC patients, superior to postoperative TNM system in terms of timing for management. We propose that, assisted by clinical imaging, a comprehensive utilization of these preoperative survival-predictors may help formulate individualized medical management for GC patients such as surgical strategy, optimal chemotherapy and radiotherapy, and appropriate follow-up intervals after surgery.
胃癌（GC）在中国非常常见，对公众健康构成威胁，发病率和死亡率都很高。肿瘤-淋巴结-转移（TNM）分期系统通常用于预测 GC 患者的预后，但仅在手术后可用。因此，寻找可预测 GC 患者手术前预后的标志物，以协助术前的管理决策，是非常可取的。在对 322 例随访 128 个月的 GC 患者中，对 168 例患者进行了术前肿瘤标志物甲胎蛋白、癌胚抗原、糖链抗原 19-9（CA19-9）、糖链抗原 15-3 和糖链抗原 72-4 的检测，并分析了它们对生存的影响。主要发现有四项：（1）术前检查的 CA19-9 水平和内镜活检的细胞分化与术后获得的淋巴转移和 TNM 分期呈正相关。（2）Kaplan-Meier 分析表明，GC 患者的不良生存与 CA19-9 水平较高、细胞分化不良和年龄较大有关。（3）Cox 多因素回归分析表明，在预测 GC 患者总生存方面，术前 CA19-9 水平、细胞分化和年龄分别是独立因素，与术后 TNM 分期系统相当。（4）通过接受者操作特征曲线分析，我们首次揭示了术前 CA19-9 水平和细胞分化对生存的影响权重（IW）与术后 TNM 成分相当。这些发现表明，术前 CA19-9 水平、细胞分化和年龄是 GC 患者有用的预后相关标志物，在管理时机方面优于术后 TNM 系统。我们建议，在临床影像学的辅助下，综合利用这些术前生存预测因子，可能有助于为 GC 患者制定个体化的医疗管理方案，如手术策略、最佳化疗和放疗，以及术后的适当随访间隔。
