血清肿瘤标志物围手术期正常化对进展期胃癌患者的预后意义
Prognostic significance of serum tumor marker normalization in the perioperative period for patients with advanced gastric cancer.
作者信息
Hu Can, Zhang Yanqiang, Xu Jingli, Chen Wujie, Yu Pengcheng, Wang Yi, Bao Zhehan, Zhang Ruolan, Xu Zhiyuan, Cheng Xiangdong
机构信息
Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Gastric Surgery, the Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.
出版信息
Ann Transl Med. 2022 Feb;10(3):153. doi: 10.21037/atm-22-109.
BACKGROUND
Neoadjuvant chemotherapy (NCT) was developed to improve the prognosis of patients with advanced gastric cancer (AGC). Some studies have confirmed the diagnostic and prognostic value of various serum tumor markers in gastric cancer. However, most of these studies were focused on the value of preoperative and postoperative tumor markers in patients undergoing surgery with or without adjuvant therapy, and only a few studies focused on AGC patients undergoing NCT.
METHODS
We retrospectively analyzed the data of consecutive patients with histologically confirmed AGC who received NCT prior to surgical resection at Zhejiang Cancer Hospital from January 2010 to September 2018. The prognostic impact of tumor markers before and after NCT, including Carcinoembryonic antigen (CEA), Carbohydrate antigen199 (CA199), Carbohydrate antigen125 (CA125), Alpha-FetoProtein (AFP), Carbohydrate antigen242 (CA242), and Carbohydrate antigen724 (CA724), were evaluated using Kaplan-Meier log-rank survival analysis. The association between tumor marker normalization during preoperative chemotherapy and clinicopathological characteristics was also investigated.
RESULTS
Four hundred and seventy-two patients were included in the study. The levels of CEA, CA199, CA125, CA242, and CA724 before NCT could predict prognosis, and the levels of CA199, CA125, CA242, and CA724 after NCT were correlated with prognosis. The overall survival (OS) rate decreased with an increasing number of positive tumor markers before and after preoperative chemotherapy. Tumor marker abnormalization after NCT was not related to chemotherapy, whereas patients with tumor marker normalization after NCT obtained survival benefits.
CONCLUSIONS
Tumor markers before and after NCT, such as CA199, CA125, CA242, and CA724, have a discriminatory ability for patients with GC. The normalization of tumor markers after NCT was associated with better survival.
背景
新辅助化疗（NCT）旨在改善晚期胃癌（AGC）患者的预后。一些研究已证实各种血清肿瘤标志物在胃癌中的诊断和预后价值。然而，这些研究大多集中于接受或未接受辅助治疗的手术患者术前和术后肿瘤标志物的价值，仅有少数研究关注接受NCT的AGC患者。
方法
我们回顾性分析了2010年1月至2018年9月在浙江省肿瘤医院接受手术切除前接受NCT的连续组织学确诊AGC患者的数据。使用Kaplan-Meier对数秩生存分析评估NCT前后肿瘤标志物（包括癌胚抗原（CEA）、糖类抗原199（CA199）、糖类抗原125（CA125）、甲胎蛋白（AFP）、糖类抗原242（CA242）和糖类抗原724（CA724））对预后的影响。还研究了术前化疗期间肿瘤标志物正常化与临床病理特征之间的关联。
结果
472例患者纳入研究。NCT前CEA、CA199、CA125、CA242和CA724水平可预测预后，NCT后CA199、CA125、CA242和CA724水平与预后相关。术前化疗前后肿瘤标志物阳性数量增加，总生存（OS）率降低。NCT后肿瘤标志物异常与化疗无关，而NCT后肿瘤标志物正常化的患者获得生存益处。
结论
NCT前后的肿瘤标志物，如CA199、CA125、CA242和CA724，对GC患者具有鉴别能力。NCT后肿瘤标志物的正常化与更好的生存相关。
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