Noh Jeongju, Park Ki Bum, Kwon Oh Kyoung
Department of Surgery, Kyungpook National University Hospital, Daegu, Korea.
Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
Korean J Clin Oncol. 2020 Dec;16(2):119-126. doi: 10.14216/kjco.20018. Epub 2020 Dec 31.
Preoperative positivity of serum tumor markers has been associated with poor long-term survival among patients with gastric cancer. However, there have been a considerable number of patients who have experienced a normalization of tumor markers (negative conversion) after curative treatment. This study aimed to evaluate the correlation between postoperative tumor marker conversion and survival after gastrectomy among gastric carcinoma patients.
We analyzed the clinical data of 129 patients who underwent curative gastrectomy with elevated preoperative carcinoembryonic antigen or carbohydrate antigen 19-9 between January 2009 and December 2013.
Positive tumor markers converted to negative markers 6 months after surgery in 91 patients (70.5%). The patients with a negative conversion of tumor markers had significantly better outcomes than those without negative conversion (overall survival [OS] 63.9 months vs. 41.1 months, P<0.001; disease-free survival [DFS] 59.3 months vs. 33.2 months, P<0.001). Multivariate analyses showed that tumor marker conversion and lymph node metastasis were independent predictors of OS and DFS. During follow-up, tumor markers became elevated again (positive reconversion) in 23 patients (25.3%), with a negative conversion of tumor markers at 6 months after gastrectomy. Among the patients with a positive reconversion of tumor markers, gastric cancer recurred in 18 patients (78.3%).
Negative tumor marker conversion after curative gastrectomy strongly predicts a better prognosis. Patients without negative tumor marker conversion and those with positive reconversion after normalization should be carefully monitored because of the high possibility of recurrence.
血清肿瘤标志物术前阳性与胃癌患者长期生存率低有关。然而，有相当数量的患者在根治性治疗后肿瘤标志物恢复正常（转阴）。本研究旨在评估胃癌患者术后肿瘤标志物转阴与胃切除术后生存率之间的相关性。
我们分析了2009年1月至2013年12月期间129例行根治性胃切除术且术前癌胚抗原或糖类抗原19-9升高的患者的临床资料。
91例患者（70.5%）术后6个月肿瘤标志物由阳性转为阴性。肿瘤标志物转阴的患者预后明显好于未转阴的患者（总生存期[OS]6个月对41.1个月，P<0.001；无病生存期[DFS]59.3个月对33.2个月，P<0.001）。多因素分析显示，肿瘤标志物转阴和淋巴结转移是OS和DFS的独立预测因素。随访期间，23例患者（25.3%）肿瘤标志物再次升高（复阳），这些患者在胃切除术后6个月肿瘤标志物转阴。在肿瘤标志物复阳的患者中，18例（78.3%）出现胃癌复发。
根治性胃切除术后肿瘤标志物转阴强烈预示预后较好。未出现肿瘤标志物转阴的患者以及转阴后复阳的患者应密切监测，因为复发可能性高。
