Sato Bin, Kanda Mitsuro, Ito Seiji, Mochizuki Yoshinari, Teramoto Hitoshi, Ishigure Kiyoshi, Murai Toshifumi, Asada Takahiro, Ishiyama Akiharu, Matsushita Hidenobu, Nakanishi Koki, Shimizu Dai, Tanaka Chie, Fujiwara Michitaka, Murotani Kenta, Kodera Yasuhiro
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan,
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
Dig Surg. 2023;40(6):187-195. doi: 10.1159/000533143. Epub 2023 Sep 12.
Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 are widely used for treating various cancers, with cutoff values of 5.0 ng/mL and 37.0 IU/mL, respectively. However, these cutoff values are not for specific diseases or purposes but are uniformly used for any disease and any purpose. It is also unclear as to whether patients are at equal risk of recurrence if they are below the cutoff values. This study aimed to investigate the optimal cutoff of serum tumor markers in the stratification of recurrence risk after curative resection of gastric cancer.
We constructed a nine-center integrated database of patients who received gastrectomy between January 2010 and December 2014 with a 5-year follow-up period. We determined the cutoff value of preoperative serum tumor marker levels correlated with postoperative recurrences and evaluated its performance in risk stratification for recurrences in 948 patients with stage II/III gastric cancer who underwent radical resection.
The hazard ratio for postoperative recurrences increased at two points of preoperative CEA levels, 3.6 ng/mL and 5.0 ng/mL, which were set as cutoffs. These two cutoffs stratified relapse-free survival into three levels.
By adding a second cutoff value for preoperative serum CEA, which was proposed specifically for the prediction of recurrences, patients can be stratified into low-, intermediate-, and high-risk recurrences after curative resection of gastric cancer.
癌胚抗原（CEA）和糖类抗原19-9被广泛用于多种癌症的治疗，其临界值分别为5.0 ng/mL和37.0 IU/mL。然而，这些临界值并非针对特定疾病或用途，而是统一用于任何疾病和任何目的。此外，如果患者低于临界值，其复发风险是否相同也尚不清楚。本研究旨在探讨胃癌根治性切除术后复发风险分层中血清肿瘤标志物的最佳临界值。
我们构建了一个九中心综合数据库，纳入2010年1月至2014年12月期间接受胃切除术且随访5年的患者。我们确定了与术后复发相关的术前血清肿瘤标志物水平的临界值，并评估了其在948例接受根治性切除的II/III期胃癌患者复发风险分层中的表现。
术前CEA水平在3.6 ng/mL和5.0 ng/mL这两个点时，术后复发的风险比增加，这两个点被设定为临界值。这两个临界值将无复发生存期分为三个层次。
通过为术前血清CEA增加一个专门用于预测复发的第二个临界值，可以将胃癌根治性切除术后的患者分为低、中、高复发风险组。
