Correlation of preoperative carcinoembryonic antigen levels and prognosis of gastric cancer patients.

BACKGROUND

The prognostic significance of preoperative serum carcinoembryonic antigen (CEA) determination in patients with gastric cancer has been controversial.

METHODS

The correlation between preoperative serum CEA levels and clinicopathologic factors was evaluated in 865 patients with gastric cancer who underwent gastrectomy between 1980 and 1990. The authors also investigated whether preoperative CEA levels represented a prognostic parameter using Cox's proportional hazard model.

RESULTS

Of the 865 patients, 249 (28.8%) were positive for CEA. The positivity rate was higher in the elderly, in male patients whose tumors were located in the lower third of the stomach, and in those with Borrmann types 2 and 3. It was also significantly correlated with tumor size, depth of invasion, lymph node metastasis, peritoneal and liver metastases, and cancer stage. The higher the serum CEA level, the more advanced the cancer stage, and the rate of curative resection also decreased as CEA levels were elevated. There was a significant difference between patients with CEA levels below 10 ng/ml and those with levels exceeding 10 ng/ml with regard to tumor progression and curability. Multivariate analysis showed a strong and highly significant association between preoperative serum CEA level and survival time. The prognosis was also significantly poorer when the CEA level was above 10 ng/ml, even in patients in the same stage (Stages 1, 2, and 3).

CONCLUSIONS

Preoperative serum CEA determination in patients with gastric cancer valuable for predicting tumor progression and prognosis. Further, in patients in Stages 1, 2, and 3, CEA levels exceeding 10 ng/ml are clinically significant and provide more prognostic information than that obtained by conventional staging methods.