Tachibana M, Takemoto Y, Nakashima Y, Kinugasa S, Kotoh T, Dhar D K, Kohno H, Nagasue N
Department of Surgery, Masuda Medical Association Hospital, Japan.
J Am Coll Surg. 1998 Jul;187(1):64-8. doi: 10.1016/s1072-7515(98)00133-1.
Carcinoembryonic antigen (CEA) has been widely accepted as a tumor marker useful in the diagnosis and management of colorectal cancer. When CEA levels are positive in gastric cancer patients, they could be useful prognostic indicators. However, the value of CEA as a tumor marker for gastric cancer remains a matter of controversy.
We measured preoperative serum CEA levels in 196 patients with resectable gastric cancer between May 1986 and April 1996 and then evaluated the correlation between serum CEA levels, clinicopathologic features, and prognostic information.
Serum levels of CEA were above the normal range in 29 of 196 (14.8%) surgically resected patients (range, 5.2-570 ng/mL). Among 100 early gastric cancers confined to the submucosal layer, only 7 patients (7.0%) had positive CEA levels, but among 96 advanced cancers, 22 patients (22.9%) had high CEA levels. The CEA positive patients had more macroscopically infiltrative tumors, a more prominent serosal invasion, more frequent lymph nodes involvement, and a more advanced stage than did the CEA negative patients. The 3- and 5-year cumulative disease-specific survival rates of patients positive for serum CEA were 39.6% and 31.7%, respectively; these rates for patients negative for CEA were 83.0% and 77.3%, respectively (p < 0.0001 for comparison of survival curves). In various clinicopathologic parameters, nine parameters (tumor size, macroscopic type, type and time of operation, Laurén classification, depth of invasion, lymph node involvement, CEA, alpha-fetoprotein [AFP], and carbohydrate antigen [CA] 19-9) showed statistically significant differences in the cumulative survival rates. Of these nine parameters, independent prognostic factors by multivariate analysis were depth of invasion (T1, 2 versus T3, 4, p < 0.0001), serum CEA levels (negative versus positive, p = 0.0003), and lymph node metastasis (negative versus positive, p = 0.0005).
Preoperative serum CEA levels provide a predictive value in determining tumor stage and prognostic information for patients with potentially resectable gastric cancer during the preoperative period.
癌胚抗原（CEA）已被广泛认可为一种有助于结直肠癌诊断和管理的肿瘤标志物。当胃癌患者的CEA水平呈阳性时，它们可能是有用的预后指标。然而，CEA作为胃癌肿瘤标志物的价值仍存在争议。
我们测量了1986年5月至1996年4月期间196例可切除胃癌患者的术前血清CEA水平，然后评估血清CEA水平、临床病理特征和预后信息之间的相关性。
196例接受手术切除的患者中，29例（14.8%）血清CEA水平高于正常范围（范围为５.２～５７０ ng/mL）。在局限于黏膜下层的100例早期胃癌中，只有7例（7.0%）CEA水平呈阳性，但在96例进展期癌症中，22例（22.9%）CEA水平较高。与CEA阴性患者相比，CEA阳性患者的肿瘤在宏观上浸润性更强、浆膜侵犯更明显、淋巴结受累更频繁且分期更晚。血清CEA阳性患者的3年和5年累积疾病特异性生存率分别为39.6%和31.7%；CEA阴性患者的这些生存率分别为83.0%和77.3%（生存曲线比较，p<0.0001）。在各种临床病理参数中，九个参数（肿瘤大小、宏观类型、手术类型和时间、劳伦分类、浸润深度、淋巴结受累情况、CEA、甲胎蛋白[AFP]和糖类抗原[CA]19-9）在累积生存率方面显示出统计学上显著差异。在这九个参数中，多变量分析的独立预后因素是浸润深度（T1、2与T3、4，p<0.0001）、血清CEA水平（阴性与阳性，p=0.0003）和淋巴结转移（阴性与阳性，p=0.0005）。
术前血清CEA水平在术前为潜在可切除胃癌患者确定肿瘤分期和预后信息方面具有预测价值。
Zotero 插件