Prognostic significance of serum and tissue carcinoembryonic antigen in patients with gastric adenocarcinomas

Salivary carcinoembryonic antigen in desquamative gingivitis: A comparative study in oral lichenoid reactions before and after topical corticosteroid therapy

Background

Desquamative gingivitis is an immunological chronic disease that is considered precancerous and has the potential to develop into squamous cell carcinoma. Carcinoembryonic antigen (CEA), a common tumor marker, increases in many cancers. The present study compared salivary CEA levels in desquamative gingivitis before and after topical corticosteroid therapy.

Methods

This case‒control study was conducted in the Department of Oral and Maxillofacial Medicine, Tabriz Faculty of Dentistry. Twenty patients with desquamative gingivitis in oral lichen planus (OLP) background were selected as the case group, with 20 healthy individuals as the control group. Desquamative gingivitis lesions were confirmed with biopsies. Salivary samples were obtained from both groups. Second, salivary samples were collected from the case group after a course of topical corticosteroid therapy. Salivary CEA levels were measured by a monobind kit using the ELISA method. Independent and paired t-tests were used to analyze the data in SPSS 17. P<0.05 was considered statistically significant.

Results

Before treatment, CEA levels were significantly higher in the case group (174.06±95.55) than in the control group (55.66±41.26 ng/mL) (P<0.001). Salivary CEA levels in the case group decreased significantly after the treatment (96.77±66.25 ng/mL) compared to before treatment (174.06±95.55 ng/mL) (P<0.001).

Conclusion

This study demonstrated that CEA levels significantly decreased in patients with desquamative gingivitis associated with oral lichenoid reaction after receiving topical corticosteroid therapy.

Carcinoembryonic Antigen Expression in Human Tumors: A Tissue Microarray Study on 13,725 Tumors

BACKGROUND/OBJECTIVES

Carcinoembryonic antigen (CEA) is a cell-surface glycoprotein serving as a drug target, diagnostic marker, and serum marker for cancer monitoring. However, prevalence data on CEA expression in cancer tissues vary considerably. This study was designed to determine CEA expression in normal and neoplastic tissues.

METHODS

A tissue microarray containing 13,725 samples from 120 different tumor types, as well as 76 different normal tissue types, was analyzed by immunohistochemistry (IHC).

RESULTS

CEA was detectable in 65 (54.2%) of 120 tumor categories, including 49 (40.8%) tumor types with at least one strongly positive case. CEA positivity was most common in colorectal adenomas (100%) and carcinomas (98.7%), other gastrointestinal adenocarcinomas (61.1-80.3%), medullary carcinomas of the thyroid (96.3%), pulmonary adenocarcinoma (73.7%), mucinous carcinomas of the ovary (79.8%) and the breast (43.2%), small-cell carcinomas of the lung (64.3%), and urinary bladder (38.9%). CEA overexpression was linked to high tumor grade and invasive growth (p < 0.0001 each) in urinary bladder cancer, and estrogen and HER2 receptor positivity (p ≤ 0.0158) in invasive breast cancer of no special type. In colorectal adenocarcinomas, reduced CEA expression was associated with mismatch repair deficiency (p < 0.0001).

CONCLUSIONS

The comprehensive list of CEA-positive human tumor types demonstrates that CEA is expressed in a broad range of epithelial neoplasms, many of which might benefit from CEA serum monitoring and anti-CEA therapies.

In Pursuit of Novel Markers: Unraveling the Potential of miR-106, CEA and CA 19-9 in Gastric Adenocarcinoma Diagnosis and Staging

Gastric cancer stands as the fourth leading cause of cancer-related deaths globally, primarily comprising adenocarcinomas, categorized by anatomic location and histologic type. Often diagnosed at advanced stages, gastric cancer prognosis remains poor. To address the critical need for accurate tumoral markers for gastric cancer diagnosis, we conducted a study to assess classical markers like CEA and CA-19-9 alongside the novel marker miR-106. Our investigation revealed distinct dynamics of these markers compared to non-cancerous groups, although no disparities were observed across different disease stages. Univariable and multivariable logistic regression analyses demonstrated that elevated levels of miR-106, CEA and CA 19-9 were predictive of a positive histopathological exam, with the respective odds ratios of 12.032 (95% CI: 1.948-74.305), 30 (95% CI: 3.141-286.576), and 55.866 (95% CI: 4.512-691.687). Subsequently, we utilized predicted probabilities from regression models to construct receiver operating characteristic (ROC) curves, identifying CA 19-9 as the optimal predictor for gastric adenocarcinoma diagnosis when considering age and gender, with an area under the curve (AUC) of 0.936 (p < 0.001). Hence, classical markers exhibit superior performance compared to the novel marker miR-106 in predicting gastric adenocarcinoma.

Combined Use of Tumor Markers in Gastric Cancer: A Novel Method with Promising Prognostic Accuracy and Practicality

BACKGROUND

The effect of a single tumor marker on the prognosis of gastric cancer patients is not ideal. This study explored a novel prognostic assessment method for gastric cancer (GC) patients using a combination of three important tumor markers (CEA, CA72-4, and CA19-9).

METHOD

Data from 1966 GC patients who underwent curative gastrectomy at Sun Yat-Sen University Cancer Center (Guangzhou, China) were included. Hazard ratios (HR) for all factors for overall survival (OS) were analyzed by Cox regression. A nomogram and calibration curve were used to establish the survival prediction model. The prediction accuracy was evaluated with the concordance index (C-index).

RESULTS

All patients were divided into four groups (C0-C3) according to the number of elevated tumor markers. The 5-year OS rates of the patients in preoperative groups C0-C3 were 83.8% (81.3-86.4%), 72.8% (68.5-77.4%), 58.9% (50.4-68.9%), and 18.5% (4.0-33.0%), respectively, and those in postoperative groups C0-C3 were 82.1% (79.4-84.8%), 76.1% (72.2-80.3%), 57.6% (48.4-68.5%), and 16.8% (5.1-28.5%), respectively, with significant differences between each C0-C3 subgroup in both preoperative and postoperative cohorts. Multivariate analysis showed that preoperative (HR: 6.001, 95% CI: 3.523-10.221) and postoperative (HR: 8.149, 95% CI: 4.962-13.528) elevated tumor markers were independent risk factors for GC patients. The C-index for the combined use of tumor markers was 0.65-0.66, which was higher than that for using a single tumor marker (0.53-0.56).

CONCLUSION

The combined use of tumor markers significantly improved the prognostic value compared with using a single tumor marker. The survival prediction model including the combined tumor markers was accurate and effective.

A novel hematological classifier predicting chemotherapy benefit and recurrence hazard for locally advanced gastric cancer A multicenter IPTW analysis

BACKGROUND

Effective classifiers for the prediction of individual adjuvant chemotherapy (AC) benefits are scarce.

PURPOSE

This study aimed to construct a useful classifier to predict the AC benefit and recurrence hazard based on preoperative hematological indices through a multicenter database.

METHODS AND RESULTS

Multivariate analysis revealing GCRF (comprehensive deep learning classifier) as an independent prognostic factor associated with overall survival (OS) and disease-free survival (DFS). Locally advanced gastric cancer (LAGC) patients are categorized into the high-risk group (HRG) and low-risk group (LRG). In HRG, OS and DFS of the AC group are significantly higher than those of the non-AC group (all p˂0.05), whereas in LRG, OS and DFS of the AC group are comparable to those of the non-AC group (all p > 0.05). Furthermore, combined GCRF with 8th AJCC TNM staging system, only 650 (51.1%) patients can benefit most from AC among 1273 patients with pStage II-III. From the perspective of recurrence pattern, the recurrence rate of HRG is significantly higher than that of LRG in any recurrence type, including local recurrence, peritoneal recurrence, and distant recurrence (all p˂0.05). Furthermore, the mean time to peritoneal recurrence and lung metastasis in HRG is earlier than that in the LRG (p = 0.028 and 0.011, respectively).

CONCLUSION

In summary, our novel classifier based on deep learning preoperative hematological indices can predict not only the AC benefit of LAGC patients, but also the recurrence hazard after surgery. This classifier is expected to be an effective supplement to the 8th AJCC TNM staging system for the prediction of AC benefits and is helpful for clinical decision in AC individual administration. Further large-scale western studies are warranted.

Expression of Matrix Metalloproteinase-7 Predicts Poor Prognosis in Gastric Cancer

To date, no potential markers have been established for predicting prognosis in gastric cancer. Matrix metalloproteinase-7 (MMP-7) has been suggested as a prognostic marker in several cancers. In this study, we aimed to determine the expression of the MMP-7 protein and its polymorphisms in gastric cancer tissues. The association between MMP-7 expression level and clinicopathological characteristics was also evaluated. MMP-7 protein expression and its polymorphisms were investigated in a total of 400 patients using immunohistochemistry and TaqMan SNP genotyping assays. The correlation of MMP-7 expression with clinicopathological characteristics, including tumor location, tumor size, histologic type, lymphatic invasion, vascular invasion, pathological T stage, pathological TNM stage, residual tumor, and CEA level, was investigated. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a multivariate Cox proportional hazards regression model. MMP-7 expression was found in 283 of 400 (70.75%) gastric cancer tissues. Expression of MMP-7 was significantly associated with poor clinicopathological characteristics, including vascular invasion ( $\text{OR}=6.61$ , $95\%\text{CI}=4.26–9.89$ , $p=0.024$ ), lymphatic invasion ( $\text{OR}=8.17$ , $95\%\text{CI}=4.47–12.39$ , $p=0.017$ ), undifferentiated histologic type ( $\text{OR}=2.46$ ; 95% CI, 1.31–4.52; $p=0.014$ ), higher TNM stage (stage IV) ( $\text{OR}=1.48$ , $95\%\text{CI}=1.08–3.08$ , $p=0.047$ ), and high CEA level ( $\text{OR}=5.96$ , $95\%\text{CI}=2.12–8.12$ , $p=0.026$ ). We further observed a significant association of the variant genotype; gastric cancer patients carrying GG of MMP-7 (-181A/G; rs11568818) had a greater increased risk of MMP-7 expression than did wild-type (WT) carriers (AG: odds ratio $\left(\text{OR}\right)=5.67$ ; $95\%\text{CI}=1.57–7.23$ ; $p=0.024$ and GG: $\text{OR}=8.32$ ; $95\%\text{CI}=2.94–11.42$ ; $p=0.016$ ). These findings suggest that MMP-7 expression can be used to predict the prognosis of gastric cancer patients.

Clinical significance of tumor necrosis factor-alpha and carcinoembryonic antigen in gastric cancer

Tumour necrosis factor (TNF)-α plays an important role in inflammatory, infectious, and tumor processes, and it is closely related to the early stages of gastric cancer. It is a pro-inflammatory cytokine, produced not only by macrophages and monocytes but also by the lymphocytes, mast cells, neutrophils, keratinocytes, smooth muscle cells, and some tumor cell lines. Large amounts of TNF are released upon contact of macrophages, CD4 + T lymphocytes, and natural killer (NK) cells with lipopolysaccharides, bacterial products, and interleukin 1. TNF-alpha inducing protein (Tipa) is a unique carcinogenic factor of Helicobacter pylori, secreted into culture broth. The biological activities of TNF alpha and deletion mutant were studied. TNF alpha protein specifically binds to cell-surface nucleolin and then enters the gastric cancer cells, where TNF-a and chemokine gene expressions are induced by NF-jB activation. Nucleolin localizes on the surface of gastric cancer cells, and interaction between TNF alpha and cell-surface nucleolin causes a cancer-oriented microenvironment that increases the risk of gastric cancer. This paper discusses a mechanism of gastric cancer development and the clinical significance of tumor necrosis-alpha and carcinoembryonic antigen in gastric cancer.

Fluorescent imaging for cancer therapy and cancer gene therapy

The translation of laboratory science into effective clinical cancer therapy is gaining momentum more rapidly than any other time in history. Understanding cancer cell-surface receptors, cancer cell growth, and cancer metabolic pathways has led to many promising molecular-targeted therapies and cancer gene therapies. These same targets may also be exploited for optical imaging of cancer. Theoretically, any antibody or small molecule targeting cancer can be labeled with bioluminescent or fluorescent agents. In the laboratory setting, fluorescence imaging (FI) and bioluminescence imaging (BLI) have long been used in preclinical research for quantification of tumor bulk, assessment of targeting of tumors by experimental agents, and discrimination between primary and secondary effects of cancer treatments. Many of these laboratory techniques are now moving to clinical trials. Imageable engineered fluorescent probes that are highly specific for cancer are being advanced. This will allow for the identification of tumors for staging, tracking novel therapeutic agents, assisting in adequate surgical resection, and allowing image-guided biopsies. The critical components of FI include (1) a fluorescent protein that is biologically safe, stable, and distinctly visible with a high target to background ratio and (2) highly sensitive optical detectors. This review will summarize the most promising optical imaging agents and detection devices for cancer clinical research and clinical care.

Discovery of a novel and a rare Kristen rat sarcoma viral oncogene homolog (KRAS) gene mutation in colorectal cancer patients

Colorectal cancer (CRC) is one of the most important causes of morbidity and mortality in the developed world and is gradually more frequent in the developing world including Saudi Arabia. According to the Saudi Cancer Registry report 2015, CRC is the most common cancer in men (14.9%) and the second most prevalent cancer. Oncogenic mutations in the KRAS gene play a central role in tumorigenesis and are mutated in 30-40% of all CRC patients. To explore the prevalence of KRAS gene mutations in the Saudi population, we collected 80 CRC tumor tissues and sequenced the KRAS gene using automated sequencing technologies. The chromatograms presented mutations in 26 patients (32.5%) in four different codons, that is, 12, 13, 17, and 31. Most of the mutations were identified in codon 12 in 16 patients (61.5% of all mutations). We identified a novel mutation c.51 G>A in codon 17, where serine was substituted by arginine (S17R) in four patients. We also identified a very rare mutation, c.91 G>A, in which glutamic acid was replaced by lysine (E31K) in three patients. In conclusion, our findings further the knowledge about KRAS mutations in different ethnic groups is indispensable to fully understand their role in the development and progression of CRC.

Overexpression of CXCL8 gene in Saudi colon cancer patients

Colorectal cancer (CRC) is one of the leading causes of death in Saudi Arabia. CRC mostly affects older age groups, but now a days it also appears frequently at a young age. However, the complete genetic etiology of CRC remains unknown. To identify the genetic factors responsible for this cancer type and to search for biomarkers for early diagnosis and prevention, we collected sixteen CRC tumor tissue samples and six normal colon tissues and extracted mRNA and synthesized cDNA. We then performed microarray transcriptomic profiling of Saudi patients with colon cancer. Gene expression was analyzed using Partek Genomics Suite, and principal component analysis (PCA) was performed to separate the different clusters of colon cancer and healthy tissues. Distinct differences in gene expression profiles were observed between colon cancer and normal tissue samples. Subsequently, we validated gene expression using real-time PCR. We found that the C-X-C motif chemokine ligand 8 (CXCL8) gene was expressed most in CRC samples. CXCL8 expressed 25.6 folds more in CRC tissues than in healthy tissues. In conclusion, we found that CXCL8 is the chief biomarker gene that is expressed most in CRC and plays an important role in tumor progression and metastasis.

Clinical significance of novel identified high-frequency tumor-specific peptides associated signature in predicting disease status of gastric cancer patients

The effectively early detection and determination of disease progression of gastric cancer (GC) are still required. An emerging demand for identifying the novel targets adherent to cancer cells has been still challenged since those valuable profilings not only could act as for early gastric tumor discovery but also being potential therapeutic views. We have retrospectively analyzed GC biopsies to identify those specific target peptides in association with disease progression. We have detected the polypeptide by liquid mass technology initiated BIO-HIGH innovational assay technology for tumor-specific target peptide identification. We have validated the accessibility and feasibility of multiple target cytotoxic T-lymphocyte for the assessment of potential molecular markers by equally comparing the frequencies of tumor peptides' loci identified in 138 GC patients. The aim was to separate peripheral blood lymphocytes by density gradient centrifugation and use specific target peptides in in vitro culture of lymphocytes. The Cell Counting Kit-8 assay was set up to prove the lymphocytes' proliferation stimulated by identified peptides. Both of GC-specific peptide and shared peptide were detected in the peripheral blood, and the frequencies and quantities were correlated with disease status and cancer differentiation, in which BHGa1510 (78%), BHGa1310 (66%), BHGa0910 (57%), BHGa0310 (54%), BHGa0210 (40%), BHGa0810 (35%), BHGa0110 (33%), and BHGa1410 (30%) were apparently scoped out as high-frequency (HF) peptides could be potentially specific tumor markers. Moreover, BHGa1410 was significantly associated with cancer progression, and BHGa0910 and BHGa0210 were significantly associated with TNM stage. The IHC data have shown that both the HF BHGa1510 and HF BHGa1310 were expressions by 100% in contrast with paracancerous tissues of 40% (p < 0.05) and 33%, respectively (p < 0.05). Those specific peptide pools could be valued in assessment of advanced tumor and differential status in GC patients.

STROBE-clinical characteristics and prognosis factors of gastric cancer in young patients aged ≤30 years

We aimed to determine the clinical characteristics and prognosis factors of young patients with gastric cancer (GC).A total of 101 young patients with GC referred to Zhengzhou University People's Hospital, Henan province, China between January 1st, 2003 and June 1st, 2015 were retrospectively reviewed. The medical records included ages, genders, marital status, family history of tumors, comorbidity, Helicobacter pylori (H.pylori) infection, fibrinogen, prealbumin, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), tumor location, tumor size, TNM stage, differentiation of the tumor, WHO type, treatment method and prognostic factors effect were further assessed.The mean age of GC patients in our group was 26.0 years. The incidence was slightly higher in females (female: male = 1.1:1). Some patients had the family history of tumor and H.pylori infection (2.0%, 6.9%). The tumor sizes were mainly under 5 cm (52.4%) and the most locations were in the antrum (43.5%) and body (42.5%). A large number of patients were diagnosed as adenocarcinomas (66.3%) and the main histological of GC was poor differentiated (72.3%). Moreover, a high proportion of patients were diagnosed at the stages III-IV (61.4%), and most patients received surgery combined chemotherapy (63.4%), however, the survival outcome was poor. In univariate Cox analysis, tumor sizes, TNM stage were significantly associated with overall survival (OS) and the multivariate Cox analysis demonstrated that TNM stage was significantly associated with OS.GC in young patients has its unique biological and clinical features. A large majority of young patients were diagnosed at their advanced stages with poor prognostic. TNM stage was an independent prognostic factor for young patients with GC, early GC screening in young people should be actively promoted.

The significance of preoperative serum carcinoembryonic antigen levels in the prediction of lymph node metastasis and prognosis in locally advanced gastric cancer: a retrospective analysis

Background

In this study, we aimed to investigate the preoperative serum carcinoembryonic antigen (CEA) in the diagnosis of positive lymph node metastasis (LNM), and to evaluated the relationship between CEA and survival in patients with locally advanced gastric cancer (LAGC).

Methods

The significance of the preoperative serum CEA level for the diagnose of LAGC and prediction of LNM was determined using the receiver operating characteristic (ROC) curve. The areas under the ROC of CEA were compared with those of other tumor markers or imaging examination including CT and MRI. Logistic regression was utilized to identify the risk factors predicting positive LNM. Independent prognosis factors were evaluated using univariate and multivariate COX regression analyses.

Results

The ROC curves showed that the AUCs of CEA, CA199, and CA125 for diagnosing LAGC were 0.727, 0.594, and 0.566. When used to predict LNM, the AUC of CEA, CA199 and CA125 were 0.696, 0.531, and 0.588. Logistic regression analysis demonstrated that preoperative serum CEA were significantly associated with positive LNM. On combining imaging examination with CEA, the sensitivity and specificity were 85.3 and 79.4%, respectively, with the AUC equal to 0.853. The combination of CEA and imaging examination preformed the highest levels of AUC and sensitivity for diagnosing LNM, which is significantly higher than using either of them alone. Although patients with abnormal CEA have a poor prognosis, two models of multivariate analysis showed that CEA was not the independent prognosis factor for survival.

Conclusions

CEA can be used to diagnose gastric cancer and determine whether it has LNM. Moreover, combined with CEA could improve the diagnostic sensitivity of imaging examination for lymph node involvement.

Clinical significance of serum tumor markers for advanced gastric cancer with the first-line chemotherapy

Background

Tumor markers play an important role in the diagnosis, monitoring and prognostic prediction of cancers. But the predictive value of serum tumor markers in gastric cancer is still unclear.

Methods

In this study, we detected serum levels of tumor markers to evaluate their relation to treatment response and prognosis in patients with unresectable advanced or metastatic gastric cancer.

Results

We collected the clinical data of 109 patients with unresectable advanced or metastatic gastric cancer who had received the first-line chemotherapy in Peking University Cancer Hospital from July 2013 to May 2015, and collected the value of serum carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), carbohydrate antigen 72.4 (CA72.4) and carbohydrate antigen 125 (CA125) before and after chemotherapy. At diagnosis, the positive rates of CEA, CA199, CA72.4 and CA125 were 46.8%, 40.2%, 53.5% and 35.0%, respectively. And the positive rate of combined detection of the four markers was 87.2%. Although patients with prechemotherapy CA199 ≥80 U/mL (92.3% vs. 68.5%, P=0.016) or CA72.4 ≥20 U/mL (91.4% vs. 62.5%, P=0.003) had higher clinical benefit rate after chemotherapy, they showed poorer prognosis (P=0.023 and P=0.006, respectively). CA72.4 ≥20 U/mL was an independent unfavorable prognostic factor (Hazard Ratio 4.84; 95% confidence interval: 1.910–12.262; P=0.001). In patients with increased levels of tumor markers before treatment, the levels of tumor markers decreased after chemotherapy, especially in those with clinical benefit (CEA, CA72.4 reached statistical significance, P=0.013 and P=0.029, respectively). A decrease of CEA ≥35%, CA199 ≥30%, or CA72.4 ≥40% after chemotherapy had positive prediction value for the response to chemotherapy (P=0.016, P=0.029, and P=0.008, respectively).

Conclusions

The results showed that both high pre-chemotherapy serum levels of tumor markers (CA199 ≥80 U/mL or CA72.4 ≥20 U/mL) and a substantial decrease in tumor markers after chemotherapy (CEA ≥35%, CA199 ≥30%, or CA72.4 ≥40%) could predict a higher clinical benefit rate in patients with unresectable advanced or metastatic gastric cancer. However, this advantage in short-term response to chemotherapy failed to convert into prolonged survival benefits.

Carcinoembryonic antigen carrying SLeX as a new biomarker of more aggressive gastric carcinomas

Malignant transformation of gastric cells is accompanied by the deregulated expression of glycosyltransferases leading to the biosynthesis of tumor-associated glycans such as the sialyl-Lewis X antigen (SLe^x). SLe^x presence on cell surface glycoconjugates increases the invasive capacity of gastric cancer cells and is associated with tumor metastasis. ST3Gal IV enzyme is involved in the synthesis of SLe^x antigen and overexpressed in gastric carcinomas. Herein, we identified the glycoproteins carrying SLe^x in gastric cancer cells overexpressing ST3Gal IV enzyme and evaluated their biomarker potential for gastric carcinoma.

Methods: SLe^x modified glycoproteins were identified applying western blot and mass spectrometry. Immunoprecipitation, proximity ligation assay (PLA), E-selectin binding assay and CRISPR/cas9 knockout experiments were performed to characterize the presence of SLe^x on the identified glycoprotein. Protein N-glycans of the SLe^x protein carrier were in deep analyzed by porous-graphitized-carbon liquid-chromatography and tandem mass spectrometry glycomics. In silico expression analysis of α2-3 sialyltransferase ST3Gal IV and SLe^x protein carrier was performed and the conjoint expression of the SLe^x modified glycoproteins evaluated by immunohistochemistry and PLA in a series of gastric carcinomas.

Results: Carcinoembryonic antigen (CEA; CEACAM5) was identified and validated by different methodologies as a major carrier of SLe^x. N-glycomics of CEA revealed that complex N-glycans are capped with α2-3 linked sialic acid (Neu5Acα2-3Galβ1-4GlcNAc). Data set analysis of ST3Gal IV and CEA showed that ST3Gal IV expression was associated with patient´s poor survival, whereas CEA did not show any prognostic value. The co-expression of both CEA and SLe^X was observed in 86,3% of gastric carcinoma cases and 74,5% of the total cases displayed the conjoint CEA+SLe^xin situ PLA expression. This expression was associated with clinicopathological features of the tumors, including infiltrative pattern of tumor growth, presence of venous invasion and patient's poor survival. CEA immunoprecipitation from gastric carcinoma tissues also confirmed the presence of SLe^x.

Conclusion: CEA is the major glycoprotein carrying SLe^x in gastric carcinoma and the conjoint detection of CEA-SLe^x is associated with aggressive tumor features highlighting its PLA detection as a biomarker of gastric cancer patient prognosis for theranostic applications.

Expression of serum tumor markers in gastric cancer with different degrees of differentiation: Significance for monitoring tumor recurrence

BACKGROUND

Carcinoembryonic antigen (CEA), cancer-associated carbohydrate antigen (CA) 19-9, and CA72-4 are three serum tumor markers that are widely used by clinicians for auxiliary diagnosis and assessment of prognosis of gastric cancer, but their clinical significance in advanced gastric cancer with different differentiation degrees is still controversial and requires the support of strong evidence of evidence-based medicine and in-depth study.

AIM

To analyze the differential expression of CEA, CA19-9, and CA72-4 in the serum of patients with different pathological types of advanced gastric cancer.

METHODS

A retrospective analysis was performed of clinical parameters, serum tumor markers, and prognosis data of 111 patients with gastric cancer who were admitted for initial diagnosis and tumor recurrence at Zhengzhou University from January 2013 to October 2017.

RESULTS

The positive rates of CEA, CA19-9, and CA72-4 at the initial diagnosis were significantly higher in the moderately differentiated group than in the poorly differentiated group and the signet ring cell carcinoma and mucinous adenocarcinoma group (χ² = 6.821, P = 0.033; χ² = 10.748, P = 0.005; χ² = 9.188, P = 0.010). A similar trend was observed in case of tumor recurrence (χ² = 7.334, P = 0.026; χ² = 10.700, P = 0.005; χ² = 9.303, P = 0.010). The differences between the first postoperative test values and the values at tumor recurrence were significantly higher in poorly differentiated cases (F = 4.175, P = 0.022; F = 4.167, P = 0.022; F = 5.801, P = 0.006).

CONCLUSION

The worse the degree of differentiation, the weaker the expression of serum CEA, CA19-9, and CA72-4, but the positive expression value is higher. These three tumor markers in poorly differentiated adenocarcinoma have lower clinical value in the auxiliary diagnosis and evaluation of tumor recurrence than in moderately differentiated adenocarcinoma.

Prognostic significance of perioperative tumor marker levels in stage II/III gastric cancer

AIM

To evaluate the prognostic significance of perioperative carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels in stage II/III gastric cancer.

METHODS

From a multi-institutional retrospective database compiled by integrating clinical data from nine institutions, data of 998 patients who underwent curative resection for stage II/III gastric cancer between 2010 and 2014 were retrieved and analyzed. The prognostic impact of the preoperative and postoperative levels and chronological changes in CEA, CA19-9 and their combination were evaluated. To test whether postoperative adjuvant chemotherapy alters the prognostic impact of perioperative CEA and CA19-9 levels, the hazard ratios for mortality were compared between patients who underwent surgery alone and patients who underwent surgery followed by adjuvant chemotherapy.

RESULTS

The prognostic impact of postoperative CEA and CA19-9 was superior to that of the preoperative levels. Multivariable analysis identified high postoperative CEA and CA19-9 levels as independent prognostic factors for overall survival. Disease-free survival rates clearly decreased in a stepwise manner in association with postoperative CEA and CA19-9 levels, and patients with high levels of both markers showed significantly poorer prognosis than other patient groups. When we analyzed perioperative changes in serum CEA and CA19-9 levels, patients with high levels before and after surgery had the worst disease-free survival rates among all patient groups. Patients with normalized CEA levels after surgery had a significantly lower disease-free survival rate than those with normal perioperative levels, whereas patients with normalized CA19-9 levels after surgery had equivalent survival to those with normal perioperative levels. The prognostic impact of high CEA levels was observably smaller in patients who underwent adjuvant chemotherapy than in patients who underwent surgery alone, whereas that of high CA19-9 was greater in patients who underwent adjuvant chemotherapy. High postoperative CEA levels were significantly associated with an increased prevalence of liver, lung and bone recurrences, and high postoperative CA19-9 levels were significantly associated with increased frequencies of lymph node and liver recurrences.

CONCLUSION

The evaluation of serum CEA and CA 19-9 levels both before and after surgery provides useful information for precise risk stratification after curative gastrectomy.

Preoperative globulin-to-albumin ratio predicts outcome after curative resection in patients with gastric cancer

AIM

The globulin-to-albumin ratio (GAR) is useful for prognostication of patients with various cancers. However, the significance of GAR in gastric cancer (GC) remains unclear. Our purpose was to investigate the relationship between the GAR and outcome after curative resection in GC patients.

METHODS

Three-hundred and seventy-six patients who had undergone curative resection for GC were retrospectively reviewed. Univariate and multivariate analyses using the Cox proportional hazard model were performed to detect clinical characteristics that correlated with overall survival (OS), and their cut-off values were identified using receiver operating characteristic (ROC) curve analyses. Kaplan-Meier analysis and log-rank test were used for comparison of OS and relapse-free survival (RFS).

RESULTS

Multivariate analysis using 17 clinical characteristics selected by univariate analyses revealed that GAR (>0.80/≤0.80) was significantly associated with OS (hazard ratio [HR], 2.305; 95% CI, 1.122-4.735; P = 0.023), as well as lymph node metastasis (presence/absence) (HR, 2.417; 95% CI, 1.077-5.426; P = 0.032), neutrophil-to-lymphocyte ratio (>2.7/≤2.7) (HR, 2.368; 95% CI, 1.138-4.930; P = 0.002), and serosal invasion (presence/absence) (HR, 3.443; 95% CI, 1.048-11.31; P = 0.042). Kaplan-Meier analysis and log-rank test demonstrated that the OS and RFS of patients with a high GAR (>0.80) were significantly poorer than those with low GAR (≤0.80).

CONCLUSIONS

The GAR is a useful predictor of postoperative outcome among GC patients undergoing curative resection.

Prognostic values of normal preoperative serum cancer markers for gastric cancer

We examined the prognostic value of normal levels of four serum cancer markers, carcinoembryonic antigen (CEA), carbohydrate associated antigen (CA19-9), alpha-fetoprotein (AFP) and cancer antigen 125 (CA125), in gastric cancer patients. Among 1927 gastric cancer patients enrolled in this study, 1477 were male (76.6%) and 450 were female (23.4%). The median age was 57 years (range 20-86). Clinicopathological features and survival times were recorded, and the association between CEA, CA19-9, AFP, and CA125 levels and patient prognosis was analyzed. The optimal cut-off values were 0.71 for CEA (P=0.317), 9.22 for CA19-9 (P=0.009), 3.76 for AFP (P=0.008) and 15.65 for CA125 (P=0.006). Serum CA19-9 levels correlated with gender, age, and tumor depth (all P<0.05); AFP levels correlated with pathological type (P=0.005); and CA125 levels correlated with gender, tumor size, pathological type, tumor depth and lymph node metastasis (all P<0.05). Relatively high levels of CA19-9, AFP and CA125, still within the normal range, were all associated with poor prognosis (5-year overall survival: 70.6% vs 64.2%, P<0.001. 69.6% vs 54.5%, P=0.011. 70.2% vs 54.9%, P<0.001). However, only CA19-9 and AFP levels were independent prognostic predictors. We conclude that the combined assessment of CA19-9, AFP and CA125 levels could have prognostic value in gastric cancer (P<0.001).

Prognostic significance of pretreatment serum carcinoembryonic antigen levels in gastric cancer with pathological lymph node-negative: A large sample single-center retrospective study

AIM

To assess whether elevated serum carcinoembryonic antigen (CEA) is in the inferior prognosis for pathological lymph node-negative (pN₀) gastric cancer (GC) patients who underwent D₂ gastrectomy.

METHODS

About 469 pN₀ GC patients, who received D₂ radical gastrectomy were retrospectively analyzed. The X-tile plots cut-off point for CEA were 30.02 ng/mL using minimum P-value from log-rank χ² statistics, and pN₀ GC patients were assigned to two groups: those more than 30.02 ng/mL (n = 48; CEA-high group) and those less than 30.02 ng/mL (n = 421; CEA-low group). Clinicopathologic characteristics were compared using Pearson's χ² or Fisher’s exact tests, and survival curves were so manufactured using the Kaplan-Meier method. Univariate and multivariate analysis were carried out using the logistic regression method.

RESULTS

The percentage of vessel carcinoma embolus (31.35% vs 17.1%) and advanced GC (T_2-4b) (81.25% vs 65.32%) were higher in CEA-high group than CEA-low group. The CEA-positive patients had a significantly poorer prognosis than the CEA-nagetive patients in terms of overall survival (57.74% vs 90.69%, P < 0.05), and no different was found between subgroup of T category, differentiation, nerve invasion, and vessel carcinoma embolus (all P > 0.05). Multivariate survival analysis showed that CEA (OR = 4.924), and T category (OR = 2.214) were significant prognostic factors for stage pN₀ GC (all P < 0.05). Besides, only T category (OR = 1.962) was an independent hazard factor in the CEA-high group (P < 0.05).

CONCLUSION

Those pretreatment serum CEA levels over 30.02 ng/mL on behalf of worse characteristics and unfavourable tumor behavior, and a poor prognosis for a nearly doubled risk of mortality in GC patients.

Serum CEA level lost its prognostic value in gastric cancer patients with AB blood type

BACKGROUND

Little is known about the relationship between ABO blood groups and serum CEA level in gastric cancer patients. The aim of this study was to investigate the prognostic value of serum CEA level in gastric cancer patients with different ABO blood types.

MATERIALS AND METHODS

From September 2008 to April 2015, a total of 3234 gastric cancer patients who underwent radical gastrectomy were retrospectively analyzed in our institution. The clinicopathological characteristics and survivals were recorded. The prognostic value of serum CEA level within different ABO blood groups were analyzed.

RESULTS

The ratio of male to female patients was 3.5:1. The median age was 57.4 years (range 20-87). In all, 980 cases (30.3%) were blood type A, 935 cases (28.9%) were blood type B, 331 cases (10.2%) were blood type AB and 988 cases (30.6%) were blood type O. The positive rate of preoperative serum CEA was 19.0%. The overall survival of patients with negative and positive CEA level were 60.2% vs 34.4% for A blood type (P<0.001), 63.6% vs 44.5% for B blood type (P<0.001), 64.7% vs 36.2% for O blood type (P<0.001), 59.9% vs 46.1% for AB blood type (P=0.210). Serum CEA level was an independent prognostic factor for patients with A, B, O blood type (all P<0.05). However, serum CEA level was not a prognostic factor for patients with AB blood type (P=0.898). The level of CEA were significantly associated with gender, tumor size, tumor location, differentiation degree, tumor depth and lymph node metastasis in patients with AB blood type (all P<0.05).

CONCLUSIONS

Serum CEA was an independent prognostic factor in gastric cancer patients with non-AB blood type, but lost its prognostic value in patients with AB blood type.

Diagnostic and prognostic value of CEA, CA19-9, AFP and CA125 for early gastric cancer

Background

The diagnostic and prognostic significance of carcinoembryonic antigen (CEA), carbohydrate associated antigen 19–9 (CA19–9), alpha-fetoprotein (AFP) and cancer antigen 125 (CA125) in early gastric cancer have not been investigated yet. Thus, the present study aimed to explore the diagnostic and prognostic significance of the four tumor markers for early gastric cancer.

Methods

From September 2008 to March 2015, 587 early gastric cancer patients were given radical gastrectomy in our center. The clinicopathological characteristics were recorded. The association between levels of CEA and CA19–9 and clinicopathological characteristics and prognosis of patients were analyzed.

Results

There were 444 men (75.6%) and 143 women (24.4%). The median age was 57 years (ranged 21–85). The 1-, 3- and 5-year overall survival rate was 99.1%, 96.8% and 93.1%, respectively. The positive rate of CEA, CA19–9, AFP and CA125 was 4.3%, 4.8%, 1.5% and 1.9%, respectively. The positive rate of all markers combined was 10.4%. The associations between the clinicopathological features and levels of CEA and CA19–9 were analyzed. No significant association was found between CEA level and clinicopathological features. However, elevated CA19–9 level was correlated with female gender and presence of lymph node metastasis. Age > 60 years old, presence of lymph node metastasis and elevation of CEA level were independent risk factors for poor prognosis of early gastric cancer.

Conclusions

The positive rates of CEA, CA19–9, APF and CA125 were relatively low for early gastric cancer. Elevation of CA19–9 level was associated with female gender and presence of lymph node metastasis. Elevation of CEA level was an independent risk factor for the poor prognosis of early gastric cancer.

Blood type AB predicts promising prognosis in gastric cancer patients with positive preoperative serum CEA

Little is known about association between ABO blood groups and tumor markers in gastric cancer (GC) patients. The aim of the present study was to assess the prognostic value of ABO blood groups in GC patients with different levels of preoperative serum carcinoembryonic antigen (CEA).From September 2008 to April 2015, a total of 3234 GC patients who received radical gastrectomy were retrospectively analyzed. The clinicopathological characteristics including ABO blood groups and preoperative CEA were recorded. The prognostic value of ABO blood groups within different levels of serum CEA was analyzed.Overall, the ratio of male to female patients was 3.5:1; the median age was 57.4 years (range 20-87). The median overall survival (OS) for GC patients with blood type A, B, AB, and O were 52.6, 52.8, 53.8, and 53.6 months, respectively. There was no significant difference for the survival of patients among the 4 groups (P = .736). Also, no significant difference was found among the OS of the 4 blood types with negative (P = .875) and positive (P = .131) preoperative serum CEA. Further, we found that the OS of patients with positive preoperative serum CEA and blood type AB was significantly higher than that with blood type non-AB (P = .026). For patients with positive preoperative serum CEA, multivariate analysis showed that ABO blood groups were an independent prognostic factor.Blood type AB was a favorable prognostic factor for GC patients with positive preoperative serum CEA.

Stage Association of Preoperative Serum Carcinoembryonic Antigen with Gastric Adenocarcinoma in Iranian Patients

Background:

Gastric cancer is the second leading cause of cancer-related mortality and the fourth most common cancer globally. Tumor markers are needed for appropriate management and monitoring of treatment to improve quality of life. Recently, carcinoembryonic antigen (CEA) has been widely used as a tumor marker in the diagnosis and follow-up of some malignancies. The aim of this study was to evaluate the significance of CEA detection in the course of disease in gastric cancer patients at different stages.

Methods:

Seventy six cases of gastric adenocarcinoma from the Rasht Razi Hospital were studied between January 2016 and December 2016, along with a control group of 152 people. Serum CEA was measured by ELISA reader. Statistical analysis was performed using SPSS 14.0 for Windows (SPSS Inc., Chicago, USA). The two groups were also compared by cross-table analysis using Pearson’s chi-square test, with P-values <0.05 considered significant.

Results:

CEA was positive in 61.8 % of patients versus 2.6% of the control group (P = 0.0001). Some 21% of patients at stages I and II (initial disease) and 40.8% at stages III and IV (advanced disease) demonstrated positive CEA. which was significantly correlated with higher N stage and poor differentiation.

Conclusions:

Our study showed that a high preoperative CEA level was not prevalent in early stage gastric cancer patients. We recommend to design other prospective studies and meta-analyses for elucidation of claims for diagnostic efficacy.

Preoperative serum CEA and CA19-9 in gastric cancer--a single tertiary hospital study of 1,075 cases

To evaluate the clinical impact of preoperative serum CEA and CA19-9 on resectable gastric cancer (GC), a total of 1,075 consecutive cases with gastric adenocarcinoma were obtained retrospectively from January 2012 and December 2013 in a single tertiary hospital, and the relationships between serum CEA, CA19-9 and clinicopathologic features were investigated. Positive preoperative serum rates of CEA and CA19-9 were 22.4% and 12.3% respectively, levels significantly correlating with each other and depth of invasion, lymph node involvement, pTNM and stage. The CEA level also presented a remarkable association with lymphovascular invasion. Both CEA and CA19-9 positivity significantly and positively correlated with depth of invasion, nodal involvement, pTNM stage, lymphovascular invasion, tumor size and tumor location. Stratified analyses according to gender or tumor location showed preoperative CEA or CA19-9 had different associations with clinicopathologic features in different gender subgroups or location subgroups. Preoperative serum CA19-9 positivity may be more meaningful for tumor size rather than CEA. In conclusion, preoperative serum CEA and CA19-9 correlate with disease progression of GC, and may have applications in aiding more accurate estimation of tumor stage, decision of treatment choice and prognosis evaluation.

Prognostic Significance of Carcinoembryonic Antigen Staining in Cancer Tissues of Gastric Cancer Patients

PURPOSE

The aim of this study was to assess the significance of the correlation among tissue carcinoembryonic antigen (CEA) expression with serum CEA (sCEA) levels and long-term survival to highlight the clinical prognostic significance of tissue CEA expression in gastric cancer patients.

METHODS

Immunohistological method and radioimmunoassay were used to assess tissue and sCEA expression, respectively. Univariate and multivariate analyses were performed to determine correlations, and the Kaplan-Meier method was used to investigate the prognostic significance.

RESULTS

Our results demonstrate that tissue CEA in gastric cancer is significantly correlated with preoperative sCEA levels (p = 0.031), depth of invasion (p = 0.001), lymph node metastasis (p < 0.001), distant metastasis (p = 0.001), and TNM staging (p < 0.001). The 5-year survival rates were 67.6, 53.9, and 40.1 % for negatively, moderately, and intensely positively stained tissues (p < 0.001), and 57.0 and 37.9 % for serum with normal and elevated CEA expression (p = 0.031). Multivariate analysis revealed that tissue CEA can be considered an independent prognostic factor. Further analysis illustrated that patients with negative expression in both tissue and serum had better prognosis compared with those positively expressing CEA in both tissue and serum and/or those positively expressing CEA in either tissue or serum (p < 0.001). Our results also demonstrated that patients with negative tissue CEA staining and elevated sCEA expression had a better 5-year survival.

CONCLUSION

Tissue CEA expression in gastric cancer is directly correlated with sCEA levels and long-term prognosis. Thus, tissue CEA expression can be considered as a useful biomarker to improve the interpretation of sCEA levels in predicting long-term survival.

Prognostic value of preoperative serum tumor markers in gastric cancer

AIM: To evaluate the prognostic value of preoperative carcinoembryonic antigen (CEA), carbohydrate antigen (CA)19-9, and CA50 in patients undergoing D2 resection.

METHODS: We evaluated 363 patients with gastric cancer who underwent gastrectomy at our hospital from January 2006 to December 2009. Blood samples were obtained from each patient within 1 wk before surgery. The cut-off values for serum CEA, CA19-9, and CA50 were 5 ng/mL, 37 U/mL, and 20 U/mL, respectively. The correlation between preoperative tumor marker levels and prognosis was studied by means of univariate and multivariate analyses.

RESULTS: The preoperative serum positive rates of CEA, CA19-9 and CA50 were 24.0%, 18.9% and 24.5%, respectively. The positivity rate of serum CEA was significantly correlated with age (P < 0.001), sex (P = 0.022), tumor size (P = 0.007) and depth of invasion (P = 0.018); CA19-9 with tumor size (P = 0.042) and lymph node metastasis (P < 0.001); and CA50 only with lymph node metastasis (P = 0.001). In multivariate analysis, tumor size, T category, N category, vascular or neural invasion, and adjuvant chemotherapy were independent prognostic factors for overall survival. CA19-9 had an independent prognostic significance in patients without adjuvant chemotherapy (P = 0.027).

CONCLUSION: Preoperative serum CEA, CA19-9 and CA50 are prognostic in patients with gastric cancer. Only CA19-9 is an independent prognostic factor after surgery without adjuvant chemotherapy.

Comparative study of CEA and CA19-9 in esophageal, gastric and colon cancers individually and in combination (ROC curve analysis)

OBJECTIVE

To determine the clinical serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), individually and in combination, for the diagnosis of 50 healthy subjects and 150 cases of esophageal, gastric, and colon cancers.

METHODS

The sensitivities of the two markers were compared individually and in combination, with specificity set at 100%. Receiver operating characteristic (ROC) curves were plotted.

RESULTS

Serum CEA levels were significantly higher in cancer patients than in the control group. The sensitivity of CEA was determined: in esophageal cancer, sensitivity=28%, negative predictive value (NPV)=61.72%, and AUC=0.742 
(SE=0.05), with a significance level of P<0.0001; in gastric cancer, sensitivity=30%, NPV=58.82%, and AUC=0.734 (SE=0.05), with a significance level of P<0.0001; in colon cancer, sensitivity=74%, NPV=79.36%, and AUC=0.856 
(SE=0.04), with a significance level of P<0.0001. The sensitivity of CA19-9 was also evaluated: in esophageal cancer, sensitivity=18%, NPV=54.94%, and AUC=0.573 (SE =0.05), with a significance level of P=0.2054. In gastric cancer, sensitivity=42%, NPV=63.29%, and AUC=0.679 (SE =0.05), with a significance level of P<0.0011. In colon cancer, sensitivity=26%, NPV=57.47%, and AUC=0.580 (SE =0.05), with a significance level of P=0.1670. The following were the sensitivities of CEA/CA19-9 combined: in esophageal cancer, sensitivity=42%, NPV=63.29%, SE=0.078 (95% CI: 0.0159-0.322); gastric cancer, sensitivity=58%, NPV=70.42%, SE=0.072 (95% CI: -0.0866-0.198); and colon cancer, sensitivity=72%, NPV=78.12%, SE=0.070 (95% CI: 0.137-0.415).

CONCLUSION

CEA exhibited the highest sensitivity for colon cancer, and CA19-9 exhibited the highest sensitivity for gastric cancer. Combined analysis indicated an increase in diagnostic sensitivity in esophageal and gastric cancer compared with that in colon cancer.

The prognosis of gastric cancer patients with marginally elevated carcinoembryonic antigen (CEA) values after D2 radical gastrectomy

AIM

To investigate the clinical significance of the postoperative serum carcinoembryonic antigen (CEA) levels in gastric cancer patients who underwent D2 radical gastrectomy and to identify the prognostic factors for patients with marginally elevated postoperative CEA levels.

METHODS

We performed a retrospective study of 480 patients who were histologically diagnosed with gastric cancer and who underwent D2 radical surgery at the Sun Yat-sen University Cancer Center between January 2004 and December 2009. The follow-up lasted until June 2011. Chi-squared tests and Kaplan-Meier methods were employed to compare the adverse events and prognoses.

RESULTS

In this group of gastric cancer patients, the postoperative serum CEA level (P = 0.002) was an independent prognostic factor; the same was true for the histological T and N staging (P < 0.001 and P = 0.045, respectively). In the group of marginally elevated postoperative CEA level gastric cancer patients, univariate analysis demonstrated that tumor position (P = 0.042); histological grade (P = 0.002); and Boarrmann type (P = 0.003) were significant prognostic factors. Multivariate analysis showed that the tumor position (P = 0.003) and histological grade (P = 0.007) were independent prognostic factors for these patients.

CONCLUSION

Our study showed that patients with normal postoperative CEA levels have a better prognosis. Furthermore, for marginally elevated postoperative CEA level gastric cancer patients, the tumor position and histological grade were two important factors for predicting the prognosis and the need for aggressive therapy.

Normal carcinoembryonic antigen indicates benefit from perioperative chemotherapy to gastric carcinoma patients

AIM: To evaluate pretreatment serum carcinoembryonic antigen (CEA) as a predictor of survival for patients with locally advanced gastric cancer receiving perioperative chemotherapy.

METHODS: We retrospectively studied a cohort of 228 gastric cancer patients who underwent D2 gastrectomy combined with chemotherapy at the Sun Yat-sen University Cancer Center between January 2005 and December 2009. Among them, 168 patients received 6-12 cycles of oxaliplatin-based adjuvant (post-operative) chemotherapy, while 60 received perioperative chemotherapy (2 cycles of FOLFOX6 or XELOX before surgery and 4-10 cycles after surgery). Serum CEA was measured using an enzyme immunoassay. The follow-up lasted until December 2010.

RESULTS: In the group that had elevated serum CEA, the difference in survival time between patients receiving perioperative chemotherapy and those receiving adjuvant chemotherapy had no statistical significance (P > 0.05). However, in the group that had normal serum CEA, patients receiving perioperative chemotherapy had a longer survival time. In multivariate analysis, T staging and lymph node metastatic rate were independent prognostic factors for the patients. Perioperative chemotherapy improved the overall survival of patients who had a normal pretreatment CEA level (P = 0.070).

CONCLUSION: Normal pretreatment serum CEA is a predictor of survival for patients receiving perioperative chemotherapy.

Prognostic factors of second and third line chemotherapy using 5-fu with platinum, irinotecan, and taxane for advanced gastric cancer

Purpose

The aims of this study are to find out whether the sequence of chemotherapeutic regimens including second- and third-line taxane and irinotecan influences the survival of patients with unresectable gastric carcinoma and to identify clinical characteristics of patients with improved response.

Materials and Methods

Fifty gastric carcinoma patients who were treated by third-line sequential chemotherapy between November 2004 and July 2010 were enrolled in this study. Their overall survival (OS) and time to progression (TTP) were set up as primary and secondary end points. For the sequence of chemotherapy regimen, two arms were used. Arm A was defined as 5-fluorouracil (5-FU)+cisplatin (FP) or folinic acid, 5-FU and oxaliplati (FOLFOX), followed by folinic acid, 5-FU and irinotecan (FOLFIRI), and paclitaxel or docetaxel plus 5-FU, with or without epirubicin. Arm B was defined as FP or FOLFOX, followed by paclitaxel or docetaxel plus 5-FU, and FOLFIRI.

Results

The median OS of all patients was 16.0 months (95% confidence interval, 13.6 to 18.3 months), which is longer than historical control of patients who did not receive third-line chemotherapy. The sequence of second and third-line regimen, including irinotecan and taxane, did not present significant difference in OS or TTP after failure of 5-FU with platinum chemotherapy. In survival analysis of patients' clinicopathologic characteristics, poor prognosis was shown in patients with poorly differentiated histologic features, elevated serum carcinoembryonic level, and shorter TTP of first line chemotherapy.

Conclusion

It is possible for patients to respond differently to chemotherapy due to differences in clinical features and underlying gene expression profiles. Development of individualized chemotherapy regimens based on gene expression profiles is warranted.

A prognostic model to predict clinical outcome in gastric cancer patients with bone metastasis

BACKGROUND

The clinicopathological manifestations and treatment outcomes of bone metastasis of gastric cancer are largely unknown. We delineated a prognostic model to identify different risk groups on the basis of clinical parameters.

METHODS

Patients who had bone metastasis at the time of diagnosis of gastric cancer (synchronous metastasis) or who developed bone metastasis during follow-up (metachronous metastasis) were retrospectively reviewed from January 1998 to May 2008.

RESULTS

Bone metastasis was identified in 203 (2.4%) of 8,633 patients: 126 patients (62%) with synchronous metastasis and 77 patients with metachronous metastasis. The median time to event was 16 months (range 4-87). As for treatment, 120 patients (59%) received systemic chemotherapy. The median survival time was 103 days (95% CI 80-126). Poor performance status [Eastern Cooperative Oncology Group 3-4; relative risk (RR) = 1.91, p = 0.011], multiple bone metastasis (RR = 2.593, p = 0.002), and abnormal carcinoembryonic antigen (RR = 1.779, p = 0.004) implied independent factors for survival. For patients who had zero to two of these factors identified, chemotherapy had a beneficial effect (175 vs. 43 days; p < 0.0001).

CONCLUSION

We recommend that the therapeutic approach with bone metastasis be customized to facilitate the risk stratification, so as to consequently provide the most appropriate therapy for each patient.