Preoperative Tumor Markers Independently Predict Survival in Stage III Gastric Cancer Patients: Should We Include Tumor Markers in AJCC Staging?

Jian Xian Lin, Wei Wang, Jun Peng Lin, Jian Wei Xie, Jia bin Wang, Jun Lu, Qi Yue Chen, Long long Cao, Mi Lin, Ruhong Tu, Chao Hui Zheng, Chang Ming Huang, Zhi wei Zhou, Ping Li

    Research output: Contribution to journalArticle

    7 Scopus citations

    Abstract

    Objective: The aim of this study was to determine the prognostic significance of preoperative carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels in patients with resectable gastric cancer (GC). Patients and Methods: Patients who underwent a radical resection for GC at the Fujian Medical University Union Hospital between 2007 and 2014 were included in this study. The estimated area under the curve (AUC) was compared to evaluate the discriminatory ability of tumor makers. Additional external validation was performed using a dataset from Sun Yat-sen University Cancer Center. Results: Preoperative CEA/CA19-9 levels were identified as an independent predictor of overall survival (OS) and disease-specific survival (DSS) (both p < 0.05) in the development group. In a subgroup analysis based on TNM stage, preoperative CEA/CA19-9 levels clearly stratified the survival rates for stage III GC (p < 0.05). A multivariate analysis revealed that preoperative CEA/CA19-9 levels were an independent prognostic factor (p < 0.05) in stage III; the AUC of the preoperative CEA/CA19-9 was equivalent to that of T stage. A prediction model (TNMC) for stage III GC was developed by incorporating preoperative CEA/CA19-9 levels into the American Joint Committee on Cancer (AJCC) staging system. The AUC of the TNMC was significantly higher than that of the TNM staging system at 1, 3, and 5 years postoperatively (all p < 0.05), with similar results also being obtained in the external validation set. Conclusion: Preoperative CEA/CA19-9 levels are an independent predictor of OS and DSS in stage III GC patients. The inclusion of preoperative CEA/CA19-9 levels in AJCC TNM staging provided an optimal prognosis in stage III GC.

    Original languageEnglish (US)
    Pages (from-to)2703-2712
    Number of pages10
    JournalAnnals of surgical oncology
    Volume25
    Issue number9
    DOIs
    StatePublished - Sep 1 2018

    ASJC Scopus subject areas

    • Surgery
    • Oncology

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    Lin, J. X., Wang, W., Lin, J. P., Xie, J. W., Wang, J. B., Lu, J., Chen, Q. Y., Cao, L. L., Lin, M., Tu, R., Zheng, C. H., Huang, C. M., Zhou, Z. W., & Li, P. (2018). Preoperative Tumor Markers Independently Predict Survival in Stage III Gastric Cancer Patients: Should We Include Tumor Markers in AJCC Staging? Annals of surgical oncology, 25(9), 2703-2712. https://doi.org/10.1245/s10434-018-6634-z