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

Lin, Jian; Wang, Wei; Lin, Jun; Xie, Jian; Wang, Jia Bin; Lü, Jun; Chen, Qi Yue; Cao, Long Long; Ma, Lin; Tu, Ru‐Hong; Zheng, Chao; Changming, Huang; Zhou, Zhiwei; Li, Ping

doi:10.1245/s10434-018-6634-z

Cited by 39 publications

(32 citation statements)

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“…It is suggested that serum tumour markers could be used in clinical practice as an additional tool for screening, tumour staging, prediction of prognosis and even surveillance of treatment in several cancer types (Zhang et al 2007, Adamo et al 2017, Lin et al 2018. Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most studied serum biomarkers for establishing both diagnosis and prognosis in pancreatic cancer patients (Goonetilleke andSiriwardena 2007, Meng et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

et al. 2020

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Purpose: It is suggested that tumour markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) could be used to predict the stage of pancreatic cancer. However, optimal cut-off values for CEA and CA19-9 are disputable. This study aimed to assess the value of CEA and CA19-9 serum levels at diagnosis of pancreatic ductal adenocarcinoma (PDAC) as predictors for the advanced stage of PDAC in patients discussed at pancreatic multidisciplinary team (MDT) meetings. Methods: Patients with suspected PDAC discussed at MDT meetings from 2013 to 2017 were reviewed, in order to determine optimal cut-off values of both CEA and CA19-9. Results: In total, 375 patients were included. Optimal cut-off values for predicting advanced PDAC were 7.0 ng/ml for CEA and 305.0 U/ml for CA19-9, resulting in positive predictive values of 83.3%, 73.6%, and 91.4% for CEA, CA19-9 and combined, respectively. Both tumour markers were independent predictors of advanced PDAC, demonstrated by an odds ratio of 4.21 (95% CI:1.85-9.56; p ¼ 0.001) for CEA and 2.58 for CA19-9 (95% CI:1.30-5.14; p ¼ 0.007).Conclusions: CEA appears to be a more robust predictor of advanced PDAC than CA19-9. Implementing CEA and CA19-9 serum levels during MDT meetings as an additional tool for establishing tumour resectability is worthwhile for tailored diagnostics. ARTICLE HISTORY

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Section: Introductionmentioning

confidence: 99%

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

et al. 2020

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“…Whether serum CA19-9 levels should be used as prognostic indicators in patients with gastric cancer has long been discussed; however, the results remain controversial. Some studies reported that CA19-9 level was an independent prognostic factor by multivariate analysis in gastric cancer; gastric cancer patients with elevated CA19-9 levels had poorer prognosis than those with normal CA19-9 (13,14,16,26). However, other studies showed than preoperative CA19-9 levels were not an independent prognostic factor in gastric cancer (27,28).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Changes in Preoperative and Postoperative Serum CA19-9 Levels in Gastric Cancer

et al. 2020

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Objective: The prognostic significance of serum CA19-9 levels in gastric cancer patients remains a matter debate. The aim of this study was to determine the prognostic value of changes in preoperative and postoperative serum CA19-9 levels in patients with gastric cancer. Methods: A total of 1,046 gastric cancer patients who underwent curative gastrectomy in West China Hospital of Sichuan University from January 2011 to December 2016 were analyzed retrospectively. Patients were categorized by minimum P-value using X-tile, while the baseline confounders for CA19-9 changes were balanced through propensity score matching (PSM). The relationships between CA19-9 changes and other clinicopathologic features were measured. Univariate and multivariate analysis were performed to explore the risk factors associated with survival outcomes. Results: We included 653 patients. Changes in CA19-9 levels significantly correlated with age, tumor size, macroscopic type, histological grade, T stage and TNM stage. Kaplan-Meier curves revealed that patients with CA19-9 changes <20% had significant better overall survival than those with changes more than 20% (p < 0.001); Cox regression analysis revealed the CA19-9 change (p = 0.010), gender (p = 0.031), histological grade (p = 0.036) and TNM stage (p < 0.001) were independent risk factors for survival after PSM. Stratification analysis indicated that patients with CA19-9 change more than 20% had worse prognosis that those with CA19-9 change no more than 20% in male (p = 0.002), poorly differentiated or undifferentiated type (p = 0.031) and TNM stage III (p = 0.006). Conclusion: Changes in preoperative and postoperative serum CA19-9 levels were closely associated with clinicopathological traits and was an independent prognostic factor in gastric cancer patients. This parameter may be a reliable marker for prediction of survival.

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“…5 Both NLR and PLR inflammation markers have demonstrated prognostic values in previous studies. 19 , 20 In the present study, we evaluated the new nomogram model for prognosis prediction in stage III CRC patients. We found that both PLR and NLR were independent prognostic factors affecting lymph node metastasis in CRC.…”

Section: Discussionmentioning

confidence: 99%

<p>Performance of a Nomogram Based on the Integration of Inflammation Markers with Tumor Staging in Prognosis Prediction of Stage III Colorectal Cancer</p>

Wang

Xiao

et al. 2020

CMAR

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The aim of the present study was to evaluate a nomogram model for predicting the 5-year overall survival (OS) in lymph node-metastatic colorectal cancer (CRC) patients by combining inflammation markers with some traditional prognostic factors. Methods: A total of 399 patients with stage III (pT X N 1-3 M 0) CRC operated from January 2007 to December 2012 were enrolled in this retrospective study. All patients underwent D 2 lymphadenectomy in the hospital. A prognostic nomogram based on the integration of traditional prognostic factors and NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) was established and compared with the nomogram based on the traditional prognostic factors alone. ROC curves were further applied to verify the predictive accuracy of the established model. Results: Both NLR (P=0.00) and PLR (P=0.01) predicted the 5-year OS. In multivariate analysis, age, T3 category, T4 category, N2 category, N3 category, Pgp (P-glycoprotein), NLR and PLR are proven to be independent (all P≤0.05). The established nomogram showed better predictive power than that of traditional profile (c-index: 0.66 versus 0.63) in both training and validation cohorts. External assessment by ROC curve analysis demonstrated that the established model had a good prediction accuracy of 5-year OS in stage III CRC patients, with area under curve values of 0.657 and 0.629 in training and validating sets, respectively. Conclusion: A nomogram based on the integration of traditional prognostic factors and inflammatory markers (NLR and PLR) could provide more precise long-term prognosis information for lymph node-metastatic CRC patients than the model based on traditional profile alone. This model might be useful for clinical application in personalized evaluation.

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

Abstract: 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.

Cited by 39 publications

References 24 publications

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

Prognostic Value of Changes in Preoperative and Postoperative Serum CA19-9 Levels in Gastric Cancer

<p>Performance of a Nomogram Based on the Integration of Inflammation Markers with Tumor Staging in Prognosis Prediction of Stage III Colorectal Cancer</p>

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