Combination of tumor markers predicts progression and pathological response in patients with locally advanced gastric cancer after neoadjuvant chemotherapy treatment

Abstract

Background The prognostic values of preoperative tumor markers (TMs) remain elusive in patients with locally advanced gastric cancer (LAGC) after neoadjuvant chemotherapy treatment (NACT). This study aimed to assess and establish a novel scoring system incorporating carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 72-4 (CA72-4) to enhance prognostic accuracy for progression-free survival (PFS) and pathological response (pCR). Methods Patients' data were retrospectively analyzed from December 2006 to December 2017 in our center. The cutoff value of TMs was determined using the time-dependent receiver operating test characteristics method. These three TMs were allocated 1 point each for the post neoadjuvant chemotherapy combination of tumor markers (post-NACT CTM) scores. The training group comprised 533 patients, responsible for full analysis, and the validation group comprised 137 patients based on the selection protocol. Results Of 533 enrolled patients, 138, 233, 117, and 45 patients scored 0, 1, 2, 3 respectively. The 3-year PFS rate Multivariate analysis revealed that post-NACT CTM score was an independent predictor of PFS (0 vs. 1, HR: 1.34, 95% CI: 0.92–1.96, P = 0.128; 0 vs. 2, HR: 2.03, 95% CI: 1.35–3.05, P = 0.001; 0 vs. 3, HR: 2.98, 95% CI: 1.83–4.86, P < 0.001). The time-dependent area under curve (AUC) revealed a consistent highest level for post-NACT CTM than other three single TMs. Lower post-NACT CTM score significantly correlated with higher pCR rate based on multivariate logistic regression (2/3 vs. 1, OR: 2.77, 95% CI: 0.90–8.53, P = 0.077; 2/3 vs. 0, OR: 4.33, 95% CI: 1.38–13.61, P = 0.012). A nomogram was formed with both internal and external validation. Conclusions The post-NACT CTM score system served as a strong independent predictor for PFS and pCR in LAGC patients who received NACT. Further population-based studies are required to confirm our results.

Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

“…Some studies pointed out AC failed to provide superior survival improvement in R0 resected gastric and esophagogastric junction adenocarcinoma under PEC setting ( 13 , 14 ). However, our previous analyses did not completely favor their idea according to which AC is always a risk factor for LAGC patients’ survival in patients with NAC treatment ( 15 , 16 ). Nevertheless, as several retrospective studies advocated the indiscrimination in survival between post-NAC (yp) and neutral stage ( 17 , 18 ), the strategies may be adapted to variation in yp stage in patients with initial LAGC diagnosis.…”

“…Various reasons can be responsible for this non-significance: (1) TRG only reflects the response to chemotherapy but might be a poor prognosticator for early-stage patents who are not required for intensive drug-based therapy; (2) current TRG classifications do not account for the involvement of lymph nodes, ypN0 with pretreated cN+ diagnosis should be a more direct indication for chemosensitivity; and (3) current cutoff values for TRG criteria may not achieve optimal discriminative ability. Fifth, the aim of our study was to summarize the impact of PEC on survival (to reach the maximum sample volume) so that some decisive factors for survival were not included in the study according to our previous reports ( 15 , 42 ). The c-index should also increase if more factors were input into the tree model.…”

Concurrent clinical and pathological response predicts favorable prognosis of patients with gastric cancer after neoadjuvant therapy: a real-world study

“…The assessment of NAT efficacy plays a crucial role in deciding postoperative chemotherapy regimens for LAGC patients. However, there is currently no unified standard for evaluating neoadjuvant treatment response and many authors have proposed various methods, including pathological tumor regression assessed by the TRG system, radiological tumor regression according to RECIST version 1.1 and serum tumor marker [ 5 , 6 , 13 ]. A retrospective study conducted by Wang et al found that TRG (P = 0.042, HR = 1.65) was an independent prognostic factor affecting the OS of GC patients, and patients who had a pathological response to NAT had a better prognosis [ 14 ].…”

Risk factors and a nomogram model for postoperative delirium in elderly gastric cancer patients after laparoscopic gastrectomy

“…Especially in China, GC is the third most common cancer and becomes the second leading cause of cancer deaths [ 2 , 3 ]. In addition, GC is often diagnosed at advanced stage in China with poor prognosis [ 4 ]. Surgical resection is the primary curative therapeutic strategy for GC.…”