Malignant Gastric Neoplasms: A Clinicopathological Study with Special Reference to Serum CA125 Level with Peritoneal Dissemination

Abstract

Introduction: Gastric cancer is a malignant tumour with a fifth position amid all cancers and its mortality rate is third globally. The most common distant mode of metastasis is Peritoneal Dissemination (PD). There is a positive correlation between serum Cancer Antigen 125 (CA125) level and PD in cases of malignant gastric neoplasm. Aim: To study the demographic features, the macroscopic and microscopic features of malignant gastric neoplasm and the relation of serum CA125 level with PD in cases of gastric cancer. Materials and Methods: This cross-sectional observational study was conducted for two years from January, 2018 to January, 2020 on 120 cases at Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal (India). Detailed history taking, clinical examination, routine investigation was done. Peripheral blood sample for CA125 assay was collected. PD was identified through Ultrasonography (USG) or Computed Tomography (CT) or intraoperatively during open surgery. The gastrectomy specimens were sent for gross examination, staging and histopathology. Microsoft excel 2016 and SPSS 18 was used. Chi-square test was used for the comparison between the groups. A p-value of <0.05 was considered significant. The sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were used for elective assessment. Results: This study comprised 120 cases with mean age of presentation as 54.3 years and male: female ratio of 2.3:1. Fifty cases (41.6%) were identified as tubular (solid)-poorly differentiated adenocarcinoma with 59 cases (49.2%) of stage IIIA and 52 cases (43.3%) of stage IV. The sensitivity and specificity of CA125 was 81.8% and 85.7%. The PPV and NPV were 56.2% and 95.4%. Conclusion: Early detection of peritoneal disease will help the clinicians to stratify the treatment of gastric cancers. Higher sensitivity suggests that preoperative serum CA125 is a promising tool to predict PD which aids in subsequent alternative mode of treatment, lesser morbidity and better survival of patients.