Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2017; 23(48): 8562-8569
Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8562
Prognostic significance of pretreatment serum carcinoembryonic antigen levels in gastric cancer with pathological lymph node-negative: A large sample single-center retrospective study
Jun Xiao, Zai-Sheng Ye, Sheng-Hong Wei, Yi Zeng, Zhen-Meng Lin, Yi Wang, Wen-Hao Teng, Lu-Chuan Chen
Jun Xiao, Zai-Sheng Ye, Sheng-Hong Wei, Yi Zeng, Zhen-Meng Lin, Yi Wang, Wen-Hao Teng, Lu-Chuan Chen, Department of Gastrointestinal Surgery, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou 350001, Fujian province, China
Author contributions: Xiao J, Ye ZS, Wei SH, Teng WH and Zeng Y participated in the design of the study, acquisition of data, and article revisions; Wang Y and Chen LC analyzed the data and wrote the article; all authors have approved the final version of the article.
Supported by Domestic Support from Young and Middle-aged Key Personnel Training Program for Provincial Health Planning Students, No. 2017-ZQN-18; Provincial Youth Health Science Research Project, No. 2014-2-8 and No. 2017-1-13; and National Key Clinical Specialty Construction Project, No. 2013-2016.
Institutional review board statement: This study was approved by Institutional Ethnic Committee of Fujian Medical University Cancer Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by verbal consent. Individuals can’t be identified according to the data presented.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lu-Chuan Chen, MD, Department of Gastrointestinal Surgery, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou 350001, Fujian Province, China. luchuanchen@sina.cn Telephone: +86-591-83660063 Fax: +86-591-83660063
Received: July 28, 2017
Peer-review started: August 2, 2017
First decision: August 10, 2017
Revised: August 19, 2017
Accepted: November 22, 2017
Article in press: November 22, 2017
Published online: December 28, 2017
Abstract
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 (T2-4b) (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.

Keywords: Carcinoembryonic antigen, Gastric cancer, Pathological lymph node-negative, X-tile plots, 5-year survial rate

Core tip: Currently, the survival rate for gastric cancer (GC) is still unsatisfactory. Reliable biomarker such as carcinoembryonic antigen (CEA) is necessary to improve the management of GC and pathological lymph node-negative (pN0) represents a group of reliable biological status. About 469 pN0 GC patients, who received D2 radical gastrectomy were retrospectively analyzed, and an optimal cut-off value of CEA was reset, and we found that 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 staging pN0 GC patients.