Published online Feb 28, 2017. doi: 10.3748/wjg.v23.i8.1424
Peer-review started: October 27, 2016
First decision: December 1, 2016
Revised: December 16, 2016
Accepted: January 4, 2017
Article in press: January 4, 2017
Published online: February 28, 2017
To evaluate the clinical and prognostic significance of preoperative and postoperative cytokeratin 19 (CK19) and carcinoembryonic antigen (CEA) mRNA levels in peripheral blood of patients with gastric cardia cancer (GCC).
We detected the preoperative and postoperative mRNA levels of CK19 and CEA in peripheral blood of 129 GCC patients by using reverse transcription-polymerase chain reaction and evaluated their clinical and prognostic significance by univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard analysis. A new prognostic model which stratified patients into three different risk groups was established based on the independent prognostic factors.
Elevated preoperative and postoperative CK19 and CEA mRNA levels in peripheral blood of GCC patients were associated with lymph node metastasis. Univariate analysis showed that tumor size, histological grade, depth of tumor invasion, lymph node metastasis, preoperative CK19 mRNA, and preoperative and postoperative CEA mRNA levels were correlated with the prognosis of GCC patients. The multivariate analysis showed that lymph node status (P = 0.018), preoperative CK19 (P = 0.035) and CEA (P = 0.011) mRNA levels were independent prognostic factors for overall survival (OS). The 5-year OS rates for the low-, intermediate-, and high-risk groups were 48.3%, 22.6%, and 4.6%, respectively (P < 0.001).
Elevated preoperative CK19 and CEA mRNA levels may be regarded as promising biomarkers for predicting lymph node metastasis and poor prognosis in patients with GCC. This new prognostic model may help us identify the subpopulations of GCC patients with the highest risk.
Core tip: This is a retrospective study that evaluated the clinical and prognostic significance of the preoperative (pre-) and postoperative (post-) mRNA levels of cytokeratin 19 (CK19) and carcinoembryonic antigen (CEA) in peripheral blood of patients with gastric cardia cancer. Increased pre- and post-CK19 and CEA mRNA levels were associated with positive lymph node metastasis. Elevated pre- but not post-CK19 and CEA mRNA levels were independent prognostic factors for overall survival (OS). A new prognostic model was established based on independent prognostic factors (lymph node status, pre-CK19 and pre-CEA mRNA levels), and there was a significant difference in OS among the three different risk groups.