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Meta-Analysis
. 2017 Nov 15;12(11):e0188139.
doi: 10.1371/journal.pone.0188139. eCollection 2017.

Prognostic value of pretreatment serum carbohydrate antigen 19-9 level in patients with colorectal cancer: A meta-analysis

Zhan Yu  1 , Zhen Chen  2 , Jian Wu  1   3 , Zhong Li  1 , Yugang Wu  1
Affiliations
Meta-Analysis

Prognostic value of pretreatment serum carbohydrate antigen 19-9 level in patients with colorectal cancer: A meta-analysis

Zhan Yu et al. PLoS One. .

Abstract

Background: Carbohydrate antigen 19-9 (CA 19-9) is one of the most frequently used tumor markers for gastrointestinal cancer, particularly for diagnostic purposes. However, its value in predicting prognosis remains controversial. In this study, we sought to clarify this by conducting a meta-analysis of relevant studies.

Methods: We systematically searched several databases, including PubMed, EMBASE and Web of Science for articles pertaining to the relationship between pretreatment serum CA 19-9 levels and prognosis in patients with colorectal cancer (CRC). The reported hazard ratios (HR) of overall survival (OS), disease-free survival (DFS), pooled progression-free survival (PFS) and recurrence-free survival (RFS) in the analyzed studies were compared by fixed effects/random effects models.

Results: Seventeen studies involving 6434 patients with CRC were included in our meta-analysis. A comprehensive analysis of the collected data revealed that high serum CA 19-9 levels before treatment were significantly associated with poor OS (HR: 1.58, 95% CI: 1.36-1.83, P<0.001), DFS (HR: 1.71, 95% CI: 1.38-2.13, P<0.001), PFS (HR: 1.30,95%CI:0.93-1.82, P = 0.121) and RFS (HR: 1.43, 95% CI: 1.11-1.83, P = 0.006). This association between high pretreatment serum CA 19-9 levels and poor survival held true across different geographical regions, analysis types, methods used for HR determination, sample size, and treatment methods.

Conclusions: The results of this study indicate that pretreatment serum CA 19-9 level can be used as a prognostic indicator for patients with CRC.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of the study selection process.
Fig 2
Fig 2. Forest plots of studies evaluating hazard ratios of pretreatment serum carbohydrate antigen 19–9 level (CA199) in patients with colorectal cancer (CRC).
(1) Pretreatment serum CA199 level was associated with shorter overall survival (OS) in CRC; (2) Pretreatment serum CA199 level was associated with shorter disease-free survival, progression-free survival, recurrence-free survival in CRC.
Fig 3
Fig 3. Sensitivity analyses for confirming robustness of OS by removing 1 study each time.
Fig 4
Fig 4. Funnel plots for the evaluation of potential publication bias of OS for CRC.
See this image and copyright information in PMC

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