Prognostic effect of CEA, AFP, CA19‑9 and CA242 for recurrence/metastasis of gastric cancer following radical gastrectomy

Abstract

The present study aimed to determine the potential of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen (CA)19-9 and CA242 in predicting recurrence/metastasis of gastric cancer in patients following radical gastrectomy. The clinical data of 368 patients with stage I-III gastric cancer who underwent radical gastrectomy were analyzed, and CEA, AFP, CA19-9 and CA242 levels were detected prior to surgery and 6-12 months following surgery. Univariate and multivariate analyses were used to evaluate the potential risk factors for post-operative recurrence/metastasis of gastric cancer, and the predictive value of CEA, AFP, CA19-9 and CA242 levels was evaluated using receiver operating characteristic (ROC) curve and area under the curve (AUC). Cumulative survival rates were calculated using Kaplan-Meier analysis, and statistical significance was evaluated using a log-rank test. Results of the univariate analysis demonstrated that open surgery, age ≥70, total gastrectomy, disease stage III, and pre-operative CA19-9 and CA242 positivity were risk factors for recurrence/metastasis. ROC curve analysis revealed that the AUC values of postoperative CA19-9 were higher than other values. According to the Kaplan-Meier survival analysis, patients with negative CEA, AFP, CA19-9 and CA242 levels prior to surgery exhibited a higher five-year survival rate than those who exhibited positive levels of these tumor markers. In addition, patients with positive CEA, AFP, CA19-9 and CA242 levels prior to surgery exhibited a significantly worse prognosis. Collectively, the results of the present study indicated that CEA, AFP, CA19-9 and CA242 exhibited potential as predictive biomarkers for recurrence/metastasis following radical gastrectomy in patients with gastric cancer. Notably, CA19-9 and CA242 may exhibit the highest potential in predicting recurrence/metastasis.

Keywords: gastrectomy; gastric cancer; recurrence/metastasis; tumor marker.

Figure 1

Receiver operating characteristic curve analyses revealed the AUC values of pre-operative CEA, AFP, CA19-9 and CA242 levels in predicting post-operative recurrence/metastasis of gastric cancer. AUC, area under the curve; CEA, carcinoembryonic antigen; AFP, alpha-fetoprotein; CA, carbohydrate antigen.

Figure 2

Receiver operating characteristic curve analysis revealed the AUC values of post-operative CEA, AFP, CA19-9 and CA242 levels in predicting post-operative recurrence/metastasis of gastric cancer. AUC, area under the curve; CEA, carcinoembryonic antigen; AFP, alpha-fetoprotein; CA, carbohydrate antigen.

Figure 3

Association between prognosis and (A) positive or negative pre-operative serum CEA levels, (B) positive or negative pre-operative serum AFP levels, (C) positive or negative pre-operative serum CA19-9 levels and (D) positive or negative pre-operative serum CA242 levels in patients with gastric cancer. CEA, carcinoembryonic antigen; AFP, alpha-fetoprotein; CA, carbohydrate antigen.

Figure 4

Association between five-year survival and (A) positive or negative post-operative serum CEA levels, (B) positive or negative post-operative serum AFP levels, (C) positive or negative post-operative serum CA19-9 levels and (D) positive or negative post-operative serum CA242 levels in patients with gastric cancer. CEA, carcinoembryonic antigen; AFP, alpha-fetoprotein; CA, carbohydrate antigen.