Significance of Preoperatively Determined CA 19-Serum Levels in Patients with Gastric Cancer

ABSTRACT

Gastric cancer is a common, frequently lethal affliction and remains a serious and unsolved problem in general surgery. And gastric cancer is still the most common cancer in Korea, and it is the number one cause of cancer death in Korea. The prediction of prognosis is as important as treatment in gastric cancer. CA 19-9 is defined by a monoclonal antibody developed by Koprowski et al., and elevated levels of CA 19-9 have been found in the sera of patients with various malignancies, especially in patients with pancreatic cancer. To evaluate the prognostic role of CA 19-9 in gastric cancer, we studied preoperative CA 19-9 serum values in 1356 patients with gastric cancer who underwent operations in the Cancer Institute Hospital, between 1988 and 1993. CA 19-9 RIA test kits (Centocor, Malvern, Pa., U.S.A.) were used, and the cut-off value was 37.0 u/ml. The Chi-square test was used to evaluate the statistical significance of differences between seropositivities and clinicopathological parameters, and the Kaplan-Meier method was used to calculate survival rate. 1159 patients (85.5%) were negative for CA 19-9 (CA 19-9 less than 37.0 u/ml), and 197 patients (14.5%) were positive for CA 19-9 (CA 19-9 greater than 37.0 u/ml). In comparison with clinicopathological parameters, seropositivity was correlated with tumor size, gross types, depth of invasion and lymph node metastasis. Peritoneal and hepatic metastases, and stage correlated with seropositivities. The five-year survival rate was significantly higher in patients negative for CA19-9 than in patients positive for CA 19-9; 80.6% versus 57.2%. This study suggests that preoperative CA 19-9 serum levels were useful for predicting the prognosis in patients with gastric cancer.