Prognostic Significance of Tumor Markers in Sera and Peritoneal Washings in Gastric Cancer Patients

ABSTRACT

BACKGROUND: Despite progress in surgical techniques and adjuvant treatments, the prognosis for advanced gastric cancer has not improved. Knowledge of the kinds of tumor markers that might indicate the postoperative prognosis for gastric cancer is important in detecting microscopic residual cancers but still needs to be developed. METHODS: The serum levels of carcinoembryonic antigen (sCEA) and carbohydrate antigen 19-9 (sCA19-9), as well as the CEA, the CA19-9, and the tissue-type plasminogen activator levels in peritoneal washings (pCEA, pCA19-9, pTPA) were measured in 57 patients with gastric cancer who had undergone laparotomies from Oct. 1996 to Mar. 1997. The relationships between the positivity of tumor markers and several clinicopathological factors were evaluated by using a univariate analysis. Also, the significance of tumor markers in predicting the survival and the recurrence of disease was analyzed. RESULTS: The positivity of pCEA and pCA19-9 increased according to the stage (p<0.01) and the presence of serosal invasion (P<0.01). When pCEA or pCA19-9 is positive, the rate of curative surgery in those patients was lower than it was in the patients with negative tumor markers (p<0.01 and p<0.05, respectively). The positivities of pCEA, sCA19-9, pCA19-9 were higher in recurring cases than in nonrecurring cases after curative surgery (p<0.01, p<0.01, and p<0.05, respectively). The positivities of the tumor markers pCEA and pCA19-9 in the 4 cases with peritoneal seeding at the laparotomy were significantly different from those in the 53 cases with no peritoneal seeding (p<0.01) and (p<0.01), respectively pCEA. The risk of peritoneal recurrence after curative surgery was higher in pCEA positive cases than in negative cases (p=0.016) and in serosal positive and pCEA positive cases than in the other cases (p=0.016). CONCLUSION: pCEA and pCA19-9 are useful prognostic factors and an adjuvant treatment to prevent peritoneal recurrence should be considered, especially, in patients presenting positive pCEA with positive serosal invasion.