Serum CEA, CA19-9, and AFP as Biomarkers for Gastric Cancer
AFP, CEA, CA19-9 in gastric cancer
Abstract
Background: The diagnostic value of AFP, CA19-9 and CEA as biomarkers in gastric carcinoma remains uncertain. This research explores their role in forecasting patient survival and disease progression.
Methods: A total of 630 early-stage gastric cancer patients who underwent gastrectomy between January 2018 and June 2024 were analyzed. Pathological evaluations were conducted, and serum concentrations of CEA, CA19-9, and AFP were measured. Statistical methods were applied to assess the relationship between these markers, tumor characteristics, and their impact on prognosis.
Results: The mean age of patients was 59 years. The 1-year and 5-year survival rates were 98.3% and 91.4%, respectively. The positivity rates for CEA, CA19-9, and AFP were 5.1%, 6.2%, and 2.3%, respectively, resulting in an overall detection rate of 12.4%. Elevated levels of CEA and CA19-9 were associated with metastasis of lymph node and higher tumor stages, while AFP showed no meaningful association with disease characteristics. Multivariate analysis identified age over 65, lymph node metastasis, and high CEA levels as independent risk factors for poorer outcomes in gastric cancer.
Conclusions: Although CEA, CA19-9, and AFP individually show low detection rates in gastric cancer, their combined use improves diagnostic accuracy. Elevated CA19-9 is associated with lymph node metastasis, and high CEA independently indicates a poorer prognosis. Additional research is necessary to clarify the clinical utility of these biomarkers in early detection and prognostic evaluation.
References
2. Ilic M, Ilic I. Epidemiology of stomach cancer. World J Gastroenterol. 2022;28(12):1187-203.
3. Conti CB, Agnesi S, Scaravaglio M, Masseria P, Dinelli ME, Oldani M, et al. Early Gastric Cancer: Update on Prevention, Diagnosis and Treatment. Int J Environ Res Public Health. 2023;20(3).
4. Yada T, Yokoi C, Uemura N. The current state of diagnosis and treatment for early gastric cancer. Diagn Ther Endosc. 2013;2013:241320.
5. Ikenoyama Y, Hirasawa T, Ishioka M, Namikawa K, Yoshimizu S, Horiuchi Y, et al. Detecting early gastric cancer: Comparison between the diagnostic ability of convolutional neural networks and endoscopists. Dig Endosc. 2021;33(1):141-50.
6. Nagpal M, Singh S, Singh P, Chauhan P, Zaidi MA. Tumor markers: A diagnostic tool. Natl J Maxillofac Surg. 2016;7(1):17-20.
7. Vaidyanathan K, Vasudevan DM. Organ Specific Tumor Markers: What's New? Indian J Clin Biochem. 2012;27(2):110-20.
8. Matsuoka T, Yashiro M. Biomarkers of gastric cancer: Current topics and future perspective. World J Gastroenterol. 2018;24(26):2818-32.
9. Sato Y, Okamoto K, Kawano Y, Kasai A, Kawaguchi T, Sagawa T, et al. Novel Biomarkers of Gastric Cancer: Current Research and Future Perspectives. J Clin Med. 2023;12(14).
10. Duffy MJ, Lamerz R, Haglund C, Nicolini A, Kalousová M, Holubec L, et al. Tumor markers in colorectal cancer, gastric cancer and gastrointestinal stromal cancers: European group on tumor markers 2014 guidelines update. Int J Cancer. 2014;134(11):2513-22.
11. Zhou Y, Tao L, Qiu J, Xu J, Yang X, Zhang Y, et al. Tumor biomarkers for diagnosis, prognosis and targeted therapy. Signal Transduction and Targeted Therapy. 2024;9(1):132.
12. Dilek ON, Arslan Kahraman D, Kahraman G. Carcinoembryonic antigen in the diagnosis, treatment, and follow-up of focal liver lesions. World J Gastrointest Surg. 2024;16(4):999-1007.
13. Acharya A, Markar SR, Matar M, Ni M, Hanna GB. Use of Tumor Markers in Gastrointestinal Cancers: Surgeon Perceptions and Cost-Benefit Trade-Off Analysis. Ann Surg Oncol. 2017;24(5):1165-73.
14. Lee T, Teng TZJ, Shelat VG. Carbohydrate antigen 19-9 - tumor marker: Past, present, and future. World J Gastrointest Surg. 2020;12(12):468-90.
15. Li Y, Lin Y, Zhao L, Yang C, Wang B, Gao Z, et al. Characteristics of alpha-fetoprotein-positive gastric cancer revealed by analysis of cancer databases and transcriptome sequencing data. Transl Oncol. 2023;36:101737.
16. Ye ZY, Xu CH, Chen W, Shao ZM, Zhao X, Tang JL, et al. α‑Fetoprotein‑positive hepatoid adenocarcinoma of the stomach and a new classification: A case report. Oncol Lett. 2024;28(6):586.
17. Yao Z, Yang H, Cui M, Xing J, Zhang C, Zhang N, et al. Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node. Front Oncol. 2023;13:1131725.
18. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-9.
19. Batra P, Narasannaiah AH, Reddy V, Subramaniyan V, K VM, R Y, et al. Prognostic Value of Tumor Markers in Gastric Cancer: A Tertiary Cancer Centre Experience. Cureus. 2023;15(7):e42328.
20. Sun AH, Zhang XY, Huang YY, Chen L, Wang Q, Jiang XC. Prognostic value and predictive model of tumor markers in stage I to III gastric cancer patients. World J Clin Oncol. 2024;15(8):1033-47.
21. Lakemeyer L, Sander S, Wittau M, Henne-Bruns D, Kornmann M, Lemke J. Diagnostic and Prognostic Value of CEA and CA19-9 in Colorectal Cancer. Diseases. 2021;9(1).
22. Wang H, Jin W, Wan C, Zhu C. Diagnostic value of combined detection of CA72-4, CA19-9, and carcinoembryonic antigen comparing to CA72-4 alone in gastric cancer: a systematic review and meta-analysis. Transl Cancer Res. 2022;11(4):848-56.
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