Background
Peritoneal carcinomatosis is the most common pattern of recurrence of gastric cancer,
and it is important to identify patients at high risk for recurrence. Although the
carcinoembryonic antigen level in peritoneal lavage (pCEA) was reported to be a useful
biomarker to predict peritoneal recurrence in a small series, its clinical significance
has not been fully validated. We evaluated the clinical significance of pCEA in a
large cohort of patients with gastric cancer.
Methods
We prospectively analyzed the pCEA level in 597 patients with histologically proven
gastric cancer who underwent laparotomy.
Results
A significant relationship was demonstrated between the value of pCEA and clinicopathologic
features, such as the peritoneal lavage cytology, peritoneal metastasis, the depth
of tumor invasion, and the lymph node metastasis. The cutoff value was set at 100
ng/g of protein, and 134 of the 462 patients who underwent curative surgery had positive
pCEA findings. The overall and the intraperitoneal-recurrence-related survival of
patients positive for pCEA were significantly poorer than those of pCEA-negative patients.
When we analyzed the patients with pathologic stage I through III gastric cancers
separately, the pCEA-positive patients had poorer prognoses than the pCEA-negative
patients who had stage III gastric cancer. In a univariate analysis, the tumor size,
depth of tumor invasion, lymph node metastasis, histologic type, serum CEA (sCEA),
and pCEA were found to affect the patients' outcomes, although a multivariate analysis
found only the extent of lymph node metastasis to be an independent prognostic factor.
Conclusion
The pCEA level is a useful biomarker to predict gastric cancer-related death. Moreover,
the pCEA level may be useful to identify a cohort of patients with gastric cancer
who need more intensive adjuvant chemotherapy to improve their prognoses.
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Article info
Publication history
Published online: June 27, 2013
Accepted:
March 13,
2013
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
