OBJECTIVES:

In the clinical practice, We aimed to investigate whether tumor markers CEA , CA125, CA19-9 and CA72-4 can be used to evaluate the response to adjuvant chemotherapy, and to evaluate the diagnosis and prognosis value of 4 tumor markers in the patients of gastric cancer.

METHODS: A retrospective study was performed of 216 gastric cancer patients who underwent a first line cisplatin chemotherapy and anti-angiogenic agents regimen. Statistical analysis was performed to identify the clinical value of these tumor markers in predicting the progression free survival and the response to adjuvant chemotherapy.

RESULTS: Progression occurred in 78 of 216 patients and overall median progression free survival was 5-Months. For serum CEA, the median PFS was 4 versus 7 Months for elevated and normal groups (P = 0.01). The median PFS for normal and elevated CA199 and CA72-4 was 6 versus 4 months (P = 0.001). In the multivariate Cox regression model elevated pre-treatment level of CEA, CA199 and distant metastases were independent factors associated with increased risk of progression (p = 0.021, p = 0.000, p = 0.006). Furthermore, patients presented with combined three or four elevated tumor markers showed worse prognosis and shorter PFS (p = 0.001). The decrease of tumor markers CEA, CA199 and CA72-4 was significant after adjuvant chemotherapy (p = 0.006, p= 0.001, p =0.002) especially in the disease control group (CR+ PR+ SD) (p = 0.03, p = 0.001, p = 0.002) and in patients using anti-angiogenic agents with first-line platinum-based chemotherapy (3-drugs therapy) (CEA, CA199 and CA72-4; p = 0.005, p =0.0006, p = 0.001).

CONCLUSIONS: Our result suggests that elevated pre-treatment level of CEA and CA199 are correlated with high risk of progression and worse prognosis, while the use of anti-angiogenic agents with first-line platinum-based chemotherapy more effective in decreasing tumor markers level after adjuvant chemotherapy.