Abstract
Background
The effect of a single tumor marker on the prognosis of gastric cancer patients is not ideal. This study explored a novel prognostic assessment method for gastric cancer (GC) patients using a combination of three important tumor markers (CEA, CA72-4, and CA19-9).
Method
Data from 1966 GC patients who underwent curative gastrectomy at Sun Yat-Sen University Cancer Center (Guangzhou, China) were included. Hazard ratios (HR) for all factors for overall survival (OS) were analyzed by Cox regression. A nomogram and calibration curve were used to establish the survival prediction model. The prediction accuracy was evaluated with the concordance index (C-index).
Results
All patients were divided into four groups (C0–C3) according to the number of elevated tumor markers. The 5-year OS rates of the patients in preoperative groups C0–C3 were 83.8% (81.3–86.4%), 72.8% (68.5–77.4%), 58.9% (50.4–68.9%), and 18.5% (4.0–33.0%), respectively, and those in postoperative groups C0–C3 were 82.1% (79.4–84.8%), 76.1% (72.2–80.3%), 57.6% (48.4–68.5%), and 16.8% (5.1–28.5%), respectively, with significant differences between each C0–C3 subgroup in both preoperative and postoperative cohorts. Multivariate analysis showed that preoperative (HR: 6.001, 95% CI: 3.523–10.221) and postoperative (HR: 8.149, 95% CI: 4.962–13.528) elevated tumor markers were independent risk factors for GC patients. The C-index for the combined use of tumor markers was 0.65–0.66, which was higher than that for using a single tumor marker (0.53–0.56).
Conclusion
The combined use of tumor markers significantly improved the prognostic value compared with using a single tumor marker. The survival prediction model including the combined tumor markers was accurate and effective.
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Data availability
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
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Acknowledgment
We thank all staff of the Department of Gastric Surgery at SYSUCC for assisting in data collection for this study.
Funding
This work was supported by grants from the National Science Foundation of China (82103586), Science and Technology Planning Project of Guangzhou (202201010885), Guangdong Provincial Natural Science Foundation (2021A1515012369), and Beijing Xisike Clinical Oncology Research Foundation (Y-tongshu2021/qn-0227).
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Y.B.C. and R.C.N. conceptualized the study and devised the study protocol. R.P.Z., X.J.C., and G.M.C. participated in the study design and manuscript writing. Z.K.Z. and Y.C.W. participated in data collection. F.Y.Z. and J.L. developed the methodology and statistical analysis. All authors approved the final version of the manuscript. Y.B.C. and R.C.N. have full access to, and verify, the underlying data and accept responsibility for submission and publication.
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This study was approved by the Institutional Review Board and Human Ethics Committee of SYSUCC. Written consent to use the samples for research purposes was obtained from all the patients before surgery. The project was examined by the Animal Ethical and Welfare Committee of SYSUCC and complies with animal protection, animal welfare, ethical principles, and the relevant provisions of the National Laboratory Animal Welfare Ethics.
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Zhang, R., Chen, X., Chen, G. et al. Combined Use of Tumor Markers in Gastric Cancer: A Novel Method with Promising Prognostic Accuracy and Practicality. Ann Surg Oncol 30, 8561–8571 (2023). https://doi.org/10.1245/s10434-023-14194-9
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DOI: https://doi.org/10.1245/s10434-023-14194-9