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Combined Use of Tumor Markers in Gastric Cancer: A Novel Method with Promising Prognostic Accuracy and Practicality

  • Gastrointestinal Oncology
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Annals of Surgical Oncology Aims and scope Submit manuscript

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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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Author notes

  1. Ruopeng Zhang, Xiaojiang Chen, and Guoming Chen have contributed equally.

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Ruopeng Zhang MD, PhD, Xiaojiang Chen MD, PhD, Zhoukai Zhao MD, Yicheng Wei MD, Feiyang Zhang MD, Jun Lin MD, Runcong Nie MD, PhD & Yingbo Chen MD

  2. Department of Gastric Surgery, Sun Yat‐Sen University Cancer Center, Guangzhou, Guangdong, China

    Guoming Chen MD

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  1. Ruopeng Zhang MD, PhD
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Contributions

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.

Corresponding authors

Correspondence to Runcong Nie MD, PhD or Yingbo Chen MD.

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Disclosure

The authors declare no competing interests.

Consent for Publication

All authors gave their consent for publication.

Ethical Approval and Consent to Participate

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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