Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
ABSTRACT
PURPOSE: This study was designed to investigate the significance of preoperative serum CA 19-9 level as a prognostic factor and postoperative serum CA 19-9 level as an indicator for recurrence in gastric adenocarcinoma patients.
MATERIALS AND METHODS: 328 patients, who received curative resection of stomach for gastric cancer from 1989 to 1996 and followed up successfully, were analyzed retrospec- tively. Median follow-up period was 24 months (range: 11-38 months). The cut off level of serum CA 19-9 was 37 U/ml.
The relationships between preoperative serum CA 19-9 status and prognostic parameters, recurrence and survival rate were analyzed.
Multivariate analysis using Cox proportional hazards regression analysis was performed to evaluate as an independent prognostic factor. The relationship between postoperative serum CA 19-9 level and recurrence was investigated.
RESULTS: Out of 328 cases, 29 cases (8.8%) showed elevated preoperative serum CA 19-9 level. The preoperative serum CA 19-9 level was correlated with the degree of depth of invasion and the status of lymph node metastasis (p<0.05). Patients with positive pre- operative serum CA 19-9 status showed higher incidence of recurrence (p<0.05) and poorer survival rate (p=0.00003) than patients with negative status. Preoperative serum CA 19-9 status (risk ratio: 3.4464, p=0.0039) revealed as an independent prognostic factor in multivariate analysis. Postoperative serum CA 19-9 status revealed as a useful predictor for recurrence in patients with positive preoperative serum CA 19-9 status.
CONCLUSION: Preoperative serum CA 19-9 determination in patients with gastric cancer was valuable for predicting tumor progression and prognosis. Preoperative serum CA 19-9 status may be helpful to predict recurrence earlier than other diagnostic tools, especially in the patients with positive preoperative serum CA 19-9 status.
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