title: Preoperative positivity of serum tumor markers is a strong predictor of hematogenous recurrence of gastric cancer.
abstract: OBJECTIVE
  Preoperative positivity of serum tumor markers has been reported to be a prognostic factor in several neoplasms. The aim of this longitudinal study was to evaluate the correlation between CEA, CA 19-9, and CA 72-4 preoperative serum levels and the site of recurrence after curative surgery for gastric cancer.
  
  
  METHODS
  One hundred sixty-seven patients resected for primary gastric cancer between January 1988 and June 1996 were considered. All patients were followed-up according to the same protocol, with a mean follow-up time of 45 +/- 39 months (range: 2-130). The correlation between marker positivity and the incidence of recurrence was studied by means of univariate and multivariate analyses.
  
  
  RESULTS
  A tumor recurrence was found in 92 patients (55.1%). For each of the three markers, preoperative positivity was related to a higher incidence of hematogenous recurrences with respect to negative cases; univariate analysis also revealed a higher incidence of locoregional recurrences in CA 72-4-positive cases. At multivariate analysis, preoperative positivity for one or more tumor markers proved to be an independent predictor of hematogenous recurrences (P < 0.005, relative risk [RR] 4.82), in addition to lymph node involvement (P < 0.05, RR 3.82); no correlation between marker positivity and the onset of locoregional or peritoneal recurrences was found.
  
  
  CONCLUSIONS
  Preoperative positivity for CEA, CA 19-9 or CA 72-4 is an independent risk factor for hematogenous recurrences of gastric carcinoma; this aspect should be considered in the option of using adjuvant chemotherapy after surgery for gastric cancer.
authors.affiliation: U.O. Chirurgia Oncologica, Istituto di Scienze Chirurgiche, University of Siena, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Marrelli
authors.forename: E
authors.initials: E
authors.lastname: Pinto
authors.forename: A
authors.initials: A
authors.lastname: De Stefano
authors.forename: G
authors.initials: G
authors.lastname: de Manzoni
authors.forename: M
authors.initials: M
authors.lastname: Farnetani
authors.forename: L
authors.initials: L
authors.lastname: Garosi
authors.forename: F
authors.initials: F
authors.lastname: Roviello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009360:Neoplastic Cells, Circulating; D013274:Stomach Neoplasms / Q000473:pathology*
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; C083825:CA-72-4 antigen; D002272:Carcinoembryonic Antigen