title: Better outcomes by monitoring tumour dynamics using sensitive tumour markers in patients with recurrent gastric cancer.
abstract: BACKGROUND
  Little is known about the prognostic value and clinical significance of monitoring tumour status using tumour markers in patients with recurrent gastric cancer.
  
  
  METHODS
  Between 2002 and 2009, 91 consecutive patients exhibited recurrence after curative gastrectomy for gastric cancer. They were followed intensively using tumour markers such as CA19-9 and CEA and their records were retrospectively analyzed.
  
  
  RESULTS
  At the time of recurrence, patients were divided into three groups. Each tumour marker was re-elevated in 45 patients (51%) (re-elevation group: REG), was continuously-elevated since initial surgery in 23 patients (25%) (continuous elevation group: CEG) and was not elevated in 22 patients (24%) (non-elevation group: NEG). Survival after recurrence in REG was significantly better than in the other groups. In particular, those in REG had significantly better outcomes than those in NEG, in both survival after recurrence (p=0.0109) and total postoperative survival (p=0.0197), although there were no significant differences in recurrence-free survival between the two groups (p=0.8818). REG patients were able to receive more chemotherapy regimens than NEG patients (p=0.0730, REG vs. NEG, first-line 43% vs. 68%, second-line 33% vs. 32%, third-line or more 24% vs. 0%). Multivariate analysis revealed that re-elevations in tumour markers were found to be an independent prognostic factor for survival after recurrence [p=0.0014, hazard ratio=0.39 (95% CI: 0.21-0.69)]. [corrected]. Particularly for peritoneal recurrence, those in REG had significantly better outcomes than those in NEG (p<0.0005).
  
  
  CONCLUSIONS
  Monitoring tumour dynamics using tumour markers may facilitate clinical decision-making, according to changes in tumour markers and contribute to survival prolongation in patients with recurrent gastric cancer.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, Japan. skomatsu@koto.kpu-m.ac.jp
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Yukihisa
authors.initials: Y
authors.lastname: Nishimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D006801:Humans; D007124:Immunoenzyme Techniques; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen