title: Clinical significance of an inflammation-based prognostic system for gastric cancer patients with a preoperative normal serum level of carcinoembryonic antigen.
abstract: OBJECTIVE
  To investigate the significance of the Glasgow Prognostic Score (GPS) for predicting the postoperative survival of gastric cancer (GC) patients with a normal preoperative serum level of carcinoembryonic antigen (CEA). Because CEA is a useful marker for prognostication of several types of cancer, some patients with GC have a normal CEA level. On the other hand, the GPS has been established as a valuable inflammation-based prognostic system for cancer patients.
  
  
  METHODS
  Among 650 patients who had undergone elective surgery for GC, 425 with a normal preoperative serum CEA level (≤5.0 ng/ml) were enrolled. Uni- and multivariate analyses were performed to evaluate the relationship of the GPS to overall survival. The Kaplan-Meier analysis and log rank test were used to compare the survival curves among patients with GPS 0, 1 and 2.
  
  
  RESULTS
  Multivariate analysis using clinical characteristics selected from univariate analyses revealed that the GPS (0, 1/2) was associated with overall survival (hazard ratio=2.048; 95% C.I. (confidence interval)=1.002-4.185; p=0.049) along with age (≤70/>70) (years), sex, tumor type (3, 4, 5/0, 1, 2), lymph node metastasis (presence/absence) and platelet count (≤35/>35) (×10(4)/mm(3)). The Kaplan-Meier analysis and log rank test demonstrated that there were significant differences in overall survival among patients with GPS 0, 1 and 2 (p<0.001).
  
  
  CONCLUSIONS
  Even if GC patients have a normal serum level of CEA, the GPS is able to predict their postoperative survival and classify such patients into three independent groups before surgery.
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan mm-ishizuka@umin.ac.jp.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ishizuka
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Oyama
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Abe
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Tago
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Genki
authors.initials: G
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000097:blood* / Q000401:mortality* / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen
keywords: Carcinoembryonic antigen; Glasgow Prognostic Score; gastric cancer; inflammation-based prognostic system; systemic inflammatory response