title: The prognostic significance of pretreatment serum CEA levels in gastric cancer: a meta-analysis including 14651 patients.
abstract: BACKGROUND
  Carcinoembryonic antigen (CEA) is commonly used as a serum tumor marker in clinical practice; however, its prognostic value for gastric cancer patients remains uncertain. This meta-analysis was performed to assess the prognostic value of CEA and investigate CEA as a tumor marker.
  
  
  METHODS
  PubMed, EMBASE and other databases were searched for potentially eligible studies. Forty-one studies reporting the prognostic effect of pretreatment serum CEA expression in gastric cancer patients were selected. Data on 14651 eligible patients were retrieved for the meta-analysis. Based on the data extracted from the available literature, the hazard ratio (HR) and 95% confidence interval (CI) for an adverse prognosis were estimated for gastric cancer patients with elevated pretreatment serum levels of CEA (CEA+) relative to patients with normal pretreatment CEA levels (CEA-).
  
  
  RESULTS
  The CEA+ patients had a significantly poorer prognosis than the CEA- patients in terms of overall survival (OS: HR 1.716, 95% CI 1.594 - 1.848, P< 0.001), disease-specific survival (DSS: HR 1.940, 95% CI 1.563 - 2.408, P< 0.001), and disease-free survival (DFS: HR 2.275, 95% CI 1.836 - 2.818, P< 0.001). Publication bias and an influence of different cut-off values were not observed (all P> 0.05). In the pooled analyses of multivariate-adjusted HRs, the results suggested that pretreatment serum CEA may be an independent prognostic factor in gastric cancer (OS: HR 1.681, 95% CI 1.425 - 1.982; DSS: HR 1.900, 95% CI 1.441 - 2.505; DFS: HR 2.579, 95% CI 1.935 - 3.436).
  
  
  CONCLUSIONS
  The meta-analysis based on the available literature supported the association of elevated pretreatment serum CEA levels with a poor prognosis for gastric cancer and a nearly doubled risk of mortality in gastric cancer patients. CEA may be an independent prognostic factor for gastric cancer patients and may aid in determining appropriate treatment which may preferentially benefit the CEA+ patients.
authors: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Kai
authors: K
authors: Deng
authors: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Li
authors: L
authors: Yang
authors: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Bing
authors: B
authors: Hu
authors: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Hao
authors: H
authors: Wu
authors: Department of Abdominal Cancer, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Hong
authors: H
authors: Zhu
authors: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Chengwei
authors: C
authors: Tang
mesh_terms: D002272:Carcinoembryonic Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D011379:Prognosis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000097:blood / Q000175:diagnosis*
chemical_list: D002272:Carcinoembryonic Antigen