Prognostic value of postoperative CEA/CA19-9 positivity and elevation relative to preoperative levels in gastric cancer

Table 1 Demographic and clinicopathologic characteristics of patients, n (%)

Variables	Patients (n = 562)
Sex
Male	385 (68.5)
Female	177 (31.5)
Age, years
< 60	248 (44.1)
≥ 60	314 (55.9)
Clinical stage (pTNM)
I	61 (10.8)
II	169 (30.1)
III	332 (59.1)
T stage
T1	45 (8)
T2	63 (11.2)
T3	117 (20.8)
T4	337 (60)
N stage
N0	151 (26.9)
N1	108 (19.2)
N2	146 (26)
N3	157 (27.9)
Differentiation
Good	21 (3.7)
Moderate	238 (42.4)
Poor	303 (53.9)
Vascular invasion
Positive	153 (27.2)
Negative	409 (72.8)
Preoperative CEA
Positive	129 (23.0)
Negative	433 (77.0)
Preoperative CA19-9
Positive	62 (11.0)
Negative	500 (89.0)
Post-preoperative CEA elevation
Yes	184 (32.7)
No	378 (67.3)
Post-preoperative CA19-9 elevation
Yes	235 (41.8)
No	327 (58.2)
Adjuvant chemotherapy
Yes	522 (92.9)
No	40 (7.1)
Recurrence status
Yes	193 (34.3)
No	369 (65.7)
Survival status
Alive	338 (60.1)
Dead	224 (39.9)
Recurrence pattern
No recurrence	369 (65.7)
Peritoneal recurrence	79 (14.1)
Other recurrence sites	114 (20.3)

CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9.

Table 2 Univariate and multivariate Cox regression analyses for overall survival of patients with gastric cancer

Variables	Univariate analysis		Multivariable analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Sex
Male	Reference		Reference
Female	1.17 (0.89-1.54)	0.265	1.03 (0.77-1.38)	0.822
Age
< 60	Reference		Reference
≥ 60	1.34 (1.02-1.75)	0.034	1.24 (0.94-1.64)	0.124
Clinical stage
I, II	Reference
III	4.00 (2.85-5.59)	< 0.001
T stage
T1, T2	Reference		Reference
T3	2.53 (1.36-4.71)	0.003	2.10 (1.02-4.33)	0.044
T4	5.44 (3.16-9.39)	< 0.001	3.98 (2.06-7.70)	< 0.001
N stage
N0, N1	Reference		Reference
N2	2.49 (1.75-3.54)	< 0.001	1.62 (1.12-2.34)	0.010
N3	4.33 (3.12-6.01)	< 0.001	1.56 (1.08-2.25)	0.017
Differentiation
Moderate, good	Reference		Reference
Poor	1.96 (1.49-2.59)	< 0.001	1.33 (0.98-1.80)	0.065
Vascular invasion
Negative	Reference		Reference
Positive	2.11 (1.61-2.77)	< 0.001	1.18 (0.88-1.58)	0.259
CEA elevation
No	Reference		Reference
Yes	4.21 (3.23-5.49)	< 0.001	2.71 (2.01-3.66)	< 0.001
CA19-9 elevation
No	Reference		Reference
Yes	3.28 (2.50-4.31)	< 0.001	2.84 (2.15-3.76)	< 0.001

CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; HR: Hazard ratio; CI: Confidence interval.

Table 3 Univariate and multivariable Cox regression analyses for disease-free survival of patients with gastric cancer

Variables	Univariate analysis		Multivariable analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Sex
Male	Reference		Reference
Female	1.12 (0.86-1.44)	0.406	1.03 (0.78-1.35)	0.842
Age, years
< 60	Reference		Reference
≥ 60	1.28 (1.00-1.64)	0.053	1.18 (0.92-1.53)	0.190
Clinical stage
I, II	Reference
III	3.48 (2.59-4.67)	< 0.001
T stage
T1, T2	Reference		Reference
T3	2.78 (1.62-4.79)	< 0.001	2.30 (1.22-4.31)	0.010
T4	4.94 (3.05-8.01)	< 0.001	3.59 (2.00-6.43)	< 0.001
N stage
N0, N1	Reference		Reference
N2	2.41 (1.76-3.32)	< 0.001	1.74 (1.25-2.42)	< 0.001
N3	3.86 (2.87-5.21)	< 0.001	1.59 (1.14-2.22)	0.006
Differentiation
Moderate, good	Reference		Reference
Poor	1.74 (1.36-2.24)	< 0.001	1.18 (0.90-1.56)	0.222
Vascular invasion
Negative	Reference		Reference
Positive	2.20 (1.71-2.83)	< 0.001	1.39 (1.07-1.82)	0.015
CEA elevation
No	Reference		Reference
Yes	3.58 (2.80-4.57)	< 0.001	2.37 (1.80-3.13)	< 0.001
CA19-9 elevation
No	Reference		Reference
Yes	2.71 (2.11-3.46)	< 0.001	2.33 (1.81-3.00)	< 0.001

CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; HR: Hazard ratio; CI: Confidence interval.

Table 4 The relationship between clinicopathological characteristics and postoperative carcinoembryonic antigen and carbohydrate antigen 19-9 elevation

Variables	Post-preoperative CEA elevation			Post-preoperative CA19-9 elevation
	Yes (n = 184)	No (n = 378)	P value	Yes (n = 235)	No (n = 327)	P value
Sex			0.172			0.856
Male	119	266		160	225
Female	65	112		75	102
Age, years			0.612			0.570
< 60	84	164		107	141
≥ 60	100	214		128	186
Clinical stage			< 0.001			0.002
I, II	38	192		78	152
III	146	186		157	175
T stage			< 0.001			0.605
T1, T2	23	85		41	67
T3	29	88		48	69
T4	132	205		146	191
N stage			< 0.001			< 0.001
N0, N1	37	222		80	179
N2	47	99		62	84
N3	100	57		93	64
Differentiation			< 0.001			0.014
Moderate, good	53	206		94	165
Poor	131	172		141	162
Vascular invasion			< 0.001			0.001
Positive	92	61		81	72
Negative	92	317		154	255
Adjuvant chemotherapy			0.104			0.247
Yes	175	345		221	299
No	9	33		14	28
Recurrence pattern			< 0.001			< 0.001
No recurrence	83	286		118	251
Peritoneal recurrence	38	41		49	30
Other recurrence sites	63	51		68	46
Post-CEA			< 0.001			< 0.001
Positive	37	22		41	18
Negative	147	356		194	309
Post-CA19-9			< 0.001			0.006
Positive	24	14		24	14
Negative	160	364		211	313
PNI			< 0.001			0.072
< 49.98	128	189		143	174
≥ 49.98	56	189		92	153
PLR			< 0.001			0.436
< 138.41	76	229		123	182
≥ 138.41	108	149		112	145
LMR			0.650			0.014
< 4.32	86	169		121	134
≥ 4.32	98	209		114	193

CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; LMR: Lymphocyte to monocyte ratio; PLR: Platelet to lymphocyte ratio; PNI: Prognostic nutritional index.

Table 5 Univariate and multivariate logistic regression analyses for postoperative carcinoembryonic antigen elevation

Variables	Univariate analysis		Multivariable analysis
	OR (95%CI)	P value	OR (95%CI)	P value
T stage
T1, T2, T3	Reference		Reference
T4	2.142 (1.466-3.131)	< 0.001	0.942 (0.590-1.505)	0.802
N stage
N0, N1	Reference		Reference
N2	2.848 (1.742-4.657)	< 0.001	2.726 (1.590-4.675)	< 0.001
N3	10.526 (6.537-16.950)	< 0.001	6.603 (3.815-11.426)	< 0.001
Differentiation
Moderate, good	Reference		Reference
Poor	2.960 (2.029-4.320)	< 0.001	2.015 (1.284-3.163)	0.002
Vascular invasion
Negative	Reference		Reference
Positive	5.197 (3.490-7.739)	< 0.001	3.953 (2.506-6.235)	< 0.001
Post-CEA
Negative	Reference		Reference
Positive	4.073 (2.323-7.142)	< 0.001	2.296 (1.152-4.575)	0.018
Post-CA19-9
Negative	Reference		Reference
Positive	3.900 (1.966-7.736)	< 0.001	1.349 (0.584-3.114)	0.483
PNI
≥ 49.98	Reference		Reference
< 49.98	2.286 (1.574-3.320)	< 0.001	1.824 (1.149-2.896)	0.011
PLR
< 138.41	Reference		Reference
≥ 138.41	2.184 (1.526-3.126)	< 0.001	1.418 (0.904-2.223)	0.128

CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; PLR: Platelet to lymphocyte ratio; PNI: Prognostic nutritional index; OR: Odds ratio; CI: Confidence interval.

Table 6 Univariate and multivariate logistic regression analyses for postoperative carbohydrate antigen 19-9 elevation

Variables	Univariate analysis		Multivariable analysis
	OR (95%CI)	P value	OR (95%CI)	P value
N stage
N0, N1	Reference		Reference
N2	1.651 (1.084-2.516)	0.019	1.489 (0.968-2.291)	0.07
N3	3.251 (2.151-4.915)	< 0.001	2.344 (1.490-3.686)	< 0.001
Differentiation
Moderate, good	Reference		Reference
Poor	1.528 (1.088-2.145)	0.014	1.245 (0.857-1.808)	0.250
Vascular invasion
Negative	Reference		Reference
Positive	1.863 (1.280-2.711)	0.001	1.414 (0.945-2.116)	0.092
Post-CEA
Negative	Reference		Reference
Positive	3.628 (2.026-6.496)	< 0.001	2.559 (1.380-4.746)	0.003
Post-CA19-9
Negative	Reference		Reference
Positive	2.543 (1.286-5.029)	0.007	1.301 (0.613-2.760)	0.493
LMR
≥ 4.32	Reference		Reference
< 4.32	1.529 (1.091-2.143)	0.014	1.442 (1.009-2.062)	0.044

CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; OR: Odds ratio; CI: Confidence interval; LMR: Lymphocyte to monocyte ratio.