Association of carcinoembryonic antigen/carbohydrate antigen 19-9 with gastric cancer recurrence and chemotherapy toxicities

Abstract

BACKGROUND

Gastric cancer is a major global health burden and ranks among the most common and deadly cancers in China and worldwide. Tumor markers, particularly carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), are vital for diagnosis, prognosis, and monitoring. Elevated CEA and CA19-9 levels are correlated with advanced disease, high recurrence risk, and poor survival. However, their specific utility in predicting recurrence during adjuvant chemotherapy and association with chemotherapy-induced toxicities require further exploration. This study aimed to analyze the correlation among CEA/CA19-9 levels, postoperative recurrence, and chemotherapy-related toxicities in gastric cancer to develop personalized treatment strategies.

AIM

To identify the correlation of serum CEA and CA19-9 levels with postoperative recurrence and chemotherapy toxicity in patients with gastric cancer to guide treatment.

METHODS

We enrolled 74 patients with gastric cancer who underwent radical resection and adjuvant S-1 and oxaliplatin chemotherapy between January 2022 and December 2023. All the patients completed six chemotherapy cycles. They were categorized into the recurrence and non-recurrence groups based on 1-year postoperative follow-up. We compared CEA and CA19-9 levels and adverse gastrointestinal reactions. The patients were also stratified by elevated (> 37 U/mL) or normal (≤ 37 U/mL) CA19-9 levels to compare recurrence rates and recurrence-free survival (RFS). Finally, we analyzed the correlation of CEA and CA19-9 levels with postoperative recurrence, RFS, and gastrointestinal toxicities.

RESULTS

The mean postoperative serum CEA (59.58 ± 11.95) ng/mL and CA19-9 (104.25 ± 28.64) U/mL levels (averaged from three time-point measurements) in the recurrence group were significantly higher than that in the non-recurrence group (44.33 ± 8.39 ng/mL, 40.81 ± 12.47 U/mL) (P < 0.05). Patients with elevated mean postoperative CA19-9 levels (70.00%, 6.25 ± 0.85 months) had a significantly higher recurrence rate and shorter mean RFS than those with normal levels (7.41%, 9.83 ± 0.97 months) (P < 0.05). The recurrence group experienced significantly more severe gastrointestinal adverse reactions [mild (33.33%), moderate (44.44%), and severe (22.22%)] than the non-recurrence group [mild (58.93%), moderate (37.50%), and severe (3.57%)] (P < 0.05). CEA and CA19-9 levels increased significantly with the severity of adverse gastrointestinal reactions (P < 0.05). CEA and CA19-9 levels correlated positively with the recurrence and severity of adverse gastrointestinal reactions (P < 0.05) and negatively with RFS (P < 0.05).

CONCLUSION

Serum CEA and CA19-9 levels could serve as effective prognostic indicators in gastric cancer. Postoperative monitoring of these markers could detect potential recurrence, assess gastrointestinal toxicity, and predict RFS, thereby guiding clinical decision-making.

Keywords: Gastric cancer; Carcinoembryonic antigen; Carbohydrate antigen 19-9; Gastrointestinal adverse reactions; Recurrence; Recurrence-free survival; Correlation

Core Tip: This study included patients with stage II-III gastric cancer who received six cycles of the S-1 and oxaliplatin chemotherapy regimen postoperatively, measured serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels, and conducted a 1-year follow-up to explore the predictive value of these markers for cancer recurrence, chemotherapy-related gastrointestinal adverse reactions, and recurrence-free survival. CEA and CA19-9 could be reliable tools for guiding individualized treatment plans in patients with gastric cancer, highlighting their practical clinical value.