Dynamic monitoring of serum tumor markers in predicting recurrence after radical gastrectomy for gastric cancer

Abstract

BACKGROUND

Postoperative recurrence remains a major challenge following radical gastrectomy for gastric cancer, with 5-year recurrence rates reaching 30%-50%. Serum tumor markers, including carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 72-4 (CA72-4), and carbohydrate antigen 125 (CA125), are widely used in postoperative surveillance due to their non-invasive and cost-effective nature. However, previous studies have predominantly focused on single preoperative measurements, which demonstrate limited sensitivity and specificity for predicting recurrence. Emerging evidence suggests that dynamic changes in tumor marker levels may better reflect tumor burden and biological behavior than static measurements, yet systematic evaluation of different dynamic patterns remains lacking.

AIM

To investigate the value of dynamic monitoring of serum tumor markers in predicting recurrence after radical gastrectomy for gastric cancer.

METHODS

A retrospective analysis was conducted on clinical data of 213 patients who underwent radical gastrectomy between January 2020 and December 2021. Serum levels of CEA, CA19-9, CA72-4, and CA125 were monitored at preoperative and various postoperative time points. Six dynamic change patterns were defined: Persistently normal, postoperative normalization, persistently elevated, recurrent elevation, progressive elevation, and delayed elevation. Receiver operating characteristic curves were used to evaluate predictive value, Cox proportional hazards regression model was used to analyze independent risk factors for recurrence, and Kaplan-Meier method was used for survival analysis.

RESULTS

The median follow-up time was 36.5 months, with 68 patients (31.9%) experiencing recurrence at a median time of 14.5 months. The recurrence group had significantly higher preoperative and 1-month postoperative marker levels compared to the non-recurrence group (P < 0.001). The area under the curve (AUC) of combined preoperative four markers for predicting recurrence was 0.825. The progressive elevation pattern of CEA, CA19-9, CA72-4, and CA125 showed AUCs of 0.856, 0.842, 0.838, and 0.831, respectively. The combined four-marker progressive elevation pattern achieved an AUC of 0.912 with 85.3% sensitivity and 89.0% specificity, superior to preoperative single detection (P = 0.003). Multivariate analysis revealed that tumor size ≥ 5 cm [hazard ratio (HR) = 2.156], poorly differentiated-undifferentiated (HR = 2.024), tumor-node-metastasis stage III (HR = 3.245), vascular invasion (HR = 1.847), neural invasion (HR = 1.726), progressive elevation of CEA (HR = 3.124), CA19-9 (HR = 2.856), CA72-4 (HR = 2.634), CA125 (HR = 2.487), recurrent elevation of CEA (HR = 2.145), and CA19-9 (HR = 1.967) were independent risk factors for recurrence (P < 0.05). The 36-month disease-free survival (DFS) rate was 92.6%-95.7% in the persistently normal group, while the median DFS was 9.0-12.0 months in the progressive elevation group (P < 0.001).

CONCLUSION

Dynamic monitoring of serum tumor markers has important value in predicting recurrence after radical gastrectomy for gastric cancer. Progressive elevation and recurrent elevation patterns can identify high-risk patients early, and combined multi-marker dynamic monitoring can improve predictive accuracy, providing a scientific basis for individualized follow-up strategies.

Keywords: Gastric cancer; Radical surgery; Tumor markers; Dynamic monitoring; Recurrence prediction; Disease-free survival

Core Tip: Dynamic post-gastrectomy monitoring of serum markers (carcinoembryonic antigen, carbohydrate antigen 19-9, carbohydrate antigen 72-4, carbohydrate antigen 125) facilitates early identification of high-risk recurrence in gastric cancer. Progressive and recurrent elevation patterns markedly outperform single preoperative marker values (area under the curve up to 0.912), offering a streamlined, cost-effective strategy to refine follow-up and personalise surveillance.