br g Department of Pathology Ayub Medical College

g Department of Pathology, Ayub Medical College, Abbottabad, Pakistan
Keywords:
Gastric cancer
Palliative chemotherapy
Cancer biomarkers
CEA
Background: Carcinoembryonic antigen (CEA), carbohydrate antigen (CA)-125, CA19-9, and CA72-4 are often found mod-ulated parameters in gastric cancer.
Objective: Our present study is focused to evaluate the syn-chronization of these biomarkers in response to palliative chemotherapy.
✩ Competing interest: None of authors have any competing interest. ∗ Corresponding authors.
Method: A retrospective study was conducted on 216 gas-tric cancer patients undergoing first-line cisplatin chemother-apy along with antiangiogenic regimen. Blood samples were taken and analyzed biochemically and statistically.
Results: Progression occurred in 78 of 216 patients and the median progression-free survival (PFS) was 5 months. For serum CEA, the median PFS was 4 versus 7 months for ele-vated and normal groups respectively (P = 0.01). The median PFS for normal and elevated CA19-9 and CA72-4 was 6 vs 4 months respectively (P = 0.001). In the multivariate Cox re-gression model, elevated pretreatment level of CEA, CA19-9, and distant metastases were independent factors associated with increased risk of progression (P = 0.021, P = 0.000, P = 0.006, respectively).
Conclusions: Conclusively, elevated pretreatment level of CEA and CA19-9 is correlated with high risk of progression and worse prognosis. Moreover, an additional antiangiogenic therapy is more effective in decreasing cancer biomarker level after palliative chemotherapy that may be correlated with therapeutic triumph.
Introduction
According to statistics, gastric cancer is the fourth most common cancer worldwide and the second most frequent cause of cancer death1,2 ides, it Dalbavancin is estimated that every year gastric cancer is affecting about 1 million people.3-5 Among these, more than 50% of the cases occur in East Asia, Korea, and Japan having the highest rate of occurrence, with a number of 988,000 new cases in 2008 and 736,000 cancer-related deaths.
For the patients diagnosed in the early stages, surgery can provide high rates of cure. But, in reality, among the patients with gastric cancer, only 25% or even less of them present to doctor when the disease is in early stage.10-13 For the rest of the patients, the survival rate is under 50% (in case of nonmetastatic disease stage) and, respectively, below 20% (in the stage at which cancer has already invaded the muscularis propria and there have already occurred regional lymph nodes that make it much harder for patient to recover after gastrectomy).
Regarding this second type of advanced cancer stage, surgery alone did not prove to give any satisfactory results, the main reason being locoregional and systemic recurrences.18,19
Patients diagnosed with extremely advanced gastric cancer may be offered radiotherapy as well as palliative treatment. The results of receiving radiotherapy after surgery are still modest, and it was not proved that it can significantly influence the rate of survival. While palliative method is not a curative treatment, but it plays an extremely important role to improve quality of life, limit complications, and ease pain and at times, prolong life when full recovery from gastric cancer is not possible.2,20-22
Tumor markers are small circulating molecules in blood or tissue which are produced by tu-mor or by host immune cells response to cancer. Measurement of these markers is important in clinical diagnosis, predicting of poor prognosis, and antidrug surveillance.23-28 The assessment of a particular tumor marker can make a huge difference for the patients in advanced disease stage that will not only help to avoid expensive, time consuming, patient’s unresting, un-necessary ra-diation exposure but also may provide statistically supportive measure to the clinicians to detect and evaluate the progression.29-33
Our present study was focused on the clinical utility of tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen (CA)-125, CA19-9, and CA72-4 in advanced stage of gas-tric cancer patients who had received palliative chemotherapy. We seek to measure whether
Table 1
Chemotherapy regimen for gastric carcinoma.
First-line cisplatin palliative Dose and cycle chemotherapy
these tumor biomarkers CEA, CA125, CA19-9, and CA72-4 can be of some value to monitor and predict the chemotherapeutic response and e cacy of 2-drugs (platinum-based chemotherapy alone) and 3-drugs (platinum-based chemotherapy plus antiangiogenic agents, ie, [Bevacizumab, Trastuzumab, Nitaluzumab, and Nidotuzumab]) in advanced stages of gastric cancer.