Analysis Of Clinicopathological Characteristics Of Gastric Cancer Patients With Serum CA19-9-positive And AFP-positive Perioperatively

BackgroundGastric cancer is one of the most common digestive malignancies in the world and is also the major cause of cancer-related death.In China,the morbidity and mortality of gastric cancer both rank the second after lung cancer according to the latest research.As patients with early gastric cancer do not have obvious symptoms,so most patients suffer from advanced gastric cancer when they visit the doctor.At the same time,even after a variety of comprehensive treatments,5-year survival rate is still low,only about 30%.Tumor markers are the specific substances that exist in patients’ tissues,body fluids,or excretions reflecting the development and progression of the tumor,as well as monitoring the response of tumor to the therapy.The substance can be detected by immunological,biological and chemical methods.When some patients were diagnosed as tumors,tumor markers in serum may increase to some extent.Sugar chain antigen 19-9(CA19-9)is a specific marker of digestive tumors,especially highly correlated with pancreatic cancer,which is widely used as an indicator of the diagnosis of pancreatic cancer and monitoring its recurrence.Elevated CA19-9 can also be observed in other malignant tumors,such as intrahepatic cholangiocarcinoma,gastric cancer,hepatocellular carcinoma,colon cancer,breast cancer.Alpha-fetoprotein(AFP)is mainly applied in the diagnosis and screening of hepatocellular carcinoma(HCC)clinically.Pathological changes of AFP can also be seen in other liver disease and other tumors.Studies have shown that AFP in serum of some patients with gastric cancer may rise,and this part of the gastric cancer patients have poor prognosis because of the rapid growth and the strong metastasis and invasion ability of gastric cancer.ObjectiveThe purpose of this study was to evaluate the clinicopathological characteristics of gastric cancer patients with perioperative serum carbohydrate antigen 19-9(CA19-9)-positive and alpha-fetoprotein(AFP)-positive,and combined effect of perioperative serum CA19-9 and AFP on clinicopathological characteristics of gastric cancer patients.Describe the necessity for preoperative detection of both tumor markers CA19-9 and AFP.MethodsThe clinicopathological characteristics of 900 gastric cancer patients with serum CA19-9 and AFP detection perioperatively from April 2012 to May 2015 at the first affiliated hospital of Nanjing Medical University were analyzed retrospectively.Postoperative pathological staging refers to the seventh edition of the 2010 American Joint Committee on Cancer(AJCC)staging standards.The clinicopathological characteristics of CA19-9 positive group and negative group,AFP positive group and negative group were compared respectively,including age,sex,depth of tumor invasion,lymph node metastasis,differentiation degree,vascular invasion and nerve invasion.And the joint analysis of CA19-9 and AFP was performed to find out the relationship between CA19-9 and AFP in the clinicopathological features of gastric cancer patients.ResultsPatients with elevated serum CA19-9 had the characteristics of more advanced T stage(T4 stage,94.2%VS.65.5%),later clinical stage(Ⅲ+Ⅳ stage,89.2%VS.61.5%),more common lymph node metastasis(81.5%VS.59.1%)and more remarkable vascular as well as neural invasion compared with those with normal level of serum CA19-9(32.5%VS.23.3%;42.5%VS.27.1%);Compared with AFP-negative patients,the AFP-positive gastric cancer patients suffered later clinical stage(Ⅲ+Ⅳ stage,88.9%VS.60.6%),more common lymph node metastasis(81.5%VS.59.1%)and more marked neural invasion(44.4%VS.27.0%)(P<0.05).Patients with one or two positive tumor markers suffered more advanced T stage,later clinical stage,more common lymph node metastasis and more remarkable vascular as well as neural invasion compared with those with double-negative tumor markers(P<0.05).Two-category Logistic regression analysis showed that CA19-9(+)was the independent risk factor for GC T stage;compared with CA19-9(-)-AFP(-),CA19-9(+)-AFP(+)was the independent risk factor for GC vascular invasion.CA19-9(+)-AFP(-)was the independent risk factor for GC T stage(P<0.05).ConclusionPerioperative serum levels of CA19-9 and AFP are closely correlated with clinicopathological features for patients with gastric cancer,and the two tumor markers are highly recommended detecting perioperatively for offering information of clinicopathological characteristics.