| Background and ObjectiveAs one of the common malignant tumors of digestive tract,gastric cancer has always had a very high incidence and mortality,and there is no obvious downward trend with the improvement of medical treatment.According to the latest cancer information released by the world health organization,the incidence rate of cancer ranks the 5th among all malignant tumors,and the mortality rate ranks the3rd.Currently,three serum tumor markers are commonly used by clinicians to assist in the diagnosis and prognosis of gastric cancer:tumor genic antigen(CEA),cancer-related carbohydrate antigen 19-9(CA19-9),and cancer-related carbohydrate antigen 72-4(CA72-4).With the development of treatment methods for gastric cancer,the prognosis of patients with advanced gastric cancer is gradually improving,but a large number of patients with gastric cancer still suffer tumor recurrence after radical resection.In order to optimize the management of each patient,accurate markers are needed to evaluate the prognosis.Intraoperative and postoperative serum CEA and CA19-9 and CA72 4 test for patients with advanced gastric cancer provides a more accurate risk stratification,but this is according to different degree of differentiation of advanced gastric cancer,the three kinds of tumor markers in the clinical significance of these there are a lot of different sounds,most researchers think this three tumor markers preoperatively in differentiation of good expression in gastric cancer is higher;Some researchers hold the opposite attitude and think that the expression is higher in differential gastric cancer.Few researchers think there is a definite link.However,these studies only analyzed the level of tumor markers before surgery,and lack of studies after surgery and after tumor recurrence.Further studies are needed on the prognostic analysis of these three tumor markers for gastric cancer with different differentiation degrees.For the purpose of this study,the expression levels of three serum tumor markers,including CEA,CA19-9 and CA72-4,in the serum of patients with gastric cancer with different degrees of differentiation and progression,and their significance in the diagnosis,prognosis assessment and recurrence monitoring of gastric cancer were analyzed.Patients and MethodsGastric cancer patients admitted to the first affiliated hospital of ZhengZhou university from 2013 to 2017 were selected.A total of 111 patients were enrolled,including 82 males and 29 females.All the enrolled patients were divided into 3groups according to the pathological histology of gastric cancer published by the world health organization(WHO)in 2010.The patients were divided into three groups according to the degree of differentiation:moderately differentiated gastric cancer group,low-differentiated gastric cancer group,signet ring cell carcinoma group,and mucinous adenocarcinoma group.The Numbers were 43,45,and 23,respectively.TNM staging was performed on all enrolled patients in accordance with the eighth edition of the TNM standard for gastric cancer jointly developed by the American joint committee on cancer(AJCC)and the international union against cancer(UICC)in 2016.Age,sex,tumor diameter,TNM stage,pathological classification,whether there was neurological invasion,initial diagnosis,first postoperative follow-up,and tumor markers after tumor recurrence were counted.Statistical analysis was performed using SPSS21.0 software.Results1.Differences of clinicopathologic parameters in gastric cancer with different degrees of differentiationDifferences in clinicopathologic parameters among the three groups of gastric cancer patients were shown in table 1.The first detection time was 21 days after surgery.As shown in the table,there was no difference in gender,age,nerve invasion,tumor size and pTNM stage among the three groups.2.Differences of three serum tumor markers in three groups of gastric cancer patientsAt the time of initial diagnosis,the positive rate of the three serum tumor markers was significantly higher in the middle differentiation group than in the two groups with poor tumor differentiation degree,and the difference was statistically significant.(CEA:x~2=6.821,P=0.033;CA19-9:x~2=10.748,P=0.005;CA72-4:x~2=9.188,P=0.010).After tumor recurrence,the three serum tumor markers showed the same expression trend as at the initial diagnosis,that is,the positive rate in the middle differentiation group was significantly higher than that in the two groups with poor tumor differentiation,and the difference was statistically significant(CEA:x~2=7.334,P=0.026;CA19-9:x~2=10.700,P=0.005;CA72-4:x~2=9.303,P=0.010).CEA,CA19-9,and CA72-4 were negative at initial diagnosis but turned positive after tumor recurrence--positive rate--in the middle differentiation group,which was also higher than that in the low-differentiation group with poor tumor differentiation degree,sign-band cell carcinoma,and mucinous adenocarcinoma group(CEA:x~2=8.673,P=0.013;CA19-9:x~2=9.065,P=0.011;CA72-4:x~2=8.563,P=0.014).3.Differences in the detection values of the positive expression of the three tumor markers among the three groups of gastric cancer patientsAt this stage,the first examination value of these three serum tumor markers after surgery and the examination value after tumor recurrence were calculated.All values were positive tumor markers.After screening these data and analysis,it was concluded that the difference between the initial examination values of CEA,CA19-9and CA72-4,three serum tumor markers after surgery,was higher in the group of low-differentiated gastric cancer,sign-ring cell carcinoma and mucous adenocarcinoma than that after tumor recurrence(CEA:F=4.175,P=0.022;CA19-9:F=4.167,P=0.022;CA72-4:F=5.801,P=0.006).Conclusion1.Serum CEA,CA19-9 and CA72-4 were more highly expressed in gastric cancer with better differentiation,and less expressed in gastric cancer with worse differentiation.2.The positive expression of serum CEA,CA19-9 and CA72-4 was higher in poorly differentiated gastric cancer.3.Clinical evaluation of patients’prognosis based on these three tumor markers should be combined with the degree of tumor differentiation of patients. |
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