Clinicopathological Features And Prognosis Of Gastric Cancer Patients With Elevated Serum CA19-9

Background and Aim: Many studies have shown that elevated serum CA19-9 levels are associated with more aggressive biological behaviors of gastric cancer.However,there are few related studies on the clinicopathological characteristics of elevated gastric cancer CA19-9 and the effect of serum CA19-9 levels on prognosis.The clinical significance of serum CA19-9 levels in patients with gastric cancer has not been fully confirmed.The purpose of this study was to investigate the clinicopathological characteristics and prognosis of gastric cancer patients with elevated serum CA19-9 level.Patients and Methods: According to the inclusion and exclusion criteria,959 patients who underwent gastrectomy in Zhejiang Provincial People's Hospital from November 2010 to September 2015 were selected as the study objects.The level of serum CA19-9 was detected before operation,and the relationship between the level of serum CA19-9 and the clinicopathological factors and survival prognosis of gastric cancer patients was analyzed.Propensity score matching analysis was used to minimize selection bias.Results: 160 of 959 patients with primary gastric cancer received gastrectomy had elevated serum CA19-9 level before gastrectomy.There were significant differences in age,tumor size,gross type,radical resection or not,pathological stage,vessel invasion or not,lymph node metastasis or not,peritoneal metastasis or not,liver metastasis or not and distant metastasis or not between CA19-9 normal group and elevated group.In univariate analysis,the risk factors related to the increase of serum CA19-9 level were age,tumor size,vessel invasion,lymph node metastasis,peritoneal metastasis,liver metastasis and distant metastasis.Multivariate logistic regression analysis showed that age,tumor size,lymph node metastasis and distant metastasis were independent risk factors for the increase of serum CA19-9.Before and after propensity score matching,patients with normal serum CA19-9 level had the better prognosis in stage?,stage ? and stage ? (P<0.05).Cox regression analysis showed that CA19-9 levels were independent prognostic factors of overall survival.For gastric cancer patients with elevated serum CA19-9 level before gastrectomy,whether postoperative chemotherapy and postoperative CA19-9 levels became normal,the cumulative survival curves also show significant differences(P<0.05).Conclusions: Gastric cancer with elevated serum CA19-9 level has the characteristics of poor biological characteristics,high metastasis rate and short overall survival.Becoming to normal levels after gastrectomy or postoperative chemotherapy may be associated with a more favorable outcome.