Preoperative positivity of serum tumor markers is a strong predictor of hematogeous recurrence of gastric cancer

BACKGROUND AND OBJECTIVES: Preoperative positivity of serum tumor markers has been reported to be a prognostic factor in several neoplasms. The aim of this longitudinal study was to evaluate the correlation between CEA, CA 19-9, and CA 72-4 preoperative serum levels and the site of recurrence after curative surgery for gastric cancer. METHODS: One hundred sixty-seven patients resected for primary gastric cancer between January 1988 and June 1996 were considered. All patients were followed-up according to the same protocol, with a mean follow-up time of 45 +/- 39 months (range: 2-130). The correlation between marker positivity and the incidence of recurrence was studied by means of univariate and multivariate analyses. RESULTS: A tumor recurrence was found in 92 patients (55.1%). For each of the three markers, preoperative positivity was related to a higher incidence of hematogenous recurrences with respect to negative cases; univariate analysis also revealed a higher incidence of locoregional recurrences in CA 72-4-positive cases. At multivariate analysis, preoperative positivity for one or more tumor markers proved to be an independent predictor of hematogenous recurrences (P < 0.005, relative risk [RR] 4.82), in addition to lymph node involvement (P < 0.05, RR 3.82); no correlation between marker positivity and the onset of locoregional or peritoneal recurrences was found. CONCLUSIONS: Preoperative positivity for CEA, CA 19-9 or CA 72-4 is an independent risk factor for hematogenous recurrences of gastric carcinoma; this aspect should be considered in the option of using adjuvant chemotherapy after surgery for gastric cancer.