Öz
Aim: Gastric cancer ranks fifth in cancer incidence and fourth in cancer-related deaths worldwide. Carcinoembryonic antigen (CEA) is a tumor marker that has been used for a long time in the diagnosis and follow-up of gastric cancer. We designed our study to investigate the predictive aspect of this marker, whose prognostic aspect has been studied extensively before.
Materials and Methods: Our study is a retrospective study in which five centers from Turkey participated. Patients who applied to the medical oncology outpatient clinic with the diagnosis of gastric cancer between 2015 and 2020 were included in the study. The cut-off value of CEA serum levels was found and the patients were divided into two groups. The effect of cisplatin-based chemotherapy on overall survival in these two groups was investigated.
Results: In patients whose serum CEA level below the cut-off value (n=166), median overall survival of patients who received cisplatin-based chemotherapy (n=94) was calculated as 11.8 months, and 8.1 months in patients who received non-cisplatin-based chemotherapy (n=72) (p=0.037). In patients whose serum CEA level above the cut-off value (n=140) median overall survival of patients who received cisplatin-based chemotherapy (n=85) was calculated as 10.4 months, and 10.6 months in patients who received non-cisplatin-based chemotherapy (n=55) (p=0.36).
Conclusion: In cases with CEA levels below the cut-off value, the overall survival of patients who received cisplatin-based chemotherapy in first-line therapy was found to be statistically significantly longer than patients who received non-cisplatin-based chemotherapy. CEA level can be a predictive tumor marker that affects treatment choice beyond being just prognostic. For this reason, it may be more appropriate to prefer cisplatin-based treatments in the patient population with low CEA levels.
Anahtar Kelimeler
Kaynakça
- Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics 2014. CA Cancer J Clin 2014; 64 (1): 9-29
- GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X, Oba K, Burzykowski T et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA 2010; 303 (17): 1729–37.
- Group G, Oba K, Paoletti X, Bang YJ, Bleiberg H, Burzykowski T, et al. Role of chemotherapy for advanced/recurrent gastric cancer: an individual patient-data meta-analysis. Eur J Cancer.2013; 49 (7): 1565–77.
- Cristescu R, Lee J, Nebozhyn M, Kim KM, Ting JC, Wong SS, et al. Molecular analysis of gastric cancer identifies subtypes associated with distinct clinical outcomes. Nat Med. 2015; 21 (5): 449–56.
- Chivu-Economescu M, Matei L, Necula LG, Dragu DL, Bleotu C, Diaconu CC. New therapeutic options opened by themolecular classification of gastric cancer. World J Gastroenterol. 2018; 24 (18): 1942–61.
- Posner MR, Mayer RJ. The use of serologic tumor markers in gastrointestinal malignancies. Hematol Oncol Clin N Am. 1994; 8 (3): 533–53.
- Takahashi Y, Takeuchi T, Sakamoto J, et al. The usefulness of CEA and/or CA19-9 in monitoring for recurrence in gastric cancer patients: a prospective clinical study. Gastric Cancer.2003; 6 (3): 142–5.
- Benchimol S, Fuks A, Jothy S, Beauchemin N, Shirota K, Stanners CP. Carcinoembryonic antigen, a human tumor marker, functions as an intercellular adhesion molecule. Cell 1989;/57:/327-34.
- Thompson J, Zimmermann W, Osthus-Bugat P, et al. Long-range chromosomal mapping of the carcinoembryonic antigen (CEA) gene family cluster. Genomics. 1992; 12 (4): 761–72.
- Tamada R, Hiramoto Y, Tsujitani S, et al. Serum CEA levels facilitate detection of recurrences of cancer in patients after gastrectomy. Jpn J Surg. 1985; 15 (1): 23–9.
- Caponetti R, Caponetti T, Vici P. Changes in tumor markers CEA, Ca 19-9 and Ca 125 in monitoring of response to chemotherapy in elderly patients with advanced gastric cancer. Clin Ter 2002;/153:/373-5.
- Al-Batran SE, Hartmann JT, Probst S, et al. Phase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol 2008; 26: 1435.
- Cunningham D, Starling N, Rao S, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 2008; 358: 36.
- Yamada Y, Higuchi K, Nishikawa K, et al. Phase III study comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapy-naïve patients with advanced gastric cancer. Ann Oncol 2015; 26: 141.
- Kang YK, Chin K, Chung HC, et al. S-1 plus leucovorin and oxaliplatin versus S-1 plus cisplatin as first-line therapy in patients with advanced gastric cancer (SOLAR): a randomised, open-label, phase 3 trial. Lancet Oncol 2020; 21: 1045.
- Van Cutsem E, Moiseyenko VM, Tjulandin S, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 2006; 24: 4991–7.
Öz
Giriş: Mide kanseri dünya genelinde kanser sıklığında beşinci sırada, kansere bağlı ölümlerde de dördüncü sıradadır. Karsinoembriyonik antijen (CEA) mide kanserinin takibinde sıklıkla kullanılan bir tümör markeridir. Daha önce prognostik yönü çok çalışılmış olan bu markerin tedaviyi belirleyici (prediktif) yönünü araştırmak amacıyla çalışmamız şekillendirilmiştir.
Gereç ve Yöntem: Çalışmamız retrospektif, Türkiye’den beş merkezin katıldığı, 2015-2020 yılları arasında tıbbi onkoloji polikliniğine başvuran hastaların dahil edildiği bir çalışmadır. Karsinoembriyonik antijen serum seviyelerinin kestirim (cut-off) değeri belirlendi. Hastalar serum CEA düzeyi kestirim değerinin altında ve üstünde olmak üzere iki gruba ayrıldı. Bu gruplarda sisplatin temelli kemoterapiler ile sisplatin temelli olmayan kemoterapilerin genel sağ kalım üzerine etkisi karşılaştırıldı.
Bulgular: CEA kestirim değerinin altındaki hastalarda (n=166) sisplatin temelli kemoterapi alan olguların (n=94) genel sağ kalımı medyan 11,8 ay, sisplatin temelli olmayan kemoterapi alan olguların (n=72) 8,1 ay olarak hesaplandı (p=0,037). CEA kestirim değerinin üzerindeki hastalarda (n=140) sisplatin temelli kemoterapi alan olguların (n=85) medyan genel sağ kalımı 10,4 ay, sisplatin temelli olmayan kemoterapi alan hastalarda (n=55) 10,6 ay olarak hesaplandı (p=0,36).
Sonuç: Çalışmamızda serum CEA düzeyi kestirim değerinin altında saptanan olgularda, birinci basamak tedavide sisplatin temelli kemoterapi alan hastaların genel sağ kalımı, sisplatin temelli olmayan kemoterapi alan hastaların genel sağ kalımına göre istatistiki olarak anlamlı şekilde daha uzun bulunmuştur. Bu sonuca göre CEA tedavi tercihini etkileyen prediktif bir tümör markeri olarak değerlendirilebilir. CEA düzeyi düşük olan hasta popülasyonunda sisplatin temelli tedavilerin tercih edilmesi daha uygun olabilir.
Anahtar Kelimeler
Kaynakça
- Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics 2014. CA Cancer J Clin 2014; 64 (1): 9-29
- GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X, Oba K, Burzykowski T et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA 2010; 303 (17): 1729–37.
- Group G, Oba K, Paoletti X, Bang YJ, Bleiberg H, Burzykowski T, et al. Role of chemotherapy for advanced/recurrent gastric cancer: an individual patient-data meta-analysis. Eur J Cancer.2013; 49 (7): 1565–77.
- Cristescu R, Lee J, Nebozhyn M, Kim KM, Ting JC, Wong SS, et al. Molecular analysis of gastric cancer identifies subtypes associated with distinct clinical outcomes. Nat Med. 2015; 21 (5): 449–56.
- Chivu-Economescu M, Matei L, Necula LG, Dragu DL, Bleotu C, Diaconu CC. New therapeutic options opened by themolecular classification of gastric cancer. World J Gastroenterol. 2018; 24 (18): 1942–61.
- Posner MR, Mayer RJ. The use of serologic tumor markers in gastrointestinal malignancies. Hematol Oncol Clin N Am. 1994; 8 (3): 533–53.
- Takahashi Y, Takeuchi T, Sakamoto J, et al. The usefulness of CEA and/or CA19-9 in monitoring for recurrence in gastric cancer patients: a prospective clinical study. Gastric Cancer.2003; 6 (3): 142–5.
- Benchimol S, Fuks A, Jothy S, Beauchemin N, Shirota K, Stanners CP. Carcinoembryonic antigen, a human tumor marker, functions as an intercellular adhesion molecule. Cell 1989;/57:/327-34.
- Thompson J, Zimmermann W, Osthus-Bugat P, et al. Long-range chromosomal mapping of the carcinoembryonic antigen (CEA) gene family cluster. Genomics. 1992; 12 (4): 761–72.
- Tamada R, Hiramoto Y, Tsujitani S, et al. Serum CEA levels facilitate detection of recurrences of cancer in patients after gastrectomy. Jpn J Surg. 1985; 15 (1): 23–9.
- Caponetti R, Caponetti T, Vici P. Changes in tumor markers CEA, Ca 19-9 and Ca 125 in monitoring of response to chemotherapy in elderly patients with advanced gastric cancer. Clin Ter 2002;/153:/373-5.
- Al-Batran SE, Hartmann JT, Probst S, et al. Phase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol 2008; 26: 1435.
- Cunningham D, Starling N, Rao S, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 2008; 358: 36.
- Yamada Y, Higuchi K, Nishikawa K, et al. Phase III study comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapy-naïve patients with advanced gastric cancer. Ann Oncol 2015; 26: 141.
- Kang YK, Chin K, Chung HC, et al. S-1 plus leucovorin and oxaliplatin versus S-1 plus cisplatin as first-line therapy in patients with advanced gastric cancer (SOLAR): a randomised, open-label, phase 3 trial. Lancet Oncol 2020; 21: 1045.
- Van Cutsem E, Moiseyenko VM, Tjulandin S, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 2006; 24: 4991–7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Mart 2022 |
| Gönderilme Tarihi | 8 Ekim 2021 |
| Yayımlandığı Sayı | Yıl 2022 |