A prognostic value of CA 19-9 but not of CEA in patients with gastric cancer.

The diagnostic and prognostic value of tumour markers CEA and CA 19-9 was studied in patients with gastric cancer. Pre-operative serum concentrations of CEA and CA 19-9 were determined in 100 gastric cancer patients and in 77 patients with relevant benign diseases. The sensitivity of both CEA (cut-off level 3 ng/ml) and CA 19-9 (cut-off level 37 U/ml) for gastric cancer was 30%. The specificities were 73% and 87%, respectively. There was a significant difference in prognosis, for both CEA (cut-off level 3 ng/ml, P < 0.05) and CA 19-9 (cut-off level 37 U/ml, P < 0.01), between patients with high vs low pre-operative serum levels. The overall 5-year survival was 26% and that of patients with low marker levels was 30% (CEA) and 35% (CA 19-9) compared with 15% (CEA) and 0% (CA 19-9) for patients with high marker levels. To evaluate whether the high vs low serum marker level was an independent prognostic factor, the patients were compared within the same stage of disease. There was still a significant difference in 5-year survival in stages II, III and IV between patients with high vs low pre-operative serum levels for CA 19-9 (P < 0.05), but not for CEA. In stage I, no differences in survival could be found for either marker. In conclusion, high pre-operative serum levels of CEA seem to predict higher stage of disease, whereas CA 19-9 might have an independent prognostic value in patients within the stage of II, III or IV gastric cancer. The diagnostic value of both CEA and CA 19-9 is limited.