Session Item

Sunday
August 29
16:45 - 17:45
Room 1
Proffered papers 25: Upper GI
Karin Haustermans, Belgium;
Thomas Brunner, Austria
1770
Proffered papers
Clinical
16:45 - 16:55
The prognostic value of tumor markers in patients with resectable gastric cancer
Astrid Slagter, The Netherlands
OC-0411

Abstract

The prognostic value of tumor markers in patients with resectable gastric cancer
Authors:

Astrid Slagter1, Marieke Vollebergh2, Irene Caspers3,4, Johanna van Sandick5, Karolina Sikorska6, Pehr Lind7,8, Marianne Nordsmark9, Hein Putter10, Jeffrey Braak11, Elma Meershoek-Klein Kranenbarg11, Cornelis van de Velde12, Edwin Jansen1, Annemieke Cats3, Hanneke van Laarhoven13, Nicole van Grieken4, Marcel Verheij1,14

1Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands; 2Netherlands Cancer Institute, Medical Oncology, Amsterdam, The Netherlands; 3Netherlands Cancer Institute, Gastrointestinal Oncology, Amsterdam, The Netherlands; 4Amsterdam University Medical Centers, Pathology, Amsterdam, The Netherlands; 5Netherlands Cancer Institute, Surgery, Amsterdam, The Netherlands; 6Netherlands Cancer Institute, Biometrics, Amsterdam, The Netherlands; 7Stockholm Söder Hospital, Oncology, Stockholm, Sweden; 8Karolinska Institutet, Oncology, Stockholm, Sweden; 9Aarhus University, Medical Oncology, Aarhus, Denmark; 10Leiden University Medical Center, Biometrics, Leiden, The Netherlands; 11Leiden University Medical Center, Surgery, Leiden, The Netherlands; 12Surgery, Leiden University Medical Center, Leiden, The Netherlands; 13Amsterdam University Medical Centers, Medical Oncology, Amsterdam, The Netherlands; 14Radboud University Medical Center, Radiation Oncology, Nijmegen, The Netherlands

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Purpose or Objective

Carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are well-known tumor markers. Most studies on CEA and CA 19-9 in patients with gastric cancer were performed in Asia, and/or in the metastatic setting. The aim of this study was to investigate the prognostic value of blood derived laboratory parameters in a cohort of European patients with resectable non-metastatic gastric cancer treated with perioperative chemo(radio)therapy.

Material and Methods

In the CRITICS trial,  788 patients with resectable gastric cancer were randomized between preoperative chemotherapy (3 cycles of epirubicin, cisplatin/oxaliplatin, and capecitabine (ECC/EOC)) plus postoperative chemotherapy (3 cycles of ECC/EOC) or preoperative chemotherapy (3 cycles of ECC/EOC) plus postoperative chemoradiotherapy (45 Gy in 25 fractions of 1.8 Gy plus capecitabine and cisplatin). Blood levels of CEA, CA 19-9, alkaline phosphatase, creatinine, neutrophils, hemoglobin and lactate dehydrogenase were determined prior to treatment. Data for these variables were available for at least 89% of the patients. Factors significant on univariable cox regression analysis were further explored in multivariable analysis. Probabilities to undergo potentially curative surgery was investigated for factors significant on multivariable analysis. The relationship between tumor markers and the presence of circulating tumor DNA (ctDNA) was explored in 50 patients with available ctDNA data.

Results

CEA and CA 19-9 were identified as independent prognostic factors for survival in multivariable analysis (Table 1). Probabilities to undergo potentially curative surgery were 86%, 77% and 60% for patients with no elevated tumor makers versus those with elevated CEA or elevated CA 19-9 versus those with both tumor markers elevated, respectively (p<0.001). No relationship was found between elevated tumor marker(s) and the presence of ctDNA neither pretreatment nor preoperatively.

Conclusion

Pretreatment blood levels of CEA and CA 19-9 were identified as prognostic factors for overall survival in a large cohort of European gastric cancer patients with potentially curable disease. Tumor markers may guide treatment choices at an early phase but might in the future also be included in a decision tool whether or not to offer postoperative chemo(radio)therapy.