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The prognostic significance of pretreatment serum CEA levels in gastric cancer: a meta-analysis including 14651 patients.

Deng K, Yang L, Hu B, Wu H, Zhu H, Tang C - PLoS ONE (2015)

Bottom Line: Data on 14651 eligible patients were retrieved for the meta-analysis.The CEA+ patients had a significantly poorer prognosis than the CEA- patients in terms of overall survival (OS: HR 1.716, 95% CI 1.594 - 1.848, P< 0.001), disease-specific survival (DSS: HR 1.940, 95% CI 1.563 - 2.408, P< 0.001), and disease-free survival (DFS: HR 2.275, 95% CI 1.836 - 2.818, P< 0.001).Publication bias and an influence of different cut-off values were not observed (all P> 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

ABSTRACT

Background: Carcinoembryonic antigen (CEA) is commonly used as a serum tumor marker in clinical practice; however, its prognostic value for gastric cancer patients remains uncertain. This meta-analysis was performed to assess the prognostic value of CEA and investigate CEA as a tumor marker.

Methods: PubMed, EMBASE and other databases were searched for potentially eligible studies. Forty-one studies reporting the prognostic effect of pretreatment serum CEA expression in gastric cancer patients were selected. Data on 14651 eligible patients were retrieved for the meta-analysis. Based on the data extracted from the available literature, the hazard ratio (HR) and 95% confidence interval (CI) for an adverse prognosis were estimated for gastric cancer patients with elevated pretreatment serum levels of CEA (CEA+) relative to patients with normal pretreatment CEA levels (CEA-).

Results: The CEA+ patients had a significantly poorer prognosis than the CEA- patients in terms of overall survival (OS: HR 1.716, 95% CI 1.594 - 1.848, P< 0.001), disease-specific survival (DSS: HR 1.940, 95% CI 1.563 - 2.408, P< 0.001), and disease-free survival (DFS: HR 2.275, 95% CI 1.836 - 2.818, P< 0.001). Publication bias and an influence of different cut-off values were not observed (all P> 0.05). In the pooled analyses of multivariate-adjusted HRs, the results suggested that pretreatment serum CEA may be an independent prognostic factor in gastric cancer (OS: HR 1.681, 95% CI 1.425 - 1.982; DSS: HR 1.900, 95% CI 1.441 - 2.505; DFS: HR 2.579, 95% CI 1.935 - 3.436).

Conclusion/significance: The meta-analysis based on the available literature supported the association of elevated pretreatment serum CEA levels with a poor prognosis for gastric cancer and a nearly doubled risk of mortality in gastric cancer patients. CEA may be an independent prognostic factor for gastric cancer patients and may aid in determining appropriate treatment which may preferentially benefit the CEA+ patients.

No MeSH data available.


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Flow chart of the meta-analysis.
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pone.0124151.g001: Flow chart of the meta-analysis.

Mentions: All articles retrieved in the systemic search were independently assessed by two reviewers (Kai Deng and Chengwei Tang) for eligibility using the following inclusion criteria: (i) all participating patients were histologically diagnosed with gastric carcinoma; (ii) studies included pretreatment CEA levels in blood; and (iii) the hazard ratio (HR) for adverse prognosis for patients with elevated pretreatment levels of CEA(CEA+) versus those with normal CEA levels (CEA-) could be extracted from multivariate Cox’s hazards proportional analysis, Kaplan-Meier survival curves or log-rank tests available in the papers. The exclusion criteria were as follow: (i) non-original research articles (such as reviews, comments, letters, conference abstracts, case reports); (ii) a small data set (eligible patients < 60); (iii) studies aimed at the effect of chemotherapy, immunotherapy, radiotherapy or novel treatment; (iv) studies published in non-English languages; and (v) the required data were not available. The flow chart for study selection is shown in Fig 1. If the data sets overlapped or were duplicated, those articles with more information were retained. For articles written by the same authors or that reported results obtained from the same series of patients in multiple publications were identified, the largest or the most informative study was retained.


The prognostic significance of pretreatment serum CEA levels in gastric cancer: a meta-analysis including 14651 patients.

Deng K, Yang L, Hu B, Wu H, Zhu H, Tang C - PLoS ONE (2015)

Flow chart of the meta-analysis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400039&req=5

pone.0124151.g001: Flow chart of the meta-analysis.
Mentions: All articles retrieved in the systemic search were independently assessed by two reviewers (Kai Deng and Chengwei Tang) for eligibility using the following inclusion criteria: (i) all participating patients were histologically diagnosed with gastric carcinoma; (ii) studies included pretreatment CEA levels in blood; and (iii) the hazard ratio (HR) for adverse prognosis for patients with elevated pretreatment levels of CEA(CEA+) versus those with normal CEA levels (CEA-) could be extracted from multivariate Cox’s hazards proportional analysis, Kaplan-Meier survival curves or log-rank tests available in the papers. The exclusion criteria were as follow: (i) non-original research articles (such as reviews, comments, letters, conference abstracts, case reports); (ii) a small data set (eligible patients < 60); (iii) studies aimed at the effect of chemotherapy, immunotherapy, radiotherapy or novel treatment; (iv) studies published in non-English languages; and (v) the required data were not available. The flow chart for study selection is shown in Fig 1. If the data sets overlapped or were duplicated, those articles with more information were retained. For articles written by the same authors or that reported results obtained from the same series of patients in multiple publications were identified, the largest or the most informative study was retained.

Bottom Line: Data on 14651 eligible patients were retrieved for the meta-analysis.The CEA+ patients had a significantly poorer prognosis than the CEA- patients in terms of overall survival (OS: HR 1.716, 95% CI 1.594 - 1.848, P< 0.001), disease-specific survival (DSS: HR 1.940, 95% CI 1.563 - 2.408, P< 0.001), and disease-free survival (DFS: HR 2.275, 95% CI 1.836 - 2.818, P< 0.001).Publication bias and an influence of different cut-off values were not observed (all P> 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

ABSTRACT

Background: Carcinoembryonic antigen (CEA) is commonly used as a serum tumor marker in clinical practice; however, its prognostic value for gastric cancer patients remains uncertain. This meta-analysis was performed to assess the prognostic value of CEA and investigate CEA as a tumor marker.

Methods: PubMed, EMBASE and other databases were searched for potentially eligible studies. Forty-one studies reporting the prognostic effect of pretreatment serum CEA expression in gastric cancer patients were selected. Data on 14651 eligible patients were retrieved for the meta-analysis. Based on the data extracted from the available literature, the hazard ratio (HR) and 95% confidence interval (CI) for an adverse prognosis were estimated for gastric cancer patients with elevated pretreatment serum levels of CEA (CEA+) relative to patients with normal pretreatment CEA levels (CEA-).

Results: The CEA+ patients had a significantly poorer prognosis than the CEA- patients in terms of overall survival (OS: HR 1.716, 95% CI 1.594 - 1.848, P< 0.001), disease-specific survival (DSS: HR 1.940, 95% CI 1.563 - 2.408, P< 0.001), and disease-free survival (DFS: HR 2.275, 95% CI 1.836 - 2.818, P< 0.001). Publication bias and an influence of different cut-off values were not observed (all P> 0.05). In the pooled analyses of multivariate-adjusted HRs, the results suggested that pretreatment serum CEA may be an independent prognostic factor in gastric cancer (OS: HR 1.681, 95% CI 1.425 - 1.982; DSS: HR 1.900, 95% CI 1.441 - 2.505; DFS: HR 2.579, 95% CI 1.935 - 3.436).

Conclusion/significance: The meta-analysis based on the available literature supported the association of elevated pretreatment serum CEA levels with a poor prognosis for gastric cancer and a nearly doubled risk of mortality in gastric cancer patients. CEA may be an independent prognostic factor for gastric cancer patients and may aid in determining appropriate treatment which may preferentially benefit the CEA+ patients.

No MeSH data available.


Related in: MedlinePlus