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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.


Related in: MedlinePlus

Funnel plots to evaluate publication bias of OS (A), DSS (B) and DFS (C).
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pone.0124151.g003: Funnel plots to evaluate publication bias of OS (A), DSS (B) and DFS (C).

Mentions: The meta-analysis for OS comprised 34 studies including 12605 patients with gastric cancer. HRs and 95% CIs were available in 19 studies[38,39,40,24,41,13,25,42,20,43,21,44,45,46,47,37,48,49,50]. In the remaining studies, the values were extracted from the published survival curves in 14 studies[51,35,52,12,53,54,55,56,17,11,16,57,23,58], and estimated from the variance and its P-value (the Log-rank test) from one study[36] using the statistical methods previously reported[26]. The pooled HR and 95% CI values of these 34 studies were estimated (HR 1.786, 95% CI 1.550–2.060), but significant heterogeneity was observed among these studies with respect to OS (I2 = 77.7%, n = 34, P< 0.001: Table 2). The following sensitivity analysis showed that heterogeneity could be attributed mainly to five studies[11,57,45,58,49]. After excluding the five reports, the significant heterogeneity disappeared (Table 2). In the meta-analysis of the remaining 29 studies, the results suggested that the CEA+ patients with gastric cancer had a worse OS than the CEA- patients (HR 1.716, 95% Cl 1.594–1.848; I2 = 28.8%, P = 0.076, n = 29: Fig 2A). No evidence of publication bias was found in the pooled analysis (Begg test P = 0.329; Egger’s test P = 0.773: Fig 3A). In the following subgroup analysis by cut-off values (CEA >= 5ng/ml versus CEA < 5 ng/ml group), no influence of different the cut-off levels used in the studies was observed (heterogeneity between groups: P = 0.720, in Table 2). In the meta-analysis of the excluded studies[11,57,45,58,49], the pooled HR estimate was 2.276 (95%CI, 1.264–4.098,n = 5; I2 = 96.1%, P< 0.001). A further subgroup analysis was performed to eliminate the heterogeneity among the excluded studies (Table 2). The results indicate that the sample sizes of the included studies might have affected the pooled HR. Although the pooled HR of two studies[45,58] (eligible cases > 1000) was decreased, the conclusion remained unchanged (pooled HR 1.127, 95%CI 1.011–1.258, n = 2, I2 = 0.0%).


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)

Funnel plots to evaluate publication bias of OS (A), DSS (B) and DFS (C).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0124151.g003: Funnel plots to evaluate publication bias of OS (A), DSS (B) and DFS (C).
Mentions: The meta-analysis for OS comprised 34 studies including 12605 patients with gastric cancer. HRs and 95% CIs were available in 19 studies[38,39,40,24,41,13,25,42,20,43,21,44,45,46,47,37,48,49,50]. In the remaining studies, the values were extracted from the published survival curves in 14 studies[51,35,52,12,53,54,55,56,17,11,16,57,23,58], and estimated from the variance and its P-value (the Log-rank test) from one study[36] using the statistical methods previously reported[26]. The pooled HR and 95% CI values of these 34 studies were estimated (HR 1.786, 95% CI 1.550–2.060), but significant heterogeneity was observed among these studies with respect to OS (I2 = 77.7%, n = 34, P< 0.001: Table 2). The following sensitivity analysis showed that heterogeneity could be attributed mainly to five studies[11,57,45,58,49]. After excluding the five reports, the significant heterogeneity disappeared (Table 2). In the meta-analysis of the remaining 29 studies, the results suggested that the CEA+ patients with gastric cancer had a worse OS than the CEA- patients (HR 1.716, 95% Cl 1.594–1.848; I2 = 28.8%, P = 0.076, n = 29: Fig 2A). No evidence of publication bias was found in the pooled analysis (Begg test P = 0.329; Egger’s test P = 0.773: Fig 3A). In the following subgroup analysis by cut-off values (CEA >= 5ng/ml versus CEA < 5 ng/ml group), no influence of different the cut-off levels used in the studies was observed (heterogeneity between groups: P = 0.720, in Table 2). In the meta-analysis of the excluded studies[11,57,45,58,49], the pooled HR estimate was 2.276 (95%CI, 1.264–4.098,n = 5; I2 = 96.1%, P< 0.001). A further subgroup analysis was performed to eliminate the heterogeneity among the excluded studies (Table 2). The results indicate that the sample sizes of the included studies might have affected the pooled HR. Although the pooled HR of two studies[45,58] (eligible cases > 1000) was decreased, the conclusion remained unchanged (pooled HR 1.127, 95%CI 1.011–1.258, n = 2, I2 = 0.0%).

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