Changing patterns of Serum CEA and CA199 for Evaluating the Response to First-line Chemotherapy in Patients with Advanced Gastric Adenocarcinoma

  • He, Bo (The Third Department of Medical Oncology, Jiangxi Cancer Hospital) ;
  • Zhang, Hui-Qing (The Third Department of Medical Oncology, Jiangxi Cancer Hospital) ;
  • Xiong, Shu-Ping (The Second Department of Radiotherapy, Jiangxi Cancer Hospital) ;
  • Lu, Shan (The Third Department of Medical Oncology, Jiangxi Cancer Hospital) ;
  • Wan, Yi-Ye (The Third Department of Medical Oncology, Jiangxi Cancer Hospital) ;
  • Song, Rong-Feng (The Third Department of Medical Oncology, Jiangxi Cancer Hospital)
  • Published : 2015.04.29


Background: This study was designed to investigate the value of CEA and CA199 in predicting the treatment response to palliative chemotherapy for advanced gastric cancer. Materials and Methods: We studied 189 patients with advanced gastric cancer who received first-line chemotherapy, measured the serum CEA and CA199 levels, used RECIST1.1 as the gold standard and analyzed the value of CEA and CA199 levels changes in predicting the treatment efficacy of chemotherapy. Results: Among the 189 patients, 80 and 94 cases had increases of baseline CEA (${\geq}5ng/ml$) and CA199 levels (${\geq}27U/ml$), respectively. After two cycles of chemotherapy, 42.9% patients showed partial remission, 33.3% stable disease, and 23.8% progressive disease. The area under the ROC curve (AUC) for CEA and CA199 reduction in predicting effective chemotherapy were 0.828 (95%CI 0.740-0.916) and 0.897 (95%CI 0.832-0.961). The AUCs for CEA and CA199 increase in predicting progression after chemotherapy were 0.923 (95%CI 0.865-0.980) and 0.896 (95%CI 0.834-0.959), respectively. Patients who exhibited a CEA decline ${\geq}24%$ and a CA199 decline ${\geq}29%$ had significantly longer PFS (log rank p=0.001, p<0.001). With the exception of patients who presented with abnormal levels after chemotherapy, changes of CEA and CA199 levels had limited value for evaluating the chemotherapy efficacy in patients with normal baseline tumor markers. Conclusions: Changes in serum CEA and CA199 levels can accurately predict the efficacy of first-line chemotherapy in advanced gastric cancer. Patients with levels decreasing beyond the optimal critical values after chemotherapy have longer PFS.


Supported by : China National Natural Science


  1. Arrieta OG, Villarreal GC, Martinez BL, et al (2013). Usefulness of Serum Carcinoembryonic Antigen (CEA) in evaluating response to chemotherapy in patients with advanced non small-cell lung cancer, a prospective cohort study. BMC Cancer, 13, 254.
  2. Bang YJ, Van CE, Feyereislova A, et al (2010). Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastrooesophageal junction cancer (ToGA), a phase 3, open-label, randomised controlled trial. Lancet, 376, 687-97.
  3. Bertuccio P, Chatenoud L, Levi F, et al (2009). Recent patterns in gastric cancer, a global overview. Int J Cancer, 125, 666-73
  4. Caponetti R, Caponetti T, Vici P (2002). Changes in tumor markers CEA, Ca 19-9 and Ca125 in monitoring of response to chemotherapy in elderly patients with advanced gastric cancer. Clin Ter, 153, 373-5.
  5. Eisenhauer EA, Therasse P, Bogaerts J, et al (2009). New response evaluation criteria in solid tumors, revised RECIST guideline (version 1.1). Eur J Cancer, 45, 228-47.
  6. Erasmus JJ, Gladish GW, Broemeling L, et al (2003). Interobserver and intraobserver variability in measurement of non-small-cell carcinoma lung lesions, implications for assessment of tumor response. J Clin Oncol, 21, 2574-82.
  7. Greiner M, Pfeiffer D, Smith RD (2000). Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med, 45, 23-41
  8. Guppy AE, Rustin GJ (2007). CA125 response, can it replace the traditional response criteria in ovarian cancer? Oncologist, 7, 437-43
  9. Hanke B, Riedel C, Lampert S, et al (2001). CEA and CA 19-9 measurement as a monitoring parameter in metastatic colorectal cancer (CRC) under palliative first-line chemotherapy with weekly 24-hour infusion of high-dose 5-fluorouracil (5-FU) and folinic acid (FA). Ann Oncol, 12, 221-6
  10. Holdenrieder S, von PJ, Dankelmann E, et al (2009). Nucleosomes and CYFRA 21-1 indicate tumor response after one cycle of chemotherapy in recurrent non-small cell lung cancer. Lung Cancer, 63, 128-35
  11. Iwanicki-CI, Di FF, Roque I, et al (2008). Usefulness of the serum carcinoembryonic antigen kinetic for chemotherapy monitoring in patients with unresectable metastasis of colorectal cancer. J Clin Oncol, 26, 3681-6.
  12. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90.
  13. Kim DH, Kim SM, Hyun JK, et al (2013). Changes in postoperative recurrence and prognostic risk factors for patients with gastric cancer who underwent curative gastric resection during different time periods. Ann Surg Oncol, 20, 2317-27.
  14. Kim DH, Oh SJ, Oh CA, et al (2011). The relationships between perioperative CEA, CA 19-9, and CA 72-4 and recurrence in gastric cancer patients after curative radical gastrectomy. J Surg Oncol, 104, 585-91.
  15. Kim G, Jung EJ, Ryu CG, et al (2010). Usefulness of carcinoembryonic antigen for monitoring tumor progression during palliative chemotherapy in metastatic colorectal cancer. Yonsei Med J, 54, 116-22.
  16. Kim HJ, Lee KW, Kim YJ, et al (2009). Chemotherapy-induced transient CEA and CA19-9 surges in patients with metastatic or recurrent gastric cancer. Acta Oncol, 48, 385-90.
  17. Kochi M, Fujii M, Kanamori N, et al (2000). Evaluation of serum CEA and CA19-9 levels as prognostic factors in patients with gastric cancer. Gastric Cancer, 3, 177-86.
  18. Macdonald JS (2006). Gastric cancer-new therapeutic options. N Engl J Med, 355, 76-7.
  19. Wagner AD, Grothe W, Haerting J, et al (2006). Chemotherapy in advanced gastric cancer, a systematic review and metaanalysis based on aggregate data. J Clin Oncol, 24, 2903-9
  20. Shimada H, Noie T, Ohashi M, et al (2014). Clinical significance of serum tumor markers for gastric cancer, a systematic review of literature by the Task Force of the Japanese Gastric Cancer Association. Gastric Cancer, 17, 26-33.
  21. Takahashi Y, Takeuchi T, Sakamoto J, et al (2003). The usefulness of CEA and/or CA19-9 in monitoring for recurrence in gastric cancer patients, a prospective clinical study. Gastric Cancer, 6, 142-5.
  22. Van CE, Moiseyenko VM, Tjulandin S, et al (2006). 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, 24, 4991-7.
  23. Yamao T, Kai S, Kazami A, et al (1999). Tumor markers CEA, CA19-9 and CA125 in monitoring of response to systemic chemotherapy in patients with advanced gastric cancer. Jpn J Clin Oncol, 29, 550-5.