MARKED ELEVATION OF PLASMA CARCINOEMBRYONIC ANTIGEN AND STOMACH CARCINOMA

BACKGROUND. This study was undertaken to clarify the relationship betw een marked elevation of plasma carcinoembryonic antigen (CEA) and sign er ring cell carcinoma of the stomach. METHODS. To elucidate the contr ibuting factor of extreme elevation of plasma CEA value, the histologi c and biochemical records for 310 cases of stomach carcinoma, includin g 202 advanced and 108 early, collected between 1980 to 1994 from the San-in Rosai Hospital and Tottori University Hospital were studied. Im munohistochemical localization of CEA in the stomach was performed usi ng a peroxidase antiperoxidase (PAP) staining technique. RESULTS. Amon g 310 cases of gastric carcinoma, 44 (14%) had abnormal plasma CEA val ues. The positivity rates of early and advanced gastric carcinoma were 3.7% (4/18) and 19% (40/202), respectively. Concerning advanced gastr ic carcinoma, 20 cases had more than 51 ng/mL, and 20 cases had betwee n 5 ng/mL and 50 ng/mL. Four cases with plasma CEA values of more than 1,000 ng/mL had histological signer ring cell carcinoma (one case), a nd poorly differentiated adenocarcinoma with signet ring cell carcinom a (2 cases). Three cases of signet ring cell carcinoma or poorly diffe rentiated adenocarcinoma of the stomach were massive local infiltratio n rather than hepatic metastasis. Among 40 cases with elevated plasma CEA, a multivariate regression analysis showed that only one variable (lymph node metastasis) was an independent factor (P < 0.05). Signific antly higher rates of peritoneal metastasis (P < 0.0001) and lymph nod e metastasis (P < 0.05) were observed in patients with marked elevatio ns of plasma CEA than in patients with moderate elevations of plasma C EA. No correlation was obtained between plasma CEA value and several b iochemical tests. CONCLUSIONS. Marked elevation of plasma CEA may be f ound in the absence of liver metastasis from signet ring or poorly dif ferentiated gastric carcinoma. Patients with marked elevations of CEA also had lymphatic and peritoneal dissemination. (C) 1996 American Can cer Society.