CHANGES IN TUMOR-MARKER LEVELS AS A PREDICTOR OF CHEMOTHERAPEUTIC EFFECT IN PATIENTS WITH GASTRIC-CARCINOMA

BACKGROUND. Evaluating chemotherapeutic effect in patients with gastri c carcinoma sometimes is difficult. The authors investigated whether c hanges in the serum levels of three tumor markers can be used to predi ct the clinical outcome after chemotherapy. METHODS. Thirty patients w ith advanced and recurrent gastric carcinoma were treated with continu ous 5-fluorouracil and low dose cisplatin for 4 weeks. Thirteen patien ts were treated neoadjuvantly prior to gastrectomy. The serum levels o f carcinoembryonic antigen, carbohydrate antigen 19-9, and sialyl-Tn a ntigen were measured prior to and after chemotherapy. Responders were defined as those in whom abnormal serum levels of all three markers de creased to at least 50% of the pretreatment values and remained stable for at least 1 month. RESULTS. The tumor markers could be evaluated i n 27 of 30 patients (90%). The median duration of survival for the 15 responders and 12 nonresponders was 17 months and 6 months, respective ly. There was a significant difference in the median duration of survi val between the responders and nonresponders using the log rank test ( P = 0.0005). In the patients who received neoadjuvant therapy, the eig ht responders had a significantly longer survival period than did the three nonresponders (P = 0.018). Seven of the eight responders showed evidence of tumor destruction histologically whereas none of the three nonresponders did. CONCLUSIONS. Changes in the serum levels of these tumor markers after chemotherapy may be an excellent prognostic indica tor for patients with gastric carcinoma. (C) 1998 American Cancer Soci ety.