Prognostic significance of carcinoembryonic antigen levels in peritoneal washes in patients with gastric cancer

Background: Peritoneal metastasis is the most frequent cause of death in pa tients with gastric cancer. Detection of free cancer cells in the peritonea l cavity at the time of surgery, therefore, is considered to be of great va lue in predicting the peritoneal recurrence and accordingly in the prognosi s in patients with gastric cancer. This study examined the clinical signifi cance of intraoperative determination of carcinoembryonic antigen (CEA) lev els in peritoneal washes (pCEA) in patients with gastric cancer. Methods: CEA levels in peritoneal washes were correlated retrospectively wi th several clinicopathologic factors including clinical outcome in 56 patie nts with resectable gastric cancer. Results: Among several clinicopathologic factors, the depth of tumor invasi on significantly and independently correlated with pCEA levels as revealed by multivariate stepwise logistic regression analysis. A Significant differ ence in overall survival rates was observed between pCEA-positive and pCEA- negative groups: 5-year survival rates were 95.7% in pCEA-negative and 20% in pCEA-positive patients(P <0.0001). Multivariate analysis indicated that pCEA level is a statistically significant independent prognostic factor for the survival of patients with gastric cancer, and is an important factor f or predicting peritoneal recurrence. Conclusions: pCEA could be a potential predictor of a poor prognosis as wel l as peritoneaI recurrence in patients with gastric cancer. We believe that this information could contribute to determining the optimal intraoperativ e and postoperative therapeutic plan including adjuvant chemotherapy of gas tric cancer. (C) 2001 Excerpta Medica, Inc. All rights reserved.