Clinical significance and prognostic value of CA72-4 compared with CEA andCA19-9 in patients with gastric cancer

Carcinoembryonic antigen (CEA) and CA 19-9 are both widely used in the foll ow up of patients with gastrointestinal cancer. More recently another tumor marker, named CA 72-4 has been identified and characterized using two diff erent monoclonal antibodies B72.3 and CC49. Several reports evaluated CA 72 -4 as a serum tumor marker for gastric cancer and compared its clinical uti lity with that of CEA or CA 19-9; few reports concerned its prognostic valu e. In the present study, CA 72-4 is evaluated and compared with CEA and CA 19-9 in various populations of patients with gastric cancer and benign dise ase; for 52 patients with gastric adenocarcinoma and 57 patients without ne oplastic disease CEA, CA 19-9 and CA 72-4 were evaluated before treatment. Sensitivity of the tumor markers CA 72-4, CA 19-9 and CEA at the recommende d cut-off level in all 52 patients were 58%, 50% and 35% respectively. When all three markers were used, the sensitivity increased to 75%. Concerning the prognostic value of these markers, for non metastatic patients, multiva riate analyses indicated that none of the markers were significant, when ad justed for gender and age (which were indicators of poor prognosis); patien ts with abnormal values of CA72-4 tended to have shorter survival than pati ents with normal values (p < 0.07). In the metastatic population, only high values of CA19-9 (p < 0.02) and gender (women) (p < 0.03) were indicators of poor prognosis in univariate analysis; multivariate analysis revealed th at both CA72-4 (p = 0.034) and CA19-9 (p = 0.009), adjusted for gender were independent prognostic factors. However, CA72-4 lost significance (p = 0.4 1) when adjusted for CA 19-9 and gender, indicating that CA 19-9 provides m ore prognostic information than CA72-4. When limited to the metastatic male population with normal values of CA 19- 9 and CEA, CA 72-4 pretherapeutic positive levels were associated with a wo rse prognosis (p < 0.005). In conclusion, this study suggests that the addition of CA 72-4 to CEA and/ or CA 19-9 could improve sensitivity in gastric cancer. The prognostic role of this marker is not yet clearly demonstrated but its usefulness in the m onitoring of gastric cancer should be taken into account.