J Cancer 2022; 13(7):2246-2257. doi:10.7150/jca.67600 This issue

Research Paper

Prognostic Value of the Combination of HB (hemoglobin) and CEA in Resectable Gastric Cancer

Xinyue Qiu1*, Cheng Shen2*, Wenjing Zhao1*, Xunlei Zhang3, Dakun Zhao1, Yueyue Zhu4, Guoxing Li5✉, Lei Yang3✉

1. Cancer Research Center, Affiliated Tumor Hospital of Nantong University, Nantong Jiangsu, China
2. Department of Computer Science and Engineering, Tandon School of Engineering, New York University, Brooklyn, NY 11201, US
3. Department of Oncology, Affiliated Tumor Hospital of Nantong University, Nantong Jiangsu, China
4. Department of Oncology, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
5. Department of Surgery, Affiliated Tumor Hospital of Nantong University, Nantong Jiangsu, China
*These authors contributed equally to this work.

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Citation:
Qiu X, Shen C, Zhao W, Zhang X, Zhao D, Zhu Y, Li G, Yang L. Prognostic Value of the Combination of HB (hemoglobin) and CEA in Resectable Gastric Cancer. J Cancer 2022; 13(7):2246-2257. doi:10.7150/jca.67600. Available from https://www.jcancer.org/v13p2246.htm

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Abstract

Graphic abstract

Objective: In order to investigate the prognostic value of a novel biomarker combining serum carcinoembryonic antigen (CEA) and hemoglobin (HB) levels in patients with resectable gastric cancer.

Introduction: This retrospective study assessed the relationship between CEA, hemoglobin levels, a novel combined prognostic biomarker (HB-CEA) and clinicopathological features of gastric cancer. Their prognostic values in gastric cancer were also analyzed.

Materials and Methods: This retrospective study evaluated the CEA, hemoglobin levels and clinicopathological features of patients with resectable gastric cancer. Kaplan-Meier curves, univariate and multivariate Cox proportional models were used to determine the prognostic significance of these factors for overall survival (OS) in the training and validation sets (n=353 and n=388, respectively). Based on optimal cutoff values of CEA and hemoglobin (3.395 ng/mL and 125.5 g/L, respectively), patients were stratified into three groups: HB-CEA=0, 1, and 2 (CEA <3.395 ng/mL and HB ≥125.5 g/L; CEA ≥3.395 ng/mL or HB <125.5 g/L; and CEA ≥3.395 ng/mL and HB <125.5 g/L, respectively).

Results: The area under the curve was larger for HB-CEA than for either HB or CEA alone (training set: 0.677, 0.650, and 0.629; validation set: 0.670, 0.605, and 0.605, respectively). HB-CEA was strongly associated with age, tumor size, differentiation, pathological TNM stage (pTNM), depth of tumor invasion, lymph node metastasis, and survival status (all p<0.05). A higher HB-CEA score correlated with poor survival (Kaplan-Meier curves, all p<0.05). Multivariate analysis showed that HB-CEA was an independent prognostic factor for OS (p<0.05).

Conclusion: Preoperative HB-CEA, as a potential novel hematological biomarker, can predict the progression of gastric cancer and the prognosis of patients, and is of great value in guiding clinical practice. Therefore, patients with a higher HB-CEA score should receive more extensive follow-up for early detection and intervention of tumor progression.

Keywords: hemoglobin, CEA, gastric carcinoma, patients, survival