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

Xinyue Qiu; Cheng Shen; Wenjing Zhao; Xunlei Zhang; Dakun Zhao; Yueyue Zhu; Guoxing Li; Lei Yang

doi:10.7150/jca.67600

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

J Cancer. 2022 Apr 11;13(7):2246-2257. doi: 10.7150/jca.67600. eCollection 2022.

Authors

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

Affiliations

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.

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: CEA; gastric carcinoma; hemoglobin; patients; survival.