Prognostic significance of tumor markers in peritoneal lavage in advanced gastric cancer

Oncology. 2004;67(1):19-26. doi: 10.1159/000080281.


Objective: Predicting peritoneal dissemination of cancer is very difficult whatever method of examination is used. Recently, a cytological examination of peritoneal lavage has been shown to be a feasible measure to predict an early state of peritoneal seeding. The predictive value of the levels of tumor markers in peritoneal lavage for peritoneal metastasis from gastric carcinoma was thus studied.

Methods: In 229 patients gastric cancer tumor markers, CEA, CA 125, and CA 19-9, in peritoneal lavage were intraoperatively evaluated using a chemiluminescent enzyme immunoassay.

Results: CEA in peritoneal lavage at a cutoff level of 0.5 ng/ml showed overall a higher sensitivity of 75.8% at a specificity of 90.8% for a diagnosis of peritoneal dissemination including cytologically positive peritoneal lavage [CY(+)] than CA 125 or CA 19-9 in peritoneal lavage. The CEA level in peritoneal lavage as well as both serosal invasion and the CA 125 level in peritoneal lavage were significant factors for the prediction of peritoneal dissemination including CY(+) with a relative risk of 6.6, 14.1 and 9.4. In patients undergoing curative operations, the recurrence rate for peritoneal dissemination and liver metastasis in cases with CEA levels in peritoneal lavage of > or = 0.5 ng/ml was significantly higher than that in cases with CEA levels of < 0.5 ng/ml (p < 0.0001, p < 0.002).

Conclusions: These finding suggest that the CEA level in peritoneal lavage is thus considered to be a predictor of peritoneal dissemination including CY(+).

MeSH terms

  • Adult
  • Aged
  • Ascitic Fluid / chemistry*
  • Biomarkers, Tumor / analysis*
  • CA-125 Antigen / analysis
  • CA-19-9 Antigen / analysis
  • Carcinoembryonic Antigen / analysis
  • Female
  • Humans
  • Immunoenzyme Techniques / methods
  • Liver Neoplasms / chemistry
  • Liver Neoplasms / secondary
  • Luminescent Measurements
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Peritoneal Neoplasms / chemistry*
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary
  • Predictive Value of Tests
  • Prognosis
  • Risk Assessment
  • Sensitivity and Specificity
  • Stomach Neoplasms / chemistry*
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / pathology*
  • Survival Analysis


  • Biomarkers, Tumor
  • CA-125 Antigen
  • CA-19-9 Antigen
  • Carcinoembryonic Antigen