Results from a retrospective, single-center, cohort study of patients with stage I-III colorectal cancer who underwent surgery showed preoperative serum carcinoembryonic antigen (CEA) level was an independent predictor of survival. The findings from this study were published in Annals of Surgical Oncology.
Serum CEA is widely used in the management of patients with colorectal cancer to evaluate response to treatment as well as to detect recurrence of disease. Although CEA is not a specific marker for colorectal cancer, and serum CEA level is not currently used in the staging of colorectal cancer or in National Comprehensive Cancer Network (NCCN) guideline-directed approaches regarding use of adjuvant chemotherapy, numerous studies have identified it as a prognostic factor for patients with colorectal cancer in a variety of settings. However, evidence is conflicting regarding the prognostic value of preoperative vs postoperative serum CEA level in patients with colorectal cancer treated with curative-intent surgery.
This study retrospectively evaluated the prognostic significance of preoperative serum CEA level for patients with stage I-III colorectal cancer treated with curative-intent surgery at a medical center in Taiwan between 1995 and 2010.
Of a total of 9634 patients with stage I-III colorectal cancer, 6099 patients were assigned to 3 groups based on preoperative serum CEA level (≤5ng/mL; 3857 patients); (≤10 ng/mL; 1121 patients); and (>5ng/mL; and >10ng/mL; 1121 patients), as well as propensity score matching with respect to specific confounders, including age, gender, diabetes history, smoking history, serum creatinine level, presence of liver cirrhosis, adjuvant chemotherapy, TNM stage, histological type, and tumor diameter.
Mean follow-up was 82.61 months. On multivariate analyses, significantly increased risks of disease recurrence, death, and cancer-specific death were observed in patients with elevated preoperative serum CEA levels compared with patients with a preoperative CEA level <5ng/mL. Using the group of patients with preoperative serum CEA <5 ng/mL as a comparator, the recurrence-free interval was significantly decreased in the 2 groups with elevated preoperative serum CEA level (hazard ratio [HR], 1.190; P =.006 [CEA ≥5 and <10 ng/mL]; HR, 1.468; P <.001 [CEA ≥10 ng/mL]). Similarly, with respect to overall survival, HR, 1.376; P <.001 [CEA ≥5 and <10 ng/mL] and HR, 1.523; P <.001 [CEA ≥10 ng/mL]). Finally, when cancer-specific survival was considered, HR, 1.404 [CEA ≥5 and <10 ng/mL; P <.001] and HR, 1.712 [CEA ≥10 ng/mL; P <.001].
Interestingly, the rates of 5-year OS were nearly identical for patients with no lymph node involvement and preoperative serum CEA level >10 ng/mL (72%) and those with positive lymph nodes and preoperative serum CEA level <5 ng/mL (69%; P =.542). A similar result was obtained when the recurrence-free interval duration was compared for those 2 groups (19.9 months [negative lymph nodes and preoperative serum CEA level >10 ng/mL] vs 21.72 months [positive lymph nodes and serum preoperative CEA level <5 ng/mL; P =.662]).
Limitations of this study include the potential for bias associated with retrospective studies, as well as possible changes in staging criteria and treatment approaches occurring over the 15-year study period.
“Patients with negative lymph nodes and preoperative CEA level >10 ng/ml should be considered for intensive follow-up or adjuvant chemotherapy,” the authors noted in conclusion.
- Huang SH, Tsai WS, You JF, et al. Preoperative carcinoembryonic antigen as a poor prognostic factor in stage I-III colorectal cancer after curative-intent resection: A propensity score matching analysis.[published March 26, 2019]. Ann Surg Oncol. doi: 10.1245/s10434-019-07184-3