Persistent high levels of carcinoembryonic antigen after tumor-resection are associated with poorer survival outcomes in patients with resected colorectal cancer

Abstract

Background: In locoregional colon cancer, interindividual survival and recurrence rates following surgical resection are highly variable. The aim of the present study was to determine whether elevated preoperative and postoperative CEA values are useful prognostic biomarkers for patients with stage I - III colon cancer that underwent surgery with curative intent. Methods: We conducted a retrospective study in patients with histologically confirmed stage I–III primary colonic adenocarcinoma who underwent radical surgical resection at Mexico’s National Institute of Cancer, between 2008 and 2020. We determined preoperative and posoperative CEA, and to review the association of the score with poorer survival outcomes in patients with resected colorectal cancer: overall survival (OS) and disease-free survival (DFS). Results: We included 640 patients with stages I and III colon cáncer, preoperative CEA levels were in the normal range in 460 (group A) and above the reference value in 180. Of the 180 patients with elevated preoperative CEA levels, 134 (group B) presented normalized CEA levels after surgery and 46 (group C) remained with CEA above reference values after surgery. Median follow- up was 46.4 months (range, 4.9–147.4 months). Median DFS was significantly shorter in Group C: 55.5 months (95% CI 39.6-71.3) than in the other two groups [Group A: 77.1 months (95% CI 72.6-81.6)]; Group B: 75.7 months (95% CI 66.8-84.5) (p-value<0.001)]. Overall survival was also significantly worse in group C [57.1 (95% CI 37.8-76.3) months] than in group A [82.8 (95% CI 78.6-86.9 months] and group B [87.1 (95% CI 79.6-94.5 months] (p-value = 0.002) To identify whether change in CEA levels before and after surgery was an independent prongostic factor for survival outcomes, a Cox proportional hazard model was performed. In multivariate analysis, change in CEA level was a statistically significant independent prognostic factor for overall survival (p-value = 0.031) Conclusions:When assessed in conjunction preoperative and postoperative CEA values are useful biomarkers for predicting survival outcomes in patients with resected CRC; prognosis is worse for patients with elevated pre and post-surgical CEA values; however, it is similar in patients with normal post-surgical values, regardless of their pre-surgery values.