Pre‐operative carcinoembryonic antigen predicts survival following colorectal cancer surgery with curative intent

Gunawardene, Ashok; Larsen, Peter; Shekouh, Ali; Dennett, Elizabeth

doi:10.1111/ans.14723

Cited by 12 publications

(12 citation statements)

References 20 publications

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“…Jung et al analyzed 472 CRC patients and found that preoperative CEA was an independent prognostic factor with regard to CSS and DFS, and CA 19-9 also had prognostic value for CSS and DFS20. Another study that enrolled 237 patients found that CEA predicted OS (HR 2.50, 95% CI 1.17-5.36, P = 0.02) and DFS (HR 1.78, 95% CI 1.02-3.13, P = 0.04)7. Similar to our study, Gao et al analyzed the relationship between serum tumor markers (including CEA, CA19-9, CA72-4 and CA125) and clinicopathologic factors and suggested that the combination of multiple preoperative tumor markers could improve the early diagnosis and treatment of CRC21.…”

Section: Discussionmentioning

confidence: 96%

“…CEA is an acid glycoprotein involved in cell recognition and cell adhesion and is secreted by solid tumors. The level of preoperative CEA influences the prognosis of multiple tumors, such as gastric cancer, lung cancer and CRC5, 6, 7. Furthermore, CEA levels are correlated with the metastasis and recurrence of CRC after curative surgery8, 9.…”

Section: Introductionmentioning

confidence: 99%

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The difference in prognosis of stage II and III colorectal cancer based on preoperative serum tumor markers

You¹,

Sheng²,

Li³

et al. 2019

J. Cancer

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Background : Preoperative serum tumor markers have been widely used to predict prognosis in stage II and III colorectal cancer (CRC). However, few previous studies addressed the effect of increased preoperative numbers of tumor markers. Methods : Patients with stage II and III CRC who underwent curative resection were included from January 2009 to October 2015. The relationship between serum tumor markers and clinicopathological parameters was analyzed. DFS and OS were compared in stage II and III CRC. Results : The median follow-up was 45 months. In this study, 735 enrolled patients were assessed based on the numbers of increased tumor markers. We found that these increased tumor markers were closely associated with clinical stage, T stage, N stage, tumor location, pathology type, differentiation, lymphatic invasion and vascular invasion (all p values < 0.05). Furthermore, the number of increased tumor markers directly affected the survival of patients with CRC after curative surgery. The 3-year DFS and OS of patients with a score of 0 were 84.0% and 91.0%, respectively, which are much higher than those of patients with a score of 4 (42.9% and 37.8%, respectively) (p < 0.05). The 5-year DFS and OS of patients with a score of 0 were 75.9% and 77.9%, respectively, which are much higher than those of patients with a score of 4 (31.7% and 23.6%, respectively). Interestingly, our results suggested that stage III CRC patients with a score of 0 had longer DFS and OS times than stage II patients with scores of 3 and 4. Further analysis revealed statistically significant differences in OS (p < 0.05) but not in DFS. Conclusions : The number of increased tumor markers could significantly predict prognosis in stage II and III CRC. In addition, these increased tumor markers had direct impacts on metastasis as well as the recurrence status and survival time of stage II and III CRC patients.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

The difference in prognosis of stage II and III colorectal cancer based on preoperative serum tumor markers

You¹,

Sheng²,

Li³

et al. 2019

J. Cancer

View full text Add to dashboard Cite

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“…Specifically, carcinoembryonic antigen (CEA) is a circulation glycoprotein that has been widely associated with colon cancer for over half a century 6–10 . Normally produced by the gastrointestinal tract during foetal development, in the adult life it is mostly expressed within epithelial cells of colon and rectum and its circulating levels are increased in 27–70% of CRC patients 6–8,11,12 . In 2000, the Colorectal Working Group of the American Joint Committee on Cancer (AJCC) suggested adding initial CEA levels in the conventional TNM classification of CRC (the ‘C‐stage’), but its inclusion has yet to take place 7,11,13 .…”

Section: Introductionmentioning

confidence: 99%

Serum carcinoembryonic antigen pre‐operative level in colorectal cancer: revisiting risk stratification

Iacuzzo

Germani

Troian

et al. 2021

ANZ Journal of Surgery

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The present paper is a retrospective cohort analysis that we conducted to verify the prognostic role of pre‐operative serum carcinoembryonic antigen (CEA) level in predicting overall survival and risk of metastatic development in colorectal cancer patients. Although already evaluated by several studies, there is still lack of consensus in literature on the optimal cut‐off values which may allow for risk stratification and individualized treatments. Our results show that a pre‐operative CEA level >4.5 ng/mL correlated with a higher risk of developing distant recurrence in stage I, II and III colorectal cancer. Moreover, a pre‐operative CEA level >10 ng/mL was found to be significantly predictive of all‐cause mortality and poor disease‐free survival in patients with stage III and IV colorectal cancer undergoing potentially curative surgery.

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“…CEA has been established as an attractive prognostic variable for colorectal cancer. Previous studies have shown that elevated preoperative CEA levels represent an independent risk factor (3)(4)(5)(18)(19)(20). Additionally, failure to normalize CEA levels after resection has been shown to play an important role in poor prognosis (21)(22)(23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

“…Carcinoembryonic antigen (CEA) is an effective serum biomarker that is recommended as part of the preoperative work-up and postoperative follow-up routine in patients with colorectal cancer. Multiple studies have demonstrated the usefulness of preoperative CEA for predicting the prognosis of colon cancer patients (3)(4)(5), while other studies have suggested that postoperative CEA performed better than preoperative CEA in prognostic stratification; moreover, the recurrence-free survival of patients with an elevated preoperative CEA level but a normalized postoperative CEA level was not significantly different from that of patients with a normal preoperative CEA (6). In the present study, we aimed to determine whether preoperative or postoperative serum CEA could be used to optimize the current prognostic model in patients with stage III colon cancer.…”

Section: Introductionmentioning

confidence: 99%

A Novel Prognostic Model Incorporating Carcinoembryonic Antigen in 3-Week or Longer Postoperative Period for Stage III Colon Cancer: A Multicenter Retrospective Study

et al. 2020

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BackgroundThe prognostic stratification of colon cancer using only the tumor-node-metastasis (TNM) stage has some limitations. We sought to increase the accuracy of stratifying patients with stage III colon cancer by constructing a prognostic model combining carcinoembryonic antigen (CEA) with TNM.MethodsWe retrospectively analyzed the data generated from stage III colon cancer patients who had early postoperative CEA measurement from 21 to 100 days after surgery from 2006 to 2017. CEA value was processed using restricted cubic splines (RCS) method. The prognostic model was developed using cox proportional hazards regression.ResultsThe time later than 20 days after surgery was optimal for measuring CEA, which was determined by comparing the prognostic value for preoperative and postoperative CEA (N = 2,049), and by evaluating the relationship between the hazard ratio (HR) and postoperative CEA measuring time. Postoperative CEA, T stage and N stage were selected into the final model, and the mean integrated-AUC (iAUC) was 0.78 with 1,000 × bootstrap resampling, which was higher than the model using only T and N stages (TN model; mean iAUC, 0.66). The net reclassification improvement (NRI) was 15% when compared with TN model. Patients could be divided into high and low risk groups by the model, and 3-year disease-free survival (DFS) were 53.7% and 87.0%, respectively (HR, 4.30; 95% CI, 2.65 to 6.96; P < 0.001). Similar results were found in the validation set.ConclusionsStage III colon cancer could be stratified more accurately using the new prognostic model combining postoperative CEA with T and N stage.

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Pre‐operative carcinoembryonic antigen predicts survival following colorectal cancer surgery with curative intent

Abstract: We identified pre-operative CEA as an independent predictor of OS and DFS on an individual level. CEA offers additional prognostic value to TNM staging and should be requested routinely as part of the pre-operative work-up.

Cited by 12 publications

References 20 publications

The difference in prognosis of stage II and III colorectal cancer based on preoperative serum tumor markers

The difference in prognosis of stage II and III colorectal cancer based on preoperative serum tumor markers

Serum carcinoembryonic antigen pre‐operative level in colorectal cancer: revisiting risk stratification

A Novel Prognostic Model Incorporating Carcinoembryonic Antigen in 3-Week or Longer Postoperative Period for Stage III Colon Cancer: A Multicenter Retrospective Study

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