Preoperative Carcinoembryonic Antigen Level as an Independent Prognostic Factor in Colorectal Cancer: Taiwan Experience

Wang, Wei Shu; Lin, Jen Kou; Chiou, Tzeon Jye; Liu, Jin Hwang; Fan, Frank S.; Yen, Chueh Chuan; Lin, Tzu Chen; Jiang, Jeng Kai; Yang, Shung Haur; Wang, Huann Sheng; Chen, Po Min

doi:10.1093/jjco/hyd003

Cited by 85 publications

(57 citation statements)

References 16 publications

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“…The majority of studies evaluating preoperative CEA levels reveal it to be an independent prognostic factor after surgical resection for colorectal cancer [1][2][3][4][5][6][7][8]10], although some contradictory studies reported that the CEA level is a predictor for survival [12][13][14][15][16]. We concur with this and confirmed a preoperative elevation in serum CEA as an independent prognostic factor for both 5-year overall and disease-free survival in this analysis.…”

Section: Discussionsupporting

confidence: 85%

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Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer

Huh

Kim

et al. 2010

Journal of Surgical Oncology

111

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Objective: We evaluated the prognostic value of the preoperative serum carcinoembryonic antigen (CEA) level in patients with colon cancer. Methods: We reviewed 474 patients who underwent potentially curative resection for nonmetastatic colon cancer. Patients were categorized into two groups according to the preoperative serum CEA level: low CEA (<5 ng/ml) and high CEA ( 5 ng/ml) groups. Results: During the median 45-month follow-up period, the 5-year overall and disease-free survival rates for patients with a low CEA level were 81.7% and 82.4%, respectively, which were significantly higher than the rates for those with a high CEA level (69.9%; P ¼ 0.011 and 70.6%; P ¼ 0.002, respectively). A multivariate analysis revealed that a preoperative serum CEA level was a significant independent prognostic factor for both overall survival (P ¼ 0.021) and disease-free survival (P ¼ 0.026). Both the overall and disease-free survival rates in patients with stage II tumors differed significantly between the low and high CEA groups, whereas the rates did not different between those with stage I and III tumors. Conclusions: Preoperative serum CEA is a reliable predictor of recurrence and survival after curative surgery in patients with colon cancer, particularly in those classified as having stage II disease.

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Section: Discussionsupporting

confidence: 85%

“…High preoperative serum CEA levels are associated with an increased risk of recurrence and poor prognosis [1][2][3][4][5][6][7][8]. Moreover, monitoring of the postoperative CEA level is commonly used in the follow-up of colorectal cancer and perioperative serum CEA change is a useful prognostic indicator for colorectal cancer [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer

Huh

Kim

et al. 2010

Journal of Surgical Oncology

111

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“…This approach is in accordance with other investigators (8,(27)(28)(29)32,33,36). However, the s-CEA is a continuous variable, therefore another level as a cut-off point might be more accurate for its ONCOLOGY REPORTS 17: 471-475, 2007 predictive value.…”

Section: Discussionsupporting

confidence: 87%

“…Different results were observed in the trial of Gastrointestinal Tumor Study Group: s-CEA affected survival of patients with one to four positive nodes (35). Moreover, Wang et al in another study concluded that prediction of significant outcomes persisted for patients analysed separately at Astler-Coller stage C1 (lack of tumor penetration beyond the bowel wall) and C2 (presence of penetration) (36).…”

Section: Discussionmentioning

confidence: 92%

Clinical factors in prediction of prognosis after anterior resection with total mesorectal excision for carcinoma of the rectum

Szynglarewicz¹,

Matkowski²,

Forgacz³

et al. 2007

Oncol Rep

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Abstract. The aim of the study was to estimate the long-term results and the prognostic value of clinical and pathological factors following R0 anterior resection with total mesorectal excision (TME). Ninety-eight consecutive patients with histologically confirmed rectal cancer were studied prospectively with five-year follow-up. Survival was calculated using the Kaplan-Meier method and differences between curves were tested by the log-rank test. Multivariate analysis was performed using the Cox regression model. Recurrence-free survival (RFS) was 63.6%. Mean time of recurrence was 13.8 months (range 3-38). Local recurrence rate was 7.8% with the mean time of 12.7 months (range 3-25). In univariate analysis Dukes' stage (RFS for stage: A=93.2%; B=53.8%; C=26.3%) and preoperative CEA serum level (s-CEA) (for s-CEA ≤5 ng/ml RFS=93.8%; for s-CEA >5 ng/ml RFS = 5.9%) significantly influenced survival (P<0.005 and P<0.00001). These parameters were also found to be independent prognostic factors in multivariate analysis (P<0.05 and P<0.00001). Survival was worse in older female patients with low-localised poorly differentiated tumors; however, those variables had not significant impact on prognosis. Neither symptom duration nor mucinous histology was significantly related to survival. Using TME technique a low local recurrence rate resulting in improved survival can be achieved. Apart from clinicopathological staging, elevated s-CEA can identify patients with poor prognosis. In addition to TME adjuvant therapy for this high-risk group should be considered.

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“…CEA is used to determine the independent prognostic factors in patients without metastasis who have undergone surgery (22), and it is also frequently used for follow-up of recurrences after surgery (23). Since currently available follow-up marker for CRC is CEA, we also evaluated CEA in our study.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Fecal and Plasma CEA, COX-2, MMP-7, and TIMP-1 in the Diagnosis of Colorectal Cancer

Kiyak

Keles

Bengi

et al. 2018

J Basic Clin Health Sci

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Purpose: Colorectal cancer (CRC) is one of the most common and death related cancers in the world. Therefore, the early diagnosis of CRC remains with a great importance to prevent its further progression and increase survival rates. Colonoscopy and pathological examinations which are invasive and painful procedures, are needed to make a definitive diagnosis of CRC. The carcinoembryonic antigen (CEA) is particularly used for postoperative follow-up of CRC patients. The imbalance between matrix metalloproteinases (MMPs) and their tissue inhibitors of metalloproteinases (TIMPs) leads to degradation of extracellular matrix which is the most important step in invasion and metastasis. It was also observed that cyclooxygenase-2 (COX-2) has crucial roles in the development and progression of colorectal cancer. The purpose of our study is to detect fecal and plasma MMP-7, COX-2, TIMP-1, and CEA protein levels in patients with colorectal cancer, colorectal polyps, and healthy individuals, and assess their association with each other and with clinicopathological variables. We also aimed to evaluate plasma and fecal MMP-7, COX-2, TIMP-1, and CEA protein levels as potential diagnostic markers in colorectal carcinoma.Methods: Plasma and fecal samples were taken from patients with fifteen colorectal cancers, twenty-six colorectal polyps, and thirty-three healthy volunteers. Protein extraction was carried out from fecal samples. Plasma and fecal MMP-7, TIMP-1, and COX-2 protein levels were determined by ELISA whereas plasma and fecal CEA protein levels were detected with CEIA.Results: Plasma and fecal CEA levels were significantly higher in CRC than the control. In addition, plasma TIMP-1 and plasma CEA levels were significantly elevated in cancer according to polyp group. We also detected decreased plasma MMP-7 levels in polyps compared to control group. Positive correlations were observed among plasma COX-2 and TIMP-1 levels (r=0.571), fecal COX-2 and CEA levels (r=0.764) in CRC. However, no association was found between biochemical parameters and clinicopathological variables. ROC analysis for discriminating CRC from healthy controls showed that area under curves (AUC) for fecal and plasma CEA levels were 0.763 and 0.692, respectively. Plasma CEA (AUC=0.735), plasma TIMP-1 (AUC=0.706), and their combination (AUC=0.760) exhibited significant diagnostic performances to differentiate CRC from polyp. In discrimination colorectal polyps from healthy tissues, MMP-7 showed the highest AUC value (0.667). Conclusion:Here we suggested that plasma and fecal CEA protein levels may be potential predictive noninvasive markers for diagnosis of colorectal adenocarcinoma. In addition, plasma CEA and TIMP-1 are also valuable biomarker candidates in differentiating colorectal cancer from colorectal polyps.

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Preoperative Carcinoembryonic Antigen Level as an Independent Prognostic Factor in Colorectal Cancer: Taiwan Experience

Cited by 85 publications

References 16 publications

Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer

Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer

Clinical factors in prediction of prognosis after anterior resection with total mesorectal excision for carcinoma of the rectum

The Importance of Fecal and Plasma CEA, COX-2, MMP-7, and TIMP-1 in the Diagnosis of Colorectal Cancer

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