Pretreatment magnetic resonance imaging of regional lymph nodes with carcinoembryonic antigen in prediction of synchronous distant metastasis in patients with rectal cancer

Abstract

Distant metastasis in patients with rectal cancer remains a problem influencing prognosis. Prediction of synchronous distant metastasis is important for the choice of personalized treatment strategies and postoperative follow-up protocol. So far, there are few studies about the predictive value of MRI features combined with clinical characteristics for synchronous distant metastasis in rectal cancer, especially for the lesions developed within 6 months after surgery. We retrospectively reviewed the pretreatment clinical characteristics and magnetic resonance imaging (MRI) features of 271 patients from January 2010 to December 2011with pathologically confirmed rectal adenocarcinoma and tried to identify independent risk factors for synchronous distant metastasis. Forty-nine patients (18.1%) were confirmed to have synchronous distant metastasis. Multivariate logistic regression model demonstrated that the elevated carcinoembryonic antigen (CEA), positive MRI-predicted lymph nodes staging (mrN), and MRI-predicted mesorectal fascia (mrMRF) involvement were independent risk factors. The odd ratios were 12.2 for elevated CEA, 5.4 for mrN1 and 7.6 for mrN2, and 3.8 for mrMRF involvement, respectively. The accuracy and specificity for predicting synchronous distant metastasis by evaluating the positive mrN combined with elevated CEA were improved to 87.8% and 94.6%, respectively. The accuracy, sensitivity and specificity of positive mrN assessment were 86.1%, 71.4% and 91.7%, respectively using the histopathologic results as the reference standard. Altogether, our findings suggest that pretreatment positive mrN and elevated CEA are independent risk factors for synchronous distant metastasis in rectal cancer and combination of both could help to recognize the patients with high risk for structuring personalized treatment protocol.

A nomogram to predict the prognosis of patients with unresected rectal adenocarcinoma undergoing chemoradiotherapy: a population-based study

“…There is evidence that lymph node metastasis is the main predictor of the prognosis of patients with colorectal cancer [43,44]. It has been suggested that compared with the presence of 1-3 positive lymph nodes (N1 disease, 3-year disease-free survival rate of 83%) and N0 disease (3-year disease-free survival rate of 89%), 4 or more lymph node metastases (N2 disease) Of patients, the 3-year disease-free survival rate (75%) is lower [45]. Therefore, whether it is to identify the presence or absence of lymph node metastasis or to accurately distinguish the number of metastatic lymph nodes is very valuable to the prognosis of patients with rectal cancer.…”

Can Elevated Pretreatment Serum Carcinoembryonic Antigen Levels Serve as a Potential Biomarker Guiding Adjuvant Chemotherapy in Rectal Cancer Patients With ypTis-3N0 After Neoadjuvant Radiotherapy and Surgery?

“…At present, there are still disputes about the value of ACT for locally advanced rectal cancer patients who received neoadjuvant CRT and surgery. Serum CEA is the most important tumor marker for the presence of subclinical hepatic or pulmonary metastases, and elevated pretreatment serum CEA levels were significantly associated with poor prognosis in rectal cancer patients (20,21). Besides, serum CEA levels could predict PCR after neoadjuvant therapy for rectal cancer (22).…”

Correlation study between serum neuro-specific enolase and gastric and colorectal cancers

“…Liu et al showed that elevated CEA before treatment and positive lymph node staging on magnetic resonance imaging were independent risk factors for synchronous distant metastasis in rectal cancer. [ 23 ] The combination of both risk factors could indicate patients at high risk and candidates for structured personalized treatment. In the present study, the clinicopathological correlation analysis showed that NSE was significantly associated with vascular invasion and nerve infiltration.…”