Prognostic Effect of Pretreatment Serum Carcinoembryonic Antigen Level

Abstract

Many studies have reported the prognostic value of pretreatment serum carcinoembryonic antigen (pre-CEA) levels on colorectal cancer outcomes. However, controversy remains concerning the significance of pre-CEA levels in patients with rectal cancer treated with neoadjuvant chemoradiotherapy (CRT). Our aim in this study was to investigate the prognostic role of the pre-CEA level in patients with locally advanced rectal cancer undergoing neoadjuvant CRT followed by total mesorectal excision (TME).A total of 419 patients with stages II and III rectal cancer treated with neoadjuvant CRT followed by TME with available pre-CEA data were included. The outcomes studied were 5-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS). Optimal pre-CEA cutoff values to predict DMFS were determined based on current smoking history.The median pre-CEA level of smokers was 3.8 ng/mL, and that of nonsmokers was 2.8 ng/mL (P < 0.01). Pre-CEA levels of 6.6 ng/mL for nonsmokers and 11.4 ng/mL for smokers were determined to best separate patients on the basis of time to distant metastasis by using log-rank statistics. The pre-CEA level was associated with DMFS (hazard ratio = 1.743, 95% confidence interval = 1.129–2.690, P = 0.01). The pre-CEA level was not associated with LRFS or DFS.The pre-CEA level appears to be a significant preoperative prognostic factor. Moreover, it is as valuable as any known pathologic factor. Future studies evaluating oncologic outcomes should take into consideration the pre-CEA level.

Predictive and Prognostic Molecular Biomarkers for Response to Neoadjuvant Chemoradiation in Rectal Cancer

“…The positive predictive value and negative predictive value of an elevated pre-nCRT CEA for incomplete pathological response was 91% and 17%, respectively [89]. Consistent with the findings, other recent studies have also shown that pre-nCRT CEA levels were significantly associated with pCR and survival [21,90,91], while low CEA levels after nCRT was suggested as an independent predictor of pCR. …”

Neoadjuvant Modified FOLFOX6 With or Without Radiation Versus Fluorouracil Plus Radiation for Locally Advanced Rectal Cancer: Final Results of the Chinese FOWARC Trial

“…CEA as a prognostic tool in rectal cancer remains controversial, with some studies showing an association between elevated pretreatment CEA and survival and others showing no association. 24 - 26 However, the equivocal findings are likely a result of inconsistent use of CEA level cutoffs among published studies. In addition, more recent studies suggest that the combination of both pre- and post-treatment CEA levels is a more accurate prognostic tool.…”

Prognostic Impact of Perineural Invasion in Rectal Cancer After Neoadjuvant Chemoradiotherapy

“…Similar to the pathologic TNM stage, these factors are currently not considered for the clinical decision-making process for adjuvant chemotherapy in rectal cancer following nCRT. However, recent studies have shown significant effects of PNI and LVI in locally advanced rectal cancer patients treated with nCRT, raising questions about the roles of these additional prognostic factors [11][12][13][14][15]. In particular, there is a growing interest in PNI as a key pathologic feature of a potential fourth route of cancer spread, in addition to the three wellknown routes of direct invasion, lymphatic spread, and hematogenous spread.…”