The relevance of serum carcinoembryonic antigen as an indicator of brain metastasis detection in advanced non-small cell lung cancer

Abstract

Although many biomarkers have emerged in non-small cell lung cancer (NSCLC), the predictive value of site-specific spread is not fully defined. We designed this study to determine if there is an association between serum biomarkers and brain metastasis in advanced NSCLC. We evaluated 227 eligible advanced NSCLC patients between May 2005 and March 2010. Patients who had been newly diagnosed with stage IV NSCLC but had not received treatment previously, and had available information on at least one of the following pretreatment serum biomarkers were enrolled: carcinoembryonic antigen (CEA), cytokeratin 19 fragments (CYFRA 21-1), cancer antigen 125 (CA 125), cancer antigen 19-9, and squamous cancer cell antigen. Whole body imaging studies and magnetic resonance imaging of the brain were reviewed, and the total number of metastatic regions was scored. Brain metastasis was detected in 66 (29.1%) patients. Although serum CEA, CYFRA 21-1, and CA 125 levels were significantly different between low total metastatic score group (score 1-3) and high total metastatic score group (score 4-7), only CEA level was significantly different between patients with brain metastasis and those without brain metastasis (p < 0.0001). The area under the receiver operating curve of serum CEA for the prediction of brain metastasis was 0.724 (p = 0.0001). The present study demonstrated that the pretreatment serum CEA level was significantly correlated with brain metastasis in advanced NSCLC. These findings suggested the possible role of CEA in the pathogenesis of brain invasion. More vigilant surveillance would be warranted in the high-risk group of patients with high serum CEA level and multiple synchronous metastasis.

Tumor marker analyses in patients with brain metastases: patterns of practice and implications for survival prediction research

“…Our previous study suggested that integration of surrogate markers such as LDH and albumin, which were confirmed as independent prognostic factors for survival, should be examined in greater detail and large databases [7]. Before proceeding with such efforts, we were interested in other potential biomarkers, in particular tumor markers, which have already been shown to correlate with risk of development of brain metastases [8][9][10][11].…”

“…On the one hand, studies suggested that abnormal serum neuron-specific enolase (NSE), cancer antigen (CA) 125, and carcinoembryonic antigen (CEA) were independent risk factors for metachronous brain metastases in patients with initial stage III non-small cell lung cancer (NSCLC) [8,9] and that CEA levels had statistically strong associations with brain metastases in patients with stage IV or IIIB/IV disease [10,11]. On the other hand, their prognostic impact after diagnosis of brain metastases is poorly defined.…”

Serum lactate dehydrogenase levels at presentation in stage IV non-small cell lung cancer: predictive value of metastases and relation to survival outcomes

“…To evaluate the whole-body metastatic extent, we applied the total metastatic scoring system in the same manner as in our previous studies [19][20][21]. Synchronous metastatic sites were categorized into seven groups as follows: abdomen/pelvis (including adrenal gland, abdomino-pelvic lymph nodes, and other abdominal or pelvic organs), lung-to-lung or pulmonary lymphangitic spread, bone (skeletal system), pleura and/or pleural effusion and/or pericardial effusion, neck and/or axillary lymph nodes, other soft tissue, and brain.…”

Risk factors of brain metastasis of lung squamous cell carcinoma: a retrospective analysis of 188 patients from single center

“…In a perspective study enrolling 293 patients with staged IIIB-IV NSCLC also found, CEA ≥ 40 ng/ml was an independent risk factor of BM [26]. In another prospective study conduced by Lee et al, the association of tumor markers including CEA, Cyfra21-1, CA125, CA199 and SCC and BM were studied in 227 patients with advanced NSCLC [27]. As a result, CEA level was the only tumor marker that was found to be significantly different between patients with BM and without BM.…”