Clinical significance of preoperative carcinoembryonic antigen level for clinical stage I non-small cell lung cancer: can preoperative carcinoembryonic antigen level predict pathological stage?

Abstract

The purpose of the present study was to retrospectively analyze the clinicopathological characteristics and clarify whether or not the preoperative carcinoembryonic antigen (CEA) level could be used as a decision-making factor as an adjunct to the TNM staging system in patients with clinical stage I non-small cell lung cancer (NSCLC). Between 1993 and 2006, 815 patients who had clinical stage I NSCLC were analyzed retrospectively. The CEA level was defined as being either normal (CEA<or=5 ng/ml), high (5<CEA<or=30 ng/ml) and very high (CEA>30 ng/ml) sub-groups. The rate of patients with an elevated CEA level was 33.6%. The five-year disease-free survival rates for patients with normal, high and very high CEA levels were 76.7, 60.0 and 31.3%, respectively. The survival curve for patients with a normal CEA level almost overlapped that for p-stage I, that for a high CEA level nearly overlapped that for p-stage II, and that for a very high CEA level nearly overlapped that for p-stage III. The present study demonstrated that the preoperative CEA level was a very good predictor of the pathological stage. These findings suggest that the preoperative CEA level may be useful as an adjunct to the TNM staging system.

Usefulness of Serum Carcinoembryonic Antigen (CEA) in evaluating response to chemotherapy in patients with advanced non small-cell lung cancer: a prospective cohort study

“…Moreover, Iwanicki et al showed that the CEA kinetic allowed accurate evaluation of progression, response, and PFS in metastatic colon cancer suggesting an important role in objective response assessment [23]. In NSCLC, many studies evaluating CEA and prognosis have been written with contrasting results in the perioperative setting, some showing its role as a prognostic value [8,10,13,24] and others not confirming it [25-27]. …”

A 79-Year-Old Man With Interstitial Lung Disease and Cryptic Area of High 18 Fluorodeoxyglucose Uptake in Left Upper Lobe

“…CEA is one of the most used "historical" cancer biomarkers but it has low sensitivity and specifi city (sometimes elevated in nonneoplastic diseases such as pancreatitis, cirrhosis, ulcerative colitis); moreover, it is not a lung cancer-specifi c marker since it is also elevated in colorectal, gastric, and breast cancer. Higher levels of CEA are related to worse prognosis 5 ; moreover, preoperative CEA levels seem to be good predictors of the pathologic stage in clinical stage I 6 and higher preoperative values, even if those within normal range (0-5 ng/mL) are related to worse prognosis. 7 Besides the mentioned nonneoplastic diseases, serum CEA concentration is elevated in approximately one-half of patients with IPF due to the disease itself.…”

Prognostic Value of Serum C-Reactive Protein (CRP) and Cytokeratin 19 Fragments (Cyfra 21-1) but Not Carcinoembryonic Antigen (CEA) in Surgically Treated Patients with Non-Small Cell Lung Cancer

“…Most published data indicate the prognostic significance of CEA (Table 6) [26][27][28][29][30][31][32][33], but the majority of reports concern groups of patients with adenocarcinoma [28,32] or with substantial adenocarcinoma predominance [18,29,31]. The authors of recently published articles have found that increased CEA concentration is a significant predictor of pN2 disease [1], tumour diameter and visceral pleural invasion [34], as well as recurrence after surgery [35].…”