Elevated preoperative serum carcinoembrionic antigen level may be an effective indicator for needing adjuvant chemotherapy after potentially curative resection of stage II colon cancer

Abstract

Patients with an elevated preoperative CEA may be candidates for adjuvant chemotherapy after curative resection in stage II colon cancer. These findings warrant clinical trials to test out the efficacy of adjuvant chemotherapy in stage II colon cancer with an elevated preoperative CEA.

Preoperative Carcinoembryonic Antigen and Prognosis of Colorectal Cancer. An Independent Prognostic Factor Still Reliable

“…Among these, the risk of relapse possible with a p-CEA .5 ng/mL is similar to the risk of relapse in patients with N1 stage according to AJCC classification, which are the ones with up to 3 neoplastic lymph-nodes at the postoperative histological exam. With regard to the p-CEA and the multivariate analysis, other authors 5,8,20,27,35 report similar results. In light of these data on the p-CEA, we could calculate a significantly lower DFS (P , 0.001) for patients who had a preoperative increase of CEA over 5 ng/mL compared with those with p-CEA within normal range (Fig.…”

“…We believe that our data on p-CEA, along with data from other previously mentioned authors, can help in the stratification of patients with high risk of relapse, even independently from an advanced staging, 5,6,29,44 who can benefit most from both intra-or postoperative adjuvant therapies and tighter controls.…”

“…5,9,11 For this reason, we have excluded all patients with clinical and instrumental evidence of liver disease from our research.…”

“…Many authors 4,5,9,19,22,32 have reported that the lack of return of the CEA to normal range after radical surgical resection, given the short half-life marker, is an index of both inadequate resection leading to early recurrence or presence of mostly hepatic occult metastases. In our study, we recorded that in 13.5% of the cases, a percentage noticeably lower than that reported by other authors, 32 the p-CEA did not fall within normal range after 3 months after a surgery judged as radical.…”

“…It must be said, however, that most of the mentioned authors 1,[3][4][5]9,10,19,21,24,27,29,32,35 do not consider this variable in their clinical cases and that the only author 20 referring to it claim it has no impact on the CEA levels.…”