Preoperative serum markers for individual patient prognosis in stage I–III colon cancer

Abstract

Carcinoembryonic antigen (CEA) remains the only recommended biomarker for follow-up care of colorectal cancer (CRC), but besides CEA, several other serological parameters have been proposed as prognostic markers for CRC. The present retrospective analysis investigates a comprehensive set of serum markers with regard to cancer-specific survival (CSS) and disease-free survival (DFS). A total of 472 patients with colon cancer underwent surgery for curative intent between January 1988 and June 2007. Preoperative serum was analyzed for the following parameters: albumin, alkaline phosphatase (aP), beta-human chorionic gonadotropin (βhCG), bilirubin, cancer antigen 125 (CA 125), cancer antigen 19-9 (CA 19-9), CA 72-4, CEA, C-reactive protein (CRP), cytokeratin-19 soluble fragment (CYFRA 21-1), ferritin, gamma-glutamyltransferase (γGT), glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), hemoglobin, haptoglobin, interleukin-6, interleukin-8, creatinine, lactate dehydrogenase (LDH), serum amyloid A (SAA), and 25-hydroxyvitamin D. After a median follow-up period of 5.9 years, the overall 3- and 5-year CSS was 91.7 and 84.9 % and DFS rates were 82.7 % (3 years) and 77.6 % (5 years). Multivariate analyses confirmed preoperative CEA as an independent prognostic factor with regard to CSS and DFS. CA 19-9 and γGT also provided prognostic value for CSS and DFS, respectively. Younger age was negatively associated with DFS. According to UICC stage, CEA provided significant prognostic value with regard to CSS and DFS, while CA 19-9 was only prognostic for CSS. Combined analysis is able to identify patients with favorable prognosis. In addition to tumor baseline parameters, preoperative CEA could be confirmed as prognostic marker in colon cancer. CA 19-9 and γGT also provide additional prognostic value with regard to survival and recurrence in stage III and stage I disease, respectively. The combined use of CEA together with CA 19-9 and γGT improve risk-adapted post-op surveillance.

Preoperative neutrophil to lymphocyte ratio predicts survival in patients with T1‐2N0 colorectal cancer

“…This result is compatible with the previous report . However, actuarial recurrence rate after curative resection was reported to be up to 12% in previous reports . It is necessary to discuss about giving chemotherapy to patients with high risk stage I colorectal cancer.…”

High preoperative serum ferritin predicted poor prognosis in non-metastatic colorectal cancer

“…Second, there are always difficulties in modeling continuous predictors. In fact, we believe the discrepancy of the results between our study and the other studies20,21 can be partly attributed to the different modeling of continuous variables. Categorizing continuous variables will reduce the statistical power.…”

“…In colorectal cancer, high baseline ferritin was shown as an independent poor prognostic factor in metastatic colorectal cancer,15 but was not prognostic in stage I-III colorectal cancer 20,21. For further clarification, we conducted a prospective cohort study to validate the significance of pre-operative serum iron metabolism parameters on the outcome of non- metastatic colorectal cancer treated with curative surgery.…”

Serum haptoglobin as a novel molecular biomarker predicting colorectal cancer hepatic metastasis

“…Presently, numerous serum biomarkers including sCEA, sCA19.9 and sTPS have been widely used in the diagnosis and monitoring the progression of CRC. 11,12 In terms of early detection of liver metastasis in CRC, sCEA was one of the most widely used tumor markers. 13 Similarly, sCA19.9 has been considered to predict CRC patients with liver metastases.…”