Prognostic value of carcinoembryonic antigen levels before and after curative surgery in colon cancer patients

Kim, Hyun Ryung; Joo, Jeong Il; Lim, Sangwoo; Oh, Bo Young

doi:10.4174/astr.2021.100.1.33

Cited by 3 publications

(6 citation statements)

References 25 publications

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“…However, these studies showed insu cient CEA data, lack of adjustment for clinical features, and inclusion of patients with palliative surgery. In other studies, there were no signi cant CEA ndings with respect to oncologic outcomes [14]. Konishi et al [15] reported similar results to ours, their research suggested that patients with elevated postoperative CEA present an increased risk for recurrence compared with patients with CEA values that returned to reference values after surgery.…”

Section: Resultssupporting

confidence: 80%

“…Observational studies revealed preoperative CEA level was a signi cant indicator for recurrence and survival, while different studies found that postoperative CEA was an independent prognostic factor [8, 12,14,18]. Also, population-based studies with large cohorts reported that preoperative CEA level was an independent poor prognostic factor [14,17]. However, these studies showed insu cient CEA data, lack of adjustment for clinical features, and inclusion of patients with palliative surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Multiple studies have demonstrated the usefulness of preoperative CEA as a biomarker of prognosis in patients with CRC that will undergo surgery. On the other hand, other studies suggest that measurement of postoperative CEA also provides valuable prognostic information regarding disease recurrence 13,14 .…”

Section: Introductionmentioning

confidence: 99%

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Persistent high levels of carcinoembryonic antigen after tumor-resection are associated with poorer survival outcomes in patients with resected colorectal cancer

Muñoz‐Montaño¹,

López-Basave²,

Sánchez-Trejo

et al. 2022

Preprint

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Background: In locoregional colon cancer, interindividual survival and recurrence rates following surgical resection are highly variable. The aim of the present study was to determine whether elevated preoperative and postoperative CEA values are useful prognostic biomarkers for patients with stage I - III colon cancer that underwent surgery with curative intent. Methods: We conducted a retrospective study in patients with histologically confirmed stage I–III primary colonic adenocarcinoma who underwent radical surgical resection at Mexico’s National Institute of Cancer, between 2008 and 2020. We determined preoperative and posoperative CEA, and to review the association of the score with poorer survival outcomes in patients with resected colorectal cancer: overall survival (OS) and disease-free survival (DFS). Results: We included 640 patients with stages I and III colon cáncer, preoperative CEA levels were in the normal range in 460 (group A) and above the reference value in 180. Of the 180 patients with elevated preoperative CEA levels, 134 (group B) presented normalized CEA levels after surgery and 46 (group C) remained with CEA above reference values after surgery. Median follow- up was 46.4 months (range, 4.9–147.4 months). Median DFS was significantly shorter in Group C: 55.5 months (95% CI 39.6-71.3) than in the other two groups [Group A: 77.1 months (95% CI 72.6-81.6)]; Group B: 75.7 months (95% CI 66.8-84.5) (p-value<0.001)]. Overall survival was also significantly worse in group C [57.1 (95% CI 37.8-76.3) months] than in group A [82.8 (95% CI 78.6-86.9 months] and group B [87.1 (95% CI 79.6-94.5 months] (p-value = 0.002) To identify whether change in CEA levels before and after surgery was an independent prongostic factor for survival outcomes, a Cox proportional hazard model was performed. In multivariate analysis, change in CEA level was a statistically significant independent prognostic factor for overall survival (p-value = 0.031) Conclusions:When assessed in conjunction preoperative and postoperative CEA values are useful biomarkers for predicting survival outcomes in patients with resected CRC; prognosis is worse for patients with elevated pre and post-surgical CEA values; however, it is similar in patients with normal post-surgical values, regardless of their pre-surgery values.

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Section: Resultssupporting

confidence: 80%

Section: Resultsmentioning

confidence: 99%

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Persistent high levels of carcinoembryonic antigen after tumor-resection are associated with poorer survival outcomes in patients with resected colorectal cancer

Muñoz‐Montaño¹,

López-Basave²,

Sánchez-Trejo

et al. 2022

Preprint

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show abstract

“…In addition, Kim et al. reported that colon cancer patients with elevated CEA levels showed worse disease-free survival (DFS) or OS than the normal or normalized groups ( 21 ). In their study, the survival difference between the normal and normalized groups was evident in OS alone, but not in DFS.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with previous studies considering the trajectory change of CEA level, our analysis had a unique design and novel results. First, most previous studies used CEA levels measured within 12 weeks after surgery ( 15 , 16 , 21 , 22 ). Although the 12-week interval is considered one of the acceptable time periods between surgery and chemotherapy initiation, some guidelines and studies recommend an interval of 8 weeks before initiating adjuvant chemotherapy in patients with CRC ( 23 – 26 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Early Carcinoembryonic Antigen Change in Patients With Nonmetastatic Colorectal Cancer

Lee

Cho

et al. 2022

Front. Oncol.

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BackgroundThis study aimed to evaluate the prognostic significance of preoperative, postoperative, and trajectory changes in carcinoembryonic antigen (CEA) levels in patients with colorectal cancer (CRC).MethodsThis retrospective study included patients who underwent surgical resection for nonmetastatic CRC. The optimal cutoff values of preoperative CEA (CEA-pre), early postoperative CEA (CEA-post), and CEA level change (CEA-delta) were determined to maximize the differences in overall survival (OS) among groups. The patients were divided into three groups according to CEA-trend: normal, low CEA-pre; normalized, high CEA-pre/low CEA-post; elevated, high CEA-pre/high CEA-post. The integrated area under the curve (iAUC) was used to compare the discriminatory power of all variables.ResultsA total of 1019 patients diagnosed with stage I–III CRC were enrolled. The optimal cutoff values of CEA level were determined as 2.3 ng/mL for CEA-pre, 2.3 ng/mL for CEA-post, and -0.93 ng/mL for CEA-delta. Although subgroup dichotomization showed that CEA-pre, CEA-post, CEA-delta, and CEA-trend were all associated with OS in univariate analysis, CEA-trend was the only independent prognostic factor in multivariate analysis. The iAUC of CEA-trend was superior to that of CEA-pre, CEA-post, and CEA-delta. Compared with the normal group, the normalized group showed worse OS (p=.0007) in stage II patients but similar OS (p=.067) in stage III patients.ConclusionThe optimal cutoff value of CEA level in the preoperative and postoperative periods was determined to be 2.3 ng/mL, and the combination of CEA-pre and CEA-post showed better prognostic stratification. However, its prognostic significance may differ depending on the CRC stage.

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Persistent high levels of carcinoembryonic antigen after tumor resection are associated with poorer survival outcomes in patients with resected colon cancer

et al. 2023

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Background Interindividual survival and recurrence rates in cases of locoregional colon cancer following surgical resection are highly variable. The aim of the present study was to determine whether elevated pre-operative and post-operative CEA values are useful prognostic biomarkers for patients with stage I-III colon cancer who underwent surgery with curative intent. Methods We conducted a retrospective study in patients with histologically confirmed stage I-III primary colonic adenocarcinoma who underwent radical surgical resection at Mexico’s National Cancer Institute, between January 2008 and January 2020. We determined pre-operative and post-operative CEA and analyzed the association of scores with poorer survival outcomes in patients with resected colon cancer, considering overall survival (OS) and disease-free survival (DFS). Results We included 640 patients with stage I-III colon cancer. Pre-operative CEA levels were in the normal range in 460 patients (group A) and above the reference value in the other 180. Of the latter, 134 presented normalized CEA levels after surgery, but 46 (group C) continued to show CEA levels above the reference values after surgery. Therefore, propensity score matching (PSM) was carried out to reduce the bias. Patients were adjusted at a 1:1:1 ratio with 46 in each group, to match the number in the smallest group. Median follow- up was 46.4 months (range, 4.9–147.4 months). Median DFS was significantly shorter in Group C: 55.5 months (95% CI 39.6–71.3) than in the other two groups [Group A: 77.1 months (95% CI 72.6–81.6). Group B: 75.7 months (95% CI 66.8–84.5) (p-value < 0.001)]. Overall survival was also significantly worse in group C [57.1 (95% CI 37.8–76.3) months] than in group A [82.8 (95% CI 78.6–86.9 months] and group B [87.1 (95% CI 79.6–94.5 months] (p-value = 0.002). To identify whether change in CEA levels operative and post-surgery was an independent prognostic factor for survival outcomes, a Cox proportional hazard model was applied. In multivariate analysis, change in CEA level was a statistically significant, independent prognostic factor for overall survival (p-value = 0.031). Conclusions When assessed collectively, pre-operative and post-operative CEA values are useful biomarkers for predicting survival outcomes in patients with resected colon cancer. Prognoses are worse for patients with elevated pre-operative and post-surgical CEA values, but similar in patients with normal post-surgical values, regardless of their pre-surgery values.

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Prognostic value of carcinoembryonic antigen levels before and after curative surgery in colon cancer patients

Cited by 3 publications

References 25 publications

Persistent high levels of carcinoembryonic antigen after tumor-resection are associated with poorer survival outcomes in patients with resected colorectal cancer

Persistent high levels of carcinoembryonic antigen after tumor-resection are associated with poorer survival outcomes in patients with resected colorectal cancer

Clinical Significance of Early Carcinoembryonic Antigen Change in Patients With Nonmetastatic Colorectal Cancer

Persistent high levels of carcinoembryonic antigen after tumor resection are associated with poorer survival outcomes in patients with resected colon cancer

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