Prognostic value of the ratio of carcinoembryonic antigen concentration to maximum tumor diameter in patients with stage II colorectal cancer

Abstract

Background: Recently, a study from our center indicated that the ratio of preoperative carcinoembryonic antigen (CEA) concentration to maximum tumor diameter (DMAX) may be a prognostic marker for patients with rectal cancer. Therefore, the study aimed to evaluate whether this ratio (CEA/DMAX) has prognostic value for patients with stage II colorectal cancer (CRC). Methods: A prospectively maintained database was searched for patients with pathologically confirmed stage II CRC who underwent surgery between January 2010 and March 2019. Patients were stratified according to the mean CEA/DMAX value into low and high CEA/DMAX groups. Kaplan-Meier, univariable, and multivariable Cox regression analyses were used to evaluate whether the CEA/DMAX could predict overall survival (OS) and disease-free survival (DFS). Nomograms were constructed in terms of the results of multivariable Cox regression analyses. Results: The study included 2,499 patients with stage II CRC. The mean CEA/DMAX value was 2.33 (ng/mL per cm). Kaplan-Meier analyses revealed that, relative to the low CEA/DMAX group, the high CEA/DMAX group had significantly poorer OS (67.31% vs. 85.02%, P<0.001) and DFS (61.41% vs. 77.10%, P<0.001). The multivariable Cox regression analysis revealed that CEA/DMAX independently predicted OS (hazard ratio: 2.58, 95% confidence interval: 1.51-4.38, P<0.001) and DFS (hazard ratio: 1.97, 95% confidence interval: 1.38-2.83, P<0.001). Two simple-to-use nomograms comprising CEA/DMAX, age, T stage, and lymphovascular invasion were developed to predict 1-, 3-, and 5-year rates of OS and DFS among patients with stage II CRC. The nomograms had good performance based on the concordance index, receiver operating characteristic (ROC) curve analysis, and calibration curves. Subgroup analyses further confirmed that a high CEA/DMAX was associated with poor OS and DFS among patients with stage II colon cancer and among patients with stage II rectal cancer (both P<0.05).Conclusions: Among patients with stage II CRC, a high CEA/DMAX independently predicted poor OS and DFS, and the predictive abilities were also observed in subgroup analyses of patients with stage II colon cancer or rectal cancer. Furthermore, we developed two nomograms that had good accuracy for predicting the prognosis of stage II CRC.

Perineural invasion is a prognostic factor in stage II colorectal cancer but not a treatment indicator for traditional chemotherapy: a retrospective cohort study

“…Tumor-node-metastasis (TNM) staging is considered the most robust predictor of outcomes and the primary guidance for the subsequent therapy of patients with CRC. Stage II CRC accounts for approximately 25% of all CRC cases (3), and approximately 15-25% of patients relapse or die within 5 years of radical surgery (4). For primary curative CRC, adjuvant chemotherapy is inappropriate for stage I patients and considered the standard treatment for stage III patients under the National Comprehensive Cancer Network guidelines.…”

Prognostic value of the ratio of pretreatment carcinoembryonic antigen to tumor volume in rectal cancer

“…Moreover, previous studies revealed that serum CEA correlates to various confounding factors such as age, smoking, and tumor diameter ( 34 , 35 ). Li et al and Cai et al identified that the CEA/tumor diameter (measured on postoperative specimens) is a more reliable predictor of DFS and OS in patients with CRC ( 23 , 24 ). In our study, we confirmed that patients with high CEA/Dia path encounter unfavorable outcomes.…”

“…It has been firmly established as an independent predictor for treatment response and postoperative survival in diverse malignant tumors, such as gastric cancer, non-small cell lung cancer, and CRC ( 19 - 22 ). Considering the robust positive correlation between serum CEA and tumor size, two studies revealed that the CEA/tumor diameter as an independent prognostic factor was superior to CEA in predicting postoperative recurrence and death in CRC ( 23 , 24 ). Unlike tumor diameter which solely refers to the longest distance across single-section, tumor volume encompasses the entirety of the tumor space, regardless of shape ( 25 ).…”

Preoperative carcinoembryonic antigen to body mass index ratio contributes to prognosis prediction in colorectal cancer

“…In previous studies on CEA levels, the positive rate was relatively low ( 19 ), and although patients with a normal range of CEA also had prognostic significance based on reduced cutoff points ( 35 , 36 ), the sensitivity was relatively low (46.00%) ( 37 ) with a limited AUC in predicting survival that ranged from 0.636 (cutoff, 11 µg/ml) ( 38 ) and 0.645 (cutoff, 5 µg/ml) ( 39 ) to 0.740 (cutoff, 12.5 µg/ml) ( 40 ). A recent study indicated that the CEA to maximum tumor diameter ratio has prognostic value; however, the AUC of the new marker in predicting 3-year OS was reported to be only 0.704 ( 41 ). For BMI, its application in prognosis was largely blocked by inconsistent criteria and conflicting results, as aforementioned ( 10 – 14 ).…”