Relationship Between Preoperative and Postoperative Serum Carcinoembryonic Antigen and Prognosis of Patients with Stage I–III Rectal Cancer: A Retrospective Study of a Multicentre Cohort of 1022 Rectal Cancer Patients

Abstract

Purpose Based on a multi-centered and a large sample size, this study aims to analyze the relationship between preoperative and postoperative serum CEA and recurrence of rectal cancer without preoperative therapy. Methods This retrospective cohort study enrolled stage I to III rectal cancer patients without preoperative therapy (N = 1,022) who received radical resection of rectal cancer from 2 hospitals in China. Based on the preoperative and postoperative serum carcinoembryonic antigen, the patients were subdivided into 3 groups ie, normal preoperative CEA (≤5.0 ng/mL, N = 627), elevated preoperative (>5.0 ng/mL) but normalized postoperative CEA (normalized postoperative CEA, N = 255), as well as elevated preoperative and postoperative CEA (elevated postoperative CEA, N = 67). The generalized additive model was used to assess the relationship between carcinoembryonic antigen and the risk of recurrence. Further, the Cox regression model was used to evaluate the relationship between carcinoembryonic antigen and 3-year recurrence-free survival (RFS) after adjusting for potential confounders. Results The 3-year RFS of patients with elevated postoperative CEA was 45.8% (95% CI, 35.2% −59.5%), which was significantly lower compared to the other two groups of patients (normalized postoperative CEA: 75.9%, 95% CI, 70.8%-81.4%; and normal preoperative CEA: 84.9%, 95% CI, 82.2%-87.8%) (P <0.001). Based on multivariable Cox model analysis, the elevated postoperative CEA was a prognostic factor for 3 years RFS (hazard ratio [HR], 3.08; 95% CI, 2.05–4.66; P<0.001). At the same time, normalized postoperative CEA was insignificantly correlated with 3-year RFS (HR, 1.38; 95% CI, 1.00–1.92; P = 0.05) and was not an independent risk factor. Conclusion We found that preoperative and postoperative serum CEA of rectal cancer patients were related to the 3-year recurrence-free survival rate. Moreover, the risk of recurrence in the normalized postoperative CEA group of patients was insignificantly different from that of the normalized preoperative CEA patients. Therefore, it is necessary to combine preoperative and postoperative CEA to predict the prognosis of patients with rectal cancer, rather than using it alone.

Trajectories of Perioperative Serum Tumor Markers and Colorectal Cancer Outcomes: A Retrospective, Multicenter Longitudinal Cohort Study

“…In the trajectory analysis, ascending levels of tumor markers indicated poor prognosis, which is consistent with other studies [23,24]. It has been reported that CEA generally dropped to normal within 4-6 weeks after resection in CRC patients [25][26][27], and a continued CEA rising after surgery often implied incomplete resection and occult metastasis, which indicated recurrence [25,26].…”

Post‐diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta‐analysis

“…There were 278 potentially eligible publications on post‐diagnosis adiposity and colorectal cancer outcomes. We excluded 193 publications 45–237 due to specific reasons related to the synthesis (Supplementary Table 5). Finally, 85 publications…”

Influence of the initial recurrence site on prognosis after radical surgery for colorectal cancer: a retrospective cohort study

“…Data from our center published previously indicates that 25.10% of patients with stage I-III colorectal cancer experience postoperative recurrence [ 2 ]. Multiple influencing factors, including histological grade, serum CEA level, tumor location, surgical method, number of positive lymph nodes, and adjuvant chemotherapy, function as independent risk factors for the recurrence and metastasis of colorectal cancer post-surgery [ 3 , 4 ]. A post-recurrence survival (PRS) of 23.1 months after colorectal cancer recurrence was reported, and the post-recurrence prognosis was found to be poor [ 5 ].…”