The role of tissue and serum carcinoembryonic antigen in stages I to III of colorectal cancer—A retrospective cohort study

Tong, Guojun; Xu, Wei; Gao, Shan; Liu, Jian; Chen, Yan; Niu, Pingping; Xu, Xuting

doi:10.1002/cam4.1814

Cited by 45 publications

(45 citation statements)

References 49 publications

(74 reference statements)

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“…Five-year DFS and OS were analyzed by the Kaplan-Meier method and the Breslow test. Survival rates were equally assessed by multivariable Cox's regression according to various clinical, pathological, and biochemical parameters, which were analyzed in our previous studies (21,26). Patient statuses were divided into two: i) Only death was considered an event, and other parameters were censored for OS analysis; ii) death and recurrence were considered events, and other parameters were censored for DFS analysis.…”

Section: Methodsmentioning

confidence: 99%

“…prognosis in CRC (25,26), Ki67 is broadly employed in pathological analyses to evaluate cell proliferation in various malignancies (27)(28)(29)(30). Although Ki67 is expressed in benign tumors, its levels are very low; however, it is found at high levels in multiple malignant lesions, and tightly associated with distant metastasis, resulting in poor patient prognosis.…”

Section: Cutoff Of 25% For Ki67 Expression Is a Good Classification Tmentioning

confidence: 99%

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Cutoff of 25% for Ki67 expression is a good classification tool for prognosis in colorectal cancer in the AJCC‑8 stratification

et al. 2020

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Ki-67 expression has been widely used in clinical practice as an index to evaluate the proliferative activity of tumor cells. The cutoff for Ki67 expression in order to increase the prognostic value of Ki67 expression in colorectal cancer varies. The present study assessed the relationship between the 25% cutoff for Ki67 expression and prognosis in colorectal cancer in the AJCC-8 (American Joint Committee on Cancer 8 edition) stratification. The current trial included 1,090 colorectal cancer patients enrolled from 2006 to 2012 at Huzhou Central Hospital. Ki67 expression was classified according to 25% intervals, dividing the patients into four groups. Measurement data were analyzed by ANOVA, and count data by Crosstabs. Bivariate correlation analysis was performed to assess clinicopathological indicators based on Ki67 expression. Disease-free survival (DFS) and overall survival (OS) based on Ki67 levels were analyzed by the Kaplan-Meier method. A total of 1,090 patients of the 2,080 enrolled CRC cases were evaluated (52.4%). Invasive depth, tumor differentiation, tumor size, AJCC-8, positive number of lymph nodes and chemotherapy status showed significant differences in the various Ki67 expression groups (all P<0.05), with significant correlations (Spearman rho: 0.170, 0.456, 0.22, 0.195, 0.514 and-0.201, respectively, all P<0.001). DFS and OS for the different Ki67 level groups based on AJCC-8 stratification were analyzed, and no significance was found in stage IV (P= 0.334). DFS and OS survival rates were assessed at different Ki67 expression levels, and no significant differences were found (all P>0.05). Cox regression analysis showed that invasive depth, lymph node metastasis, tumor differentiation, AJCC-8 and Ki67 were independent factors affecting colorectal cancer (P= 0.030, all others P<0.001). In conclusion, a cutoff of 25% for Ki67 expression is a good classification tool. High Ki67 has a close association with poor prognosis in colorectal cancer and independently predicts prognosis in the AJCC-8 stratification.

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Section: Methodsmentioning

confidence: 99%

Section: Cutoff Of 25% For Ki67 Expression Is a Good Classification Tmentioning

confidence: 99%

Cutoff of 25% for Ki67 expression is a good classification tool for prognosis in colorectal cancer in the AJCC‑8 stratification

et al. 2020

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“…Recent studies have noted that CEA is insufficiently sensitive to be used alone, and some researchers have sought new ways to improve its prognostic value by the addition of another factor, such as CD44v6, carbohydrate antigen (CA) 19-9, neutrophil-to-lymphocyte ratio (NLR), or peritoneal carcinomatosis index ratio (PCI)[6,8-11]. Intriguingly, a recent study indicated that postoperative tissue CEA (t-CEA) rather than serum CEA (s-CEA) is an independent prognostic factor in stage I to III CRC[12]. This indicated that we should pay more attention to the local CEA produced by tumor cells rather than the overall serum CEA level.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of preoperative carcinoembryonic antigen/tumor size in rectal cancer

Cai

Huang

et al. 2019

WJG

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BACKGROUNDCarcinoembryonic antigen (CEA) is a commonly used biomarker in colorectal cancer. However, controversy exists regarding the insufficient prognostic value of preoperative serum CEA alone in rectal cancer. Here, we combined preoperative serum CEA and the maximum tumor diameter to correct the CEA level, which may better reflect the malignancy of rectal cancer.AIMTo assess the prognostic impact of preoperative CEA/tumor size in rectal cancer.METHODSWe retrospectively reviewed 696 stage I to III rectal cancer patients who underwent curative tumor resection from 2007 to 2012. These patients were randomly divided into two cohorts for cross-validation: training cohort and validation cohort. The training cohort was used to generate an optimal cutoff point and the validation cohort was used to further validate the model. Maximally selected rank statistics were used to identify the optimum cutoff for CEA/tumor size. The Kaplan-Meier method and log-rank test were used to plot the survival curve and to compare the survival data. Univariate and multivariate Cox regression analyses were used to determine the prognostic value of CEA/tumor size. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), respectively.RESULTSIn all, 556 patients who satisfied both the inclusion and exclusion criteria were included and randomly divided into the training cohort (2/3 of 556, n = 371) and the validation cohort (1/3 of 556, n = 185). The cutoff was 2.429 ng/mL per cm. Comparison of the baseline data showed that high CEA/tumor size was correlated with older age, high TNM stage, the presence of perineural invasion, high CEA, and high carbohydrate antigen 19-9 (CA 19-9). Kaplan-Meier curves showed a manifest reduction in 5-year OS (training cohort: 56.7% vs 81.1%, P < 0.001; validation cohort: 58.8% vs 85.6%, P < 0.001) and DFS (training cohort: 52.5% vs 71.9%, P = 0.02; validation cohort: 50.3% vs 79.3%, P = 0.002) in the high CEA/tumor size group compared with the low CEA/tumor size group. Univariate and multivariate analyses identified CEA/tumor size as an independent prognostic factor for OS (training cohort: hazard ratio (HR) = 2.18, 95% confidence interval (CI): 1.28-3.73, P = 0.004; validation cohort: HR = 4.83, 95%CI: 2.21-10.52, P < 0.001) as well as DFS (training cohort: HR = 1.47, 95%CI: 0.93-2.33, P = 0.096; validation cohort: HR = 2.61, 95%CI: 1.38-4.95, P = 0.003).CONCLUSIONPreoperative CEA/tumor size is an independent prognostic factor for patients with stage I-III rectal cancer. Higher CEA/tumor size is associated with worse OS and DFS.

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“…91 Novel Targeted Therapy and Drug Delivery Vehicles mABs against CEA, a membrane-anchored glycoprotein, such as labetuzumab, aim to target payloads to tissue CEA which is overexpressed in over 90% of CRC. 92 Such payloads include targeted photodynamic therapy, radio-guided surgery, and radioimmunotherapy for peritoneal metastases. [93][94][95] A phase 1/2 trial using the payload govitecan (a liposomal irinotecan metabolite) demonstrated tumor response in 38% of the 72 patients enrolled, with SD in 48%.…”

Section: Using Novel Agentsmentioning

confidence: 99%

<p>Refractory Metastatic Colorectal Cancer: Current Challenges and Future Prospects</p>

Lam¹,

Lum²,

Latham³

et al. 2020

CMAR

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Despite advances, patients with metastatic colorectal cancer (mCRC) still have poor long-term survival. Identification of molecular subtypes is important to guide therapy through standard treatment pathways and holds promise for the development of new treatments. Following standard firstand second-line chemotherapy plus targeted agents, many patients retain a reasonable performance status, and thus are seeking further effective treatment to extend life and maintain symptom control. The challenge lies in selecting the most appropriate therapy in the third-and fourth-line settings, from a range of options including the relatively new oral agents TAS-102 and regorafenib, or rechallenge with previous chemotherapy or anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibodies (mAB). Beyond this, therapy consists of trials involving novel agents and new combinations of treatments with theoretical synergy and/or non-overlapping toxicity. There is a great focus on enhancing immunogenicity in mCRC, to reflect the impressive results of immunotherapy drugs in the small cohort with mismatch repair deficient (dMMR) mCRC. Rare molecular subtypes of mCRC are increasingly being identified, including Her2-positive disease, NTRK fusions and others. Clinical trials exploring the efficacy of immunomodulatory and precision agents are plentiful and will hopefully yield clinically meaningful results that can be rapidly translated into routine care.

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The role of tissue and serum carcinoembryonic antigen in stages I to III of colorectal cancer—A retrospective cohort study

Cited by 45 publications

References 49 publications

Cutoff of 25% for Ki67 expression is a good classification tool for prognosis in colorectal cancer in the AJCC‑8 stratification

Cutoff of 25% for Ki67 expression is a good classification tool for prognosis in colorectal cancer in the AJCC‑8 stratification

Prognostic value of preoperative carcinoembryonic antigen/tumor size in rectal cancer

<p>Refractory Metastatic Colorectal Cancer: Current Challenges and Future Prospects</p>

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