Use of a Combination of CEA and Tumor Budding to Identify High-risk Patients with Stage II Colon Cancer

Du, Changsheng; Xue, Weicheng; Dou, Fangyuan; Peng, Yifan; Yao, Yunfeng; Zhao, Jun; Gu, Jin

doi:10.5301/jbm.5000255

Cited by 8 publications

(8 citation statements)

References 35 publications

(33 reference statements)

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“…CEA is a glycoprotein involved in cell adhesion processes during the fetal development of gastrointestinal tissue 42 . Currently, increasing attention has been paid to CEA as a biomarker for diagnosis and predicting prognosis in ICC patients 43 , 44 .…”

Section: Discussionmentioning

confidence: 99%

Preoperative CEA levels are supplementary to CA19-9 levels in predicting prognosis in patients with resectable intrahepatic cholangiocarcinoma

He¹,

Song²,

Wang³

et al. 2018

J. Cancer

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Background: There are few diagnostic tools that can be used to determine which patient with intrahepatic cholangiocarcinoma (ICC) can benefit from surgery actually, highlighting that the need for new preoperative stratification strategies. The aim of this study was to investigate the predictive values of preoperative biomarkers in survival analyses for patients with ICC after surgical resection.Methods: A total of 285 patients with ICC were retrospectively reviewed. Receiver operating charateristics (ROC) curves were used to evaluate the predictive effects of preoperative carbohydrate antigen 19-9 (CA19-9) with different cutoff values and carcinoembryonic antigen (CEA) in patients with ICC.Results: Preoperative CA19-9 with a cutoff value of 200 U/ml performed better in predicting overall survival (OS) and progression free survival (PFS) in ICC patients. Patients with preoperative CA19-9 value > 200 U/ml generally had a poor surgical response. However, surgical resection could also benefit patients whose CA19-9 levels decreased postoperatively or preoperative CEA levels were negative.Conclusions: With the cutoff value of 200U/ml, CA19-9 was a better preoperative biomarker for predicting survival for ICC patients after surgical resection. Combination of preoperative CA19-9 and CEA showed the strongest predictive power in survival analyses in these patients and should be recognized in daily clinical care.

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Section: Discussionmentioning

confidence: 99%

Preoperative CEA levels are supplementary to CA19-9 levels in predicting prognosis in patients with resectable intrahepatic cholangiocarcinoma

He¹,

Song²,

Wang³

et al. 2018

J. Cancer

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“…Consequently, it has been inferred that the efficacy of adjuvant chemotherapy is limited to patients with stage II CRC and with potentially high‐risk clinicopathological characteristics. In this context, various biomarkers of high malignancy have been proposed in many clinical studies . In particular, tumour budding has been repeatedly reported to contribute to the selection of patients with this type of stage II cancer …”

Section: Introductionmentioning

confidence: 99%

“…In this context, various biomarkers of high malignancy have been proposed in many clinical studies. [14][15][16][17][18][19] In particular, tumour budding has been repeatedly reported to contribute to the selection of patients with this type of stage II cancer. [4][5][6][7]20,21 The prospect of using artificial intelligence (AI) to evaluate cytokeratin-stained slides has emerged as a potential option for the future.…”

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confidence: 99%

Differential clinical impacts of tumour budding evaluated by the use of immunohistochemical and haematoxylin and eosin staining in stage II colorectal cancer

et al. 2019

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Aims The aim of this study was to clarify the quantitative and qualitative differences in tumour budding identification between haematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin, and to estimate the respective clinical impacts in stage II colorectal cancer. Methods and results We retrospectively examined 314 surgically resected cases of stage II colorectal cancer, and assessed tumour budding on serial section slides with H&E staining and IHC staining for cytokeratin. Tumour budding counts based on cytokeratin‐stained slides were strongly correlated with those based on H&E‐stained slides, and had higher detection and reproducibility. On the basis of receiver operating characteristic analyses, the optimal cut‐off values of budding counts for relapse‐free survival (RFS) were 7 and 16 in a ×200 microscopic field with H&E and IHC staining, respectively. With these cut‐off values, tumour budding based on H&E staining had a significant correlation with RFS (80.3% and 93.2% of 5‐year RFS in the high‐budding group and the low‐budding group, respectively), and similar results were observed for IHC staining (79.9% and 91.7%, respectively). The Akaike Information Criterion value for RFS with H&E staining was favourable as compared with that with IHC staining. Conclusions Tumour budding counts based on cytokeratin‐stained slides showed higher detection and better reproducibility, but did not have as satisfactory clinical impacts as those based on H&E staining.

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“…For example, in Li et al's study, the AUCs for PFS and OS of ALB were 0.644 and 0.611, respectively, and ALB alone was not an independent prognostic factor when compared to PLR [11]; in both ALB and cholinesterase high groups would have a better DSS than others; however, the AUCs of the combined groups were not compared with individual ALB (0.71) and cholinesterase (0.69) in their study [22]. Some authors tried to combine CEA with Ki-67 [49], p53 [50], tumor budding [51], CD44v6 [52], peritoneal carcinomatosis index [53], D-dimer [54] and NLR [55] to generate new prognostic indicators, but these studies did not compare the AUC of the new indicators with individual CEA. In our study, we found that ACR displayed the largest AUC when compared with individual ALB, CEA and NLR, LMR, PLR both for PFS and OS, which supports its priority in prognosis prediction in CRC.…”

Section: Discussionmentioning

confidence: 97%

“…[22]. Some authors tried to combine CEA with Ki-67 [49], p53 [50], tumor budding [51], CD44v6 [52], peritoneal carcinomatosis index [53], D-dimer [54] and NLR [55] to generate new prognostic indicators, but these studies did not compare the AUC of the new indicators with individual CEA. In our study, we found that ACR displayed the largest AUC when compared with individual ALB, CEA and NLR, LMR, PLR both for PFS and OS, which supports its priority in prognosis prediction in CRC.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Implication of Preoperative Serum Albumin to Carcinoembryonic Antigen Ratio in Colorectal Cancer Patients

You

Xue

et al. 2021

Preprint

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Both preoperative serum albumin (ALB) and carcinoembryonic antigen (CEA) were previously reported as useful prognostic factors in colorectal cancer (CRC); however, the ALB to CEA ratio (ACR) and their individual prognostic efficacies have been less studied. In this study, a total of 156 CRC patients staged I-IV were retrospectively enrolled. Patients were divided into ACR-low or ACR-high subgroups, and the differences in progression-free survival (PFS) and overall survival (OS) were conducted by Kaplan-Meier curves, log-rank test and Cox proportional model. As a result, a total of 31.41% (49/156) of patients presented with ACR-low disease, and these patients had tumors with advanced T stages (T3 + T4) (P<0.01), larger tumor diameters (P<0.01) and distant metastases (P = 0.01) and a relatively lower lymphocyte to monocyte ratio (LMR) (P<0.01). The ACR was significant in predicting survival. When 5.98 was used as the cutoff point, it had a sensitivity of 58.50% and 61.50% and a specificity of 83.50% and 80.50% for PFS and OS, respectively. ACR displayed a superior prognostic efficacy than other tested markers for both PFS and OS (except LMR). Patients in the ACR-low group displayed significantly worse PFS (log rank = 35.75, P<0.01) and OS (log rank = 29.68, P<0.01) than those in the ACR-high group. Finally, ACR was an independent prognostic factor for both PFS (HR = 0.31, 95% CI: 0.17–0.56, P < 0.01) and OS (HR = 0.33, 95% CI: 0.16–0.66, P < 0.01). For conclusion, the ACR was a robust prognostic factor in CRC, and patients with a relatively low preoperative ACR had significantly worse survival.

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Use of a Combination of CEA and Tumor Budding to Identify High-risk Patients with Stage II Colon Cancer

Abstract: The findings indicate that the combination of CEA levels and tumor budding grade has greater prognostic value for identifying patients with stage II colon cancer who are at high-risk for disease progression, than either marker alone.

Cited by 8 publications

References 35 publications

Preoperative CEA levels are supplementary to CA19-9 levels in predicting prognosis in patients with resectable intrahepatic cholangiocarcinoma

Preoperative CEA levels are supplementary to CA19-9 levels in predicting prognosis in patients with resectable intrahepatic cholangiocarcinoma

Differential clinical impacts of tumour budding evaluated by the use of immunohistochemical and haematoxylin and eosin staining in stage II colorectal cancer

Prognostic Implication of Preoperative Serum Albumin to Carcinoembryonic Antigen Ratio in Colorectal Cancer Patients

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