Elsevier

Surgical Oncology

Volume 21, Issue 1, March 2012, Pages 45-51
Surgical Oncology

Review
The prognostic significant of percentage drop in serum CEA post curative resection for colon cancer

https://doi.org/10.1016/j.suronc.2010.10.003Get rights and content

Abstract

Objective/background

This study aimed to analyze the hypothesis that increased percentage drop in serum CEA post curative resection for colon cancer is associated with improved survival.

Methods

Five hundred thirty three patients who underwent colon resection with a curative intent were retrospectively analyzed for their pre- and postoperative CEA levels. The disease-free and overall survival curves were calculated using Kaplan Meier analysis to evaluate cancer related outcomes. For multivariate analysis, the Cox regression model was used.

Results

The estimated 5-year overall survival for the preoperative serum CEA > 5 ng/mL group with respect to a postoperative CEA level drop rate of 40%, 50% and 60% were 72.9%, 80.9% and 81.8%, respectively. The estimated 5-year overall survival for the preoperative serum CEA ≤ 5 ng/mL group with respect to each postoperative CEA level drop rate were 86.6%, 97.1% and 97.7%, respectively (P = 0.257, P = 0.092 and P = 0.073, respectively). The prognostic factors for poor survival were the depth of invasion (p = 0.042, hazard ratio: 2.617, 95% CI = 1.021–3.012) and lymph node metastasis (p = 0.008, hazard ratio: 2.249, 95% CI = 1.231–4.111). A 60% drop of the CEA level was an independent prognostic factor for survival (p = 0.001, hazard ratio: 2.954, 95% CI = 1.686–5.176) for patients with a preoperative CEA level > 5 ng/mL.

Conclusion

Determining the preoperative CEA level and the early postoperative percent drop of the serum CEA level may be a helpful factor for the prognosis of colon caner patients. However, the percent drop from the pre to postoperative CEA level from the normal range was not associated with survival difference.

Introduction

Colon cancer accounts for 10–15% of all cancers and it is the second leading cause of cancer deaths in Western countries [15]. Colon cancer is the 4th most common cancer in Korea [26]. The most reliable prognostic factor for colon cancer is currently the stage of tumor node metastasis (TNM) [13], [23]. Although the prognosis of individual patients is dependent upon the extent of the disease, the prognosis of patients with the same stage varies widely, and especially for those patients with stage II and III tumors [14], [16], [35]. To further improve the survival rates, it is crucial to identify predictive factors for relapse, and such prognostic factors have been investigated, including molecular and biochemical markers [1], [2], [11], [18]. However, these factors are not readily obtainable due to the relatively high cost of measurement and so their clinical application is limited [31]. Since its initial description in 1965 by Gold and Freedman [8] carcinoembryonic antigen(CEA) has been the most extensively investigated tumor marker for colon cancer. Tumor markers have been applied potentially in clinical practice for several decades for screening, recurrence and monitoring the effects of treatment[5], [12], [19]. Many studies have demonstrated the prognostic value of preoperative CEA level after surgical resection of colon[1], [8], [19], [28]. However, the evaluation of the early postoperative percent drop of the CEA level, as compared to the preoperative CEA level, as an independent predictor of disease-free and overall survival in colon cancer patients has rarely been published. The primary aim was to analyze the early postoperative percent drop of the CEA levels, as compared to the preoperative CEA level, as a predictor of survival for curatively resected colon cancer patients.

Section snippets

Patients

Of the 602 consecutive patients who were referred to our department during the period between March 2002 and October 2006, 59 patients were classified as stage IV according to the AJCC Cancer Staging Manual 6th edition [10]. Six hundred and twelve stage I–III colon cancer patients who underwent curative resection for a primary lesion were enrolled in the present study for retrospective analysis. Seventy-nine(15.0%) were excluded from the analysis due to incomplete medical records and serum CEA

Patient characteristics

The clinicopathological features of the colon cancer patients are shown in Table 1. The median age of the 533 patients was 63 years (range: 19–88years). The median follow-up duration was 46.3 months (range: 6–105.8 months). A high preoperative CEA level (CEA > 5.0 ng/mL) was found in 181 of the 533 patients (33.9%). Two hundred thirty three patients(43.6%) had stage III cancers. Fifty patients (9.4%) had an abnormal CEA level after primary resection of colon cancer (Table 1). The postoperative

Discussion

The major findings of this study were that an elevated preoperative CEA level with a postoperative 60 percent drop was necessary to predict survival, and a drop from a normal preoperative CEA level was not a significant predictor of survival.

CEA is the most widely accepted and frequently used tumor marker worldwide for colon cancer, and the method of measurement is standardized and it is cheap and easy to measure. The postoperative CEA level is commonly assessed during the follow-up of colon

Conflict of interest statement

None.

Authorship statement

Guarantor of the integrity of the study: Jeong Heum Baek.

Study concepts: Won-Suk Lee.

Study design: Won-Suk Lee.

Data analysis: Yeon Ho Park.

Statistical analysis: Jeong Heum Baek.

Manuscript review: Won-Suk Lee, Keon Kuk Kim.

References (35)

  • D.J. Bruinvels et al.

    Follow-up of patients with colorectal cancer. A meta-analysis

    Ann Surg

    (1994)
  • L.A. Carriquiry et al.

    Should carcinoembryonic antigen be used in the management of patients with colorectal cancer?

    Dis Colon Rectum

    (1999)
  • C.C. Compton et al.

    Prognostic factors in colorectal cancer. College of American Pathologists consensus statement 1999

    Arch Pathol Lab Med

    (2000)
  • P. Gold et al.

    Specific carcinoembryonic antigens of the human digestive system

    J Exp Med

    (1965)
  • M.J. Goldstein et al.

    Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer

    Cancer Invest

    (2005)
  • Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al. AJCC Cancer staging manual. 6th ed....
  • K.C. Halling et al.

    Microsatellite instability and 8p allelic imbalance in stage B2 and C colorectal cancers

    J Natl Cancer Inst

    (1999)
  • Cited by (0)

    Won-Suk Lee and Jeong-Heum Baek equally contributed as first authors.

    View full text