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Early postoperative CEA level is a better prognostic indicator than is preoperative CEA level in predicting prognosis of patients with curable colorectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Carcinoembryonic antigen (CEA) measurements performed preoperatively and during the early postoperative period were examined prospectively to assess their prognostic value for colorectal cancer (CRC) patients receiving curative surgery.

Methods

Between 2000 and 2004, 1,361 patients with CRC who underwent curative surgery at the Taipei Veterans General Hospital were enrolled prospectively. CEA was measured prior to surgery and during the third or fourth postoperative week. The endpoint was length of postoperative disease-free survival, and prognostic importance was determined using the log-rank test and Cox regression hazard model.

Results

Six hundred (44.1%) CRC patients had high CEA concentrations preoperatively, and 188 (13.8%) patients retained high values postoperatively. Within the median follow-up period of 61 (6–108) months, CRC recurred in 313 patients. By univariate analysis TNM staging, tumor differentiation, lymphovascular invasion, preoperative CEA concentration, and postoperative CEA concentration affected the outcome. By multivariate analysis, the prognostic importance of postoperative CEA was retained (95% CI, 1.73–3.01; HR = 2.28) but that of preoperative CEA was lost (95% CI, 0.82–1.33; HR = 1.05). CRC recurred earlier in patients with high postoperative CEA concentrations; metastasis to the liver was common (72.3%) among patients in this group.

Conclusions

Early postoperative CEA concentration is an independent prognostic factor for CRC. Patients with high postoperative CEA values should receive aggressive follow-up examinations for early relapse of CRC, with special attention paid to recurrence at the liver.

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Abbreviations

CEA:

Carcinoembryonic antigen

CRC:

Colorectal cancer

DFS:

Disease-free survival

References

  1. Cancer registry annual report, Taiwan, R.O.C. The Department of Health, the Executive Yuan, R.O.C. December 2007

  2. Compton CC, Fielding LP, Burgart LJ et al (2000) Prognostic factors in colorectal cancer. College of American Pathologists consensus statement 1999. Arch Pathol Lab Med 124:979–994

    PubMed  CAS  Google Scholar 

  3. Desch CE, Benson AB III, Somerfield MR et al (2005) Colorectal cancer surveillance: 2005 update of an American Society of clinical oncology practice guideline. J Clin Oncol 23:8512–8519

    Article  PubMed  Google Scholar 

  4. Compton C, Fenoglio-Preiser CM, Pettigrew N et al (2000) American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer 88:1739–1757

    Article  PubMed  CAS  Google Scholar 

  5. Bast RC Jr, Ravdin P, Hayes DF, American Society of Clinical Oncology Tumor Markers Expert Panel et al (2001) 2000 update of recommendations for the use of tumor markers in breast and colorectal cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 19:1865–1878

    PubMed  Google Scholar 

  6. Duffy MJ, van Dalen A, Haglund C et al (2003) Clinical utility of biochemical markers in colorectal cancer: European Group on Tumour Markers (EGTM) guidelines. Eur J Cancer 39:718–727

    Article  PubMed  CAS  Google Scholar 

  7. Locker GY, Hamilton S, Harris J, ASCO et al (2006) 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol 24:5313–5527

    Article  PubMed  CAS  Google Scholar 

  8. Duffy MJ, van Dalen A, Haglund C et al (2007) Tumour markers in colorectal cancer: European Group on Tumour Markers (EGTM) guidelines for clinical use. Eur J Cancer 43:1348–1360

    Article  PubMed  CAS  Google Scholar 

  9. Chen CC, Yang SH, Lin JK et al (2005) Is it reasonable to add preoperative serum level of CEA and CA19-9 to staging for colorectal cancer? J Surg Res 124:169–174

    Article  PubMed  CAS  Google Scholar 

  10. Takagawa R, Fujii S, Ohta M et al (2008) Preoperative serum carcinoembryonic antigen level as a predictive factor of recurrence after curative resection of colorectal cancer. Ann Surg Oncol 15:3433–3439

    Article  PubMed  Google Scholar 

  11. Secco GB, Fardelli R, Gianquinto D et al (2002) Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. Eur J Surg Oncol 28:418–423

    Article  PubMed  Google Scholar 

  12. Huh JW, Oh BR, Kim HR, Kim YJ (2010) Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer. J Surg Oncol 101:396–400

    PubMed  Google Scholar 

  13. Oussoultzoglou E, Rosso E, Fuchshuber P, Stefanescu V, Diop B, Giraudo G, Pessaux P, Bachellier P, Jaeck D (2008) Perioperative carcinoembryonic antigen measurements to predict curability after liver resection for colorectal metastases: a prospective study. Arch Surg 143:1150–1158

    Article  PubMed  Google Scholar 

  14. Wang JY, Lu CY, Chu KS, Ma CJ, Wu DC, Tsai HL, Yu FJ, Hsieh JS (2007) Prognostic significance of pre- and postoperative serum carcinoembryonic antigen levels in patients with colorectal cancer. Eur Surg Res 39:245–250

    Article  PubMed  CAS  Google Scholar 

  15. Choi JS, Min JS (1997) Significance of postoperative serum level of carcinoembryonic antigen (CEA) and actual half life of CEA in colorectal cancer patients. Yonsei Med J 38:1–7

    PubMed  CAS  Google Scholar 

  16. Park YA, Lee KY, Kim NK et al (2006) Prognostic effect of perioperative change of serum carcinoembryonic antigen level: a useful tool for detection of systemic recurrence in rectal cancer. Ann Surg Oncol 13:645–650

    Article  PubMed  Google Scholar 

  17. Wittekind C, Greene FL, Henson DE et al (eds) (2003) TNM supplement: a commentary on uniform use, 3rd edn. Wiley, New York

    Google Scholar 

  18. Park IJ, Choi GS, Lim KH et al (2009) Serum carcinoembryonic antigen monitoring after curative resection for colorectal cancer: clinical significance of the preoperative level. Ann Surg Oncol 16:3087–3093

    Article  PubMed  Google Scholar 

  19. Kaiser AM, Kang JC, Chan LS et al (2006) The prognostic impact of the time interval to recurrence for the mortality in recurrent colorectal cancer. Colorectal Dis 8:696–703

    Article  PubMed  CAS  Google Scholar 

  20. Tsai HL, Chu KS, Huang YH et al (2009) Predictive factors of early relapse in UICC stage I–III colorectal cancer patients after curative resection. J Surg Oncol 100:736–743

    Article  PubMed  Google Scholar 

  21. Kim JY, Kim NK, Sohn SK et al (2009) Prognostic value of postoperative CEA clearance in rectal cancer patients with high preoperative CEA levels. Ann Surg Oncol 16:2771–2778

    Article  PubMed  Google Scholar 

  22. Ogata Y, Murakami H, Sasatomi T et al (2009) Elevated preoperative serum carcinoembrionic antigen level may be an effective indicator for needing adjuvant chemotherapy after potentially curative resection of stage II colon cancer. J Surg Oncol 99:65–70

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, No 201, Section 2, Shih-Pai Road Taipei, 11217, Taipei, Taiwan

    Jen-Kou Lin, Chun-Chi Lin, Shung-Haur Yang, Huann-Sheng Wang, Jeng-Kai Jiang, Yuan-Tzu Lan, Tzu-Chen Lin, Wei-Shone Chen & Shih-Ching Chang

  2. Department of Medical Research and Education, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan

    Chun-Chi Lin

  3. Department of Pathology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan

    Anna Fen-Yau Li

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  1. Jen-Kou Lin
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Corresponding author

Correspondence to Shih-Ching Chang.

Additional information

Jen-Kou Lin and Chun-Chi Lin have equal contributions to this manuscript.

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Table S1

Multivariate analysis for 5-year disease-free survival (DFS) stratified by tumor location (DOC 27 kb)

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Lin, JK., Lin, CC., Yang, SH. et al. Early postoperative CEA level is a better prognostic indicator than is preoperative CEA level in predicting prognosis of patients with curable colorectal cancer. Int J Colorectal Dis 26, 1135–1141 (2011). https://doi.org/10.1007/s00384-011-1209-5

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  • DOI: https://doi.org/10.1007/s00384-011-1209-5

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