Adjuvant radiochemotherapy of stage II and III rectal adenocarcinoma: role of CEA and CA 19-9

Abstract

Background: This analysis was undertaken to evaluate the impact of pre-radiotherapy CEA and CA 19-9 values on clinical outcome of locally advanced rectal cancer.

Patients and methods: Retrospective data were collected from patients (n=203) with UICC stage II and III rectal adenocarcinomas, who underwent low anterior or abdominoperineal resection and received post-operative or pre-operative radiochemotherapy from January 1989 until July 2002. The rates of survival and distant and local recurrences were evaluated using Kaplan-Meier survival analysis, Log-rank test and Cox's proportional hazards (median follow-up 8 years). Multivariate analysis was used to assess the prognostic value of CEA and CA 19-9.

Results: The 5-year actuarial rates for patients with normal (n =118) and elevated (n=88) CEA values were as follows: overall survival 62.4% and 32.0% (p<0.001), local control 73.5% and 55.0% (p=0.007), and absence of distant metastasis 83.3% and 88.0% (n.s.), respectively. Similar results were obtained for patients with normal (n=82) and elevated (n = 10) CA 19-9 values: overall survival 60.7% and 14.0% (p=0.007), local control 83.7% and 80.0% (n.s.), and absence of distant metastasis 64.9% and 75.0% (n.s.), respectively. After adjustment for TNM stage, sex, age, LDH, tumor site and grading, the elevation of CEA proved to be an independent prognostic factor for overall survival (relative risk of 1.01 per ng/ml, CI 1.002 - 1.01; p=0.005).

Conclusion: This study confirmed the prognostic value of pre-radiotherapy CEA and CA 19-9 in patients with stage II or III rectal carcinoma.