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. 2012 Jul 10;107(2):266-74.
doi: 10.1038/bjc.2012.267. Epub 2012 Jun 26.

Elevated preoperative CEA is associated with worse survival in stage I-III rectal cancer patients

I Tarantino  1 , R Warschkow, M Worni, K Merati-Kashani, D Köberle, B M Schmied, S A Müller, T Steffen, T Cerny, U Güller
Affiliations

Elevated preoperative CEA is associated with worse survival in stage I-III rectal cancer patients

I Tarantino et al. Br J Cancer. .

Abstract

Background: The objective of this investigation was to assess whether preoperative carcinoembryonic antigen (CEA) level is an independent predictor of overall survival in rectal cancer patients.

Methods: All patients (n=504) undergoing a resection for stage I-III rectal cancer at the Kantonsspital St Gallen were included into a database between 1991 and 2008. The impact of preoperative CEA level on overall survival was assessed using risk-adjusted Cox proportional hazard regression models and propensity score methods.

Results: In risk-adjusted Cox proportional hazard regression analyses, preoperative CEA level (hazard ratio (HR): 1.98, 95% confidence interval (CI): 1.36-2.90, P<0.001), distance from anal verge (<5 cm: HR: 1.93, 95% CI: 1.11-3.37; P=0.039), older age (HR: 1.07, 95% CI: 1.05-1.09; P<0.001), lower body mass index (HR: 0.94, 95% CI: 0.89-0.98; P=0.006), advanced tumour stage (stage II HR: 1.41, 95% CI: 0.85-2.32; stage III HR: 2.08, 95% CI: 1.31-3.31; P=0.004), R 1 resection (HR: 5.65, 95% CI: 1.59-20.1; P=0.005) and chronic kidney disease (HR: 2.28, 95% CI: 1.03-5.04; P=0.049) were all predictors for poor overall survival.

Conclusion: This is one of the first investigations based on a large cohort of exclusively rectal cancer patients demonstrating that preoperative CEA level is a strong predictor of decreased overall survival. Preoperative CEA should be used as a prognostic factor in the preoperative assessment of rectal cancer patients.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient selection.
Figure 2
Figure 2
Kaplan–Meier curve for overall survival in unmatched analysis. Life tables for the number of rectal adenocarcinoma patients at risk are given below each plot. Survival curves are provided with 95% point-wise confidence intervals.
Figure 3
Figure 3
Kaplan–Meier curve for disease-free survival in unmatched analysis. Life tables for the number of rectal adenocarcinoma patients at risk are given below each plot. Survival curves are provided with 95% point-wise confidence intervals. Analysis limited to 500 patients with R0-resection.
Figure 4
Figure 4
Distribution of propensity score before and after propensity score analysis. Left upper and lower panel show the distribution of the propensity score for patients with C1-stage and C0-stage before the matching procedure. Right upper and lower panel demonstrate the distribution of the propensity score after full propensity score matching.
Figure 5
Figure 5
Kaplan–Meier curve for overall survival in propensity score-matched analysis. Life tables for the number of rectal adenocarcinoma patients at risk are given below each plot. Survival curves are provided with 95% point-wise confidence interval.
Figure 6
Figure 6
Kaplan–Meier curve for disease-free survival in propensity score-matched analysis. Life tables for the number of rectal adenocarcinoma patients at risk are given below each plot. Survival curves are provided with 95% point-wise confidence intervals. Analysis limited to 500 patients with R0-resection.
See this image and copyright information in PMC

References

    1. AJCC (2010) In AJCC Cancer Staging Manual, Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds). 7th edn, Vol X, 646pp, 130 illus. with CD-ROM. ISBN 978-0-387-88440-0 Springer: New York
    1. Boonpipattanapong T, Chewatanakornkul S (2006) Preoperative carcinoembryonic antigen and albumin in predicting survival in patients with colon and rectal carcinomas. J Clin Gastroenterol 40(7): 592–595 - PubMed
    1. Cancer-Statistics US (2010) US Cancer Statistics Working Group. United States Cancer Statistics: 1999–2007 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute (2010) Available at: www.cdc.gov, last accessed 12 March 2012
    1. Chapman MA, Buckley D, Henson DB, Armitage NC (1998) Preoperative carcinoembryonic antigen is related to tumour stage and long-term survival in colorectal cancer. Br J Cancer 78(10): 1346–1349 - PMC - PubMed
    1. Diez M, Pollan M, Muguerza JM, Gaspar MJ, Duce AM, Alvarez MJ, Ratia T, Hernandez P, Ruiz A, Granell J (2000) Time-dependency of the prognostic effect of carcinoembryonic antigen and p53 protein in colorectal adenocarcinoma. Cancer 88(1): 35–41 - PubMed

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