Accessing new prognostic significance of preoperative carcinoembryonic antigen in colorectal cancer receiving tumor resection: More than positive and negative

Article type: Research Article

Authors: Cai, Zerong^{a; 1} | Xiao, Jian^{b; 1} | He, Xiaosheng^a | Ke, Jia^a | Zou, Yifeng^a | Chen, Yufeng^a | Wu, Xianrui^a | Li, Xiaoling^c | Wang, Lei^{a; d} | Wang, Jianping^{a; d} | Lan, Ping^{a; d} | Wu, Xiaojian^{a; d; *}

Affiliations: [a] Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China | [b] Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China | [c] Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China | [d] Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

Correspondence: [*] Corresponding author: Xiaojian Wu, Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, 26th, Yuancun Erheng Road, Guangzhou, China. Tel.: +86 020 3825 4049; Fax: +86 020 3825 4221; E-mail:wuxjian@mail.sysu.edu.cn

Note: [1] These authors contributed equally to this work.

Abstract: OBJECTIVE: Evaluating the prognostic significance of carcinoembryonic antigen (CEA) for colorectal cancer (CRC) patients in new cutoffs. PATIENTS: Three hundred and seventy cases and 1164 cases of CRC patients receiving tumor resection from hospitals of Sun Yat-sen University were retrospectively investigated as training cohort and validation cohort respectively. CEA was categorized into quintiles for Kaplan-Meier analysis and Cox proportional hazards regression analysis. RESULTS: CEA was categorized into quintiles with the cutoff points of (0-1.5) ng/ml, (1.5-2.3) ng/ml, (2.3-3.98) ng/ml, (3.98-8.02) ng/ml, (8.02-Maximum) ng/ml. In CRC patients from training cohort, progressively worse outcomes were observed in each increasing quintile of CEA in term of overall survival (Log-rank Test: P< 0.0001, Log-rank Test for Trend: P< 0.0001) and progression free survival (Log-rank Test: P= 0.0002, Log-rank Test for Trend: P< 0.0001). CEA quintile was associated with overall survival (HR: 1.209, 95%CI: 1.033-1.416, P= 0.018) and progression free survival (HR: 1.195, 95%CI: 1.024-1.394, P= 0.024). Validation analysis also showed that patients with increasing CEA quintile suffered unfavorable overall survival (Log-rank Test: P= 0.0001, Log-rank Test for Trend: P= 0.0001) and progression free survival (Log-rank Test: P= 0.0001, Log-rank Test for Trend: P= 0.0001). CEA quintile was associated with overall survival (HR: 1.330, 95%CI: 1.123-1.576, P< 0.001) and progression free survival (HR: 1.218, 95%CI: 1.089-1.362, P= 0.001). CONCLUSIONS: Preoperative CEA quintile was an independent predictor of unfavorable prognosis in CRC patients. Even within normal range, CEA quintile might still impact prognosis outcomes of CRC.

Keywords: Colorectal cancer, carcinoembryonic antigen, prognosis

DOI: 10.3233/CBM-160287

Journal: Cancer Biomarkers, vol. 19, no. 2, pp. 161-168, 2017