Abstract
Background: Serum carcinoembryonic antigen (CEA), a classic tumour marker, is widely used in lung cancer in clinical practice. Nevertheless, few studies have elucidated the influence of dynamic changes in CEA in the perioperative phases, as a prognostic indicator, on lung cancer prognosis. Methods: This retrospective cohort analysis included consecutive patients with stage I-III lung cancer who underwent curative resection between December 2010 and December 2014. The patients were grouped into three cohorts: group A included patients with normal preoperative CEA, group B included patients with elevated preoperative CEA but normal postoperative CEA, and group C included patients with elevated preoperative and postoperative CEA. Five-year overall survival (OS) was estimated by Kaplan-Meier analysis (log-rank test). Multivariate analyses were performed with Cox proportional hazard regression. Results: A total of 1662 patients with stage I-III lung cancer were enrolled in our study. Patients with normal preoperative CEA had 15.9 and 20.1% better 3- and 5-year OS rates than the cohort with elevated preoperative CEA (p < 0.001). Furthermore, group C had 36.0 and 26.6% lower 5-year OS rates (n = 74, 32.4%) than group A (n = 1188, 68.4%) and group B (n = 139, 59.0%) (p < 0.001). Group B had poorer OS than group A (p = 0.016). For patients with different pathological TNM stages, subgroup analyses showed that group C had the shortest OS in stages I and II (p < 0.05), and patients with a post-preoperative CEA increment had poorer OS than those without an increment (p = 0.029). Multivariate analyses suggested that group C (HR = 2.0, 95% CI, 1.5–2.7, p < 0.001) rather than the group with normalized postoperative CEA (HR = 1.2, 95% CI, 0.9–1.5, p = 0.270) was an independent prognostic factor. In subgroup analysis of adenocarcinoma (ADC), survival analyses suggested that group C predicted a worse prognosis. Multivariate analysis of ADC indicated that group C was an independent adverse prognostic factor (HR = 1.9, 95% CI, 1.4–2.7, p < 0.001). Conclusions: Combined elevated preoperative and postoperative CEA is an independent adverse prognostic factor for stage I-III lung adenocarcinoma. Additionally, routine perioperative detection of serum CEA can yield valuable prognostic information for patients after lung cancer surgery.
Highlights
Cancer Statistics, 2021 indicated that in both sexes, lung cancer is a commonly diagnosed cancer (11.4% of total cancer cases) and the leading cause of cancer mortality (18.0% of total cancer deaths) (Sung et al, 2021)
Some studies have reported that a high preoperative serum carcinoembryonic antigen (CEA) level is an independent prognostic factor and that a high postoperative level of serum CEA always indicates a poor prognosis in lung cancer (Sawabata et al, 2002; Sawabata et al, 2004a; Okada et al, 2004)
A total of 2477 consecutive patients with stage I-III lung cancer who underwent curative resection were included in our study
Summary
Cancer Statistics, 2021 indicated that in both sexes, lung cancer is a commonly diagnosed cancer (11.4% of total cancer cases) and the leading cause of cancer mortality (18.0% of total cancer deaths) (Sung et al, 2021). Serum tumour markers are widely used in the diagnosis and prognostic monitoring of lung cancer, and carcinoembryonic antigen (CEA) is one of the most sensitive markers (Moertel et al, 1993; Plebani et al, 1995; Molina et al, 2009). CEA has been widely acknowledged and recommended as a reliable tumour marker in colorectal cancer. It plays vital roles in lung cancer diagnosis, progression, recurrence, metastasis, and various treatment effects (Wang et al, 2014; Chen et al, 2018; Konishi et al, 2018). Some studies have reported controversial findings on whether serum CEA can serve as a prognostic and predictive marker in lung cancer. Serum carcinoembryonic antigen (CEA), a classic tumour marker, is widely used in lung cancer in clinical practice. Few studies have elucidated the influence of dynamic changes in CEA in the perioperative phases, as a prognostic indicator, on lung cancer prognosis
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