Combining PT and CEA Levels With the TNM Stage System to Identify Postoperative Recurrence Patients With Stage I-III Colorectal Cancer

Abstract

Background: TNM stage alone cannot accurately predict the recurrence risk after curative resection of colorectal cancer (CRC) and the benefit of adjuvant chemotherapy for patients with stage II CRC. We assessed the value of prothrombin time (PT) and carcinoembryonic antigen (CEA) levels in recurrence prediction and whether the combination of PT and CEA levels and TNM stage can improve the accuracy in predicting postoperative recurrence of CRC. Methods: The coagulation indexes and tumor markers of 451 patients with CRC were analyzed retrospectively. Log-rank test, Cox proportional hazard regression model and Kaplan-Meier survival curve were used to analyze the value of these indexes in predicting postoperative recurrence in different TNM stage subgroups. Results: Preoperatively elevated levels of PT (≥12.65s) and CEA (≥ 10.175ng/ml) were independent factors affecting postoperative recurrence of CRC (p 0.05); moreover, the RFS of the High-risk group of early-stage was notably shorter than that of the Low-risk group (38.9 vs 53 months; p < 0.001) and even that of IIIA and B (38.9 vs 45.2 months; p < 0.05). Conclusion: Preoperatively elevated levels of PT and CEA were reliable predictors of postoperative high recurrence in CRC patients. Incorporation of PT and CEA levels to a recurrence prediction model with TNM stage can precisely identify a subgroup of CRC patients with -risk of recurrence in stage I-III, especially the risk of recurrence population in stage I and II. Funding Information: This work was supported by the National Natural Science Foundation of China (81502039), the Natural Science Foundation of Fujian Province (2016J01616 and 2020J011214), the Health and Family Planning Commission of Fujian Province for Youth Research Project (2015-2-49), the Scientific Research Foundation for Returned Scholars from Ministry of Human Resources and Social Security (2015142), and the Digestive Center of Xiamen University Foundation. Declaration of Interests: The authors had declared no conflict of interest. Ethics Approval Statement: This study was approved by the Ethics Review Committee of Zhongshan Hospital of Xiamen University and the informed consent of the patients was obtained.