Pretreatment Serum CEA as a Prognostic Factor for Rectal Cancer Treated with Preoperative Chemoradiotherapy

Abstract

Purpose: Preoperative serum carcinoembryonic antigen (s-CEA) is well known to be a prognostic factor in patients with colorectal cancer. However, the prognostic effect of s-CEA in patients with rectal cancer treated with preoperative chemoradiotherapy (CRT) has not been well studied. The aim of this study is to evaluate the prognostic value of pretreatment s-CEA for rectal cancer treated with preoperative CRT. Methods: This study analyzed the data of 436 patients who received preoperative CRT and underwent curative surgery for locally advanced rectal cancer from January 2002 to July 2007. Patients were categorized into two groups according to pretreatment CEA levels: ≤10 and >10 ng/mL. The disease-free survivals between the two groups were compared. Results: The three-year disease-free survival rates of the CEA ≤10 ng/mL group and the CEA >10 ng/mL group were 80.4% and 67.3%, respectively (P=0.002). Multivariate analysis revealed the following independent risk factor for recurrence: pretreatment CEA >10 ng/mL (hazard ratio [HR] 1.616; 95% confidence interval [CI], 1.007 to 2.594; P=0.047), positive lymph node status (HR, 2.580; 95% CI, 1.625 to 4.094; P<0.001), and positive circumferential resection margin (HR, 1.889; 95% CI, 1.035 to 3.446; P=0.038). Conclusion: Pretreatment s-CEA (cutoff value 10 ng/mL) may be a prognostic factor for disease-free survival in rectal cancer patients treated with preoperative CRT and surgery.