Prognosis of lung cancer patients with high preoperative carcinoembryonic antigen (CEA) level: Are they surgical candidates

Abstract

7181 Background: Elevated preoperative serum carcinoembryonic antigen (CEA) level has been reported to be a poor prognostic factor in non-small cell lung cancer (NSCLC). Surgical indication remains controversial in clinical (c-) stage I NSCLC patients with very high CEA levels. Methods: Between Jan. 1985 and Dec. 2000, 1502 patients with c-stage I NSCLC underwent surgical resection at the National Cancer Center Hospital, Tokyo, Japan. They were retrospectively analyzed for preoerative CEA level, pathologic (p-) stage and postoperative prognosis. Patients were divided into three groups according to CEA levels: Group A (n=1077, CEA< 5.0ng/ml), Group B (n=394, 5.0 ≤ CEA < 50ng/ml), and Group C (n=31, 50ng/ml ≤ CEA). Results: The p-stages of the 1502 patients were: stage I in 909 patients (60.5%), stage II in 464 (30.9%), stage III in 52 (3.5%) and stage IV in 64(4.3%). Group C patients were significantly (P < 0.0001) upstaged post-operatively; among the 31 patients in Group C, 4 (12.9%) had p-stage II disease, 12 (38.7%) stage III, and 4 (12.9%) stage IV. Among the 1077/394 patients in Group A/B, 259 (24.0%) /175 (44.4%) were upstage to p-stage II or more, respectively. The 5-year survival was 81.8% in Group A (n=1077), 63.5% in Group B (n=394) and 28.2% in Group C (P < 0.0001). There were 7 long-term survivors (> 5 years) in Group C. Conclusions: Patients with high CEA levels (50ng/ml ≤) significantly had advanced disease in terms of p-stage. High CEA level was a poor prognostic factor. However, we did observe long term survivors in this group, and high CEA per se is not a contraindication for surgical resection after intensive preoperative evaluation. No significant financial relationships to disclose.