Abstract
BackgroundUntil date, there are no clear recommendations for regular perioperative measurements of serum CEA levels for lung cancer in any guidelines. The purpose in the present study is to evaluate the prognostic significance of perioperative serum carcinoembryonic antigen (CEA) levels in patients with pathological-stage I non-small cell lung cancer (NSCLC).MethodsWe retrospectively reviewed 263 completely resected pathological-stage I NSCLC patients whose preoperative and postoperative serum CEA levels were measured. Patients were subdivided according to the perioperative change of CEA levels: continuously normal CEA levels (NN group), continuously high CEA levels (HH group), and high preoperative CEA levels that returned to normal levels post-operation (HN group). The clinicopathological factors and overall survival (OS) among these 3 groups were compared. Univariate and multivariate analyses of the correlation between clinicopathological factors and OS were performed.ResultsHigh preoperative CEA levels significantly correlated with men aged >70 years with smoking history, high serum CYFRA 21–1 levels, greater tumor diameter, presence of visceral pleural invasion (VPI), and moderate-to-poor differentiation. Five-year OS rates in the NN and HH groups were 95.5% and 59.3%, respectively. Four-year OS rate in the HN group was 85.5%. Multivariate analyses indicated tumor diameter of more than 30 mm, presence of VPI, and the HH group were independent unfavorable prognostic factors.ConclusionsA high postoperative CEA level was an independent unfavorable prognostic factor in pathological-stage I NSCLC patients. Patients with high postoperative CEA levels may benefit from adjuvant chemotherapy.
Highlights
Until date, there are no clear recommendations for regular perioperative measurements of serum carcinoembryonic antigen (CEA) levels for lung cancer in any guidelines
263 consecutive patients who met all of the following criteria were included and retrospectively reviewed in the present study: (1) those who had their serum CEA concentrations measured within the 1-month period before surgery and again within the 2-month period after surgery, (2) those without multiple lung tumors or malignancies in other organs and (3) those who were anticancer treatment-naïve in both the neoadjuvant setting and adjuvant setting
The medical records of each patient were examined for age, gender, smoking history, preoperative European Cooperative Oncology Group performance status (ECOG European cooperative oncology group performance status (PS)), both preoperative and postoperative serum CEA levels, preoperative serum cytokeratin 19 fragment (CYFRA21-1) levels, tumor location, surgical procedure, tumor histology, tumor diameter, visceral pleural invasion (VPI), angiolymphatic invasion (ALI), differentiation grade, and survival
Summary
There are no clear recommendations for regular perioperative measurements of serum CEA levels for lung cancer in any guidelines. The purpose in the present study is to evaluate the prognostic significance of perioperative serum carcinoembryonic antigen (CEA) levels in patients with pathological-stage I non-small cell lung cancer (NSCLC). Subsequent reports demonstrated that high postoperative CEA levels predicted recurrence and prognosis in NSCLC patients [4,8,10,11,12,13,14,15].
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