Abstract
Serum carcinoembryonic antigen (CEA) levels can help predict the prognosis of colorectal cancer patients. Accordingly, high preoperative CEA levels that is not restored after surgery are indicative of a worse outcome. On the other hand, smoking can increase serum CEA levels independently of the disease status. Thus, we aimed to evaluate the impact of smoking on the prognostic value of serum CEA levels. This retrospective cohort study included 273 patients who underwent curative resection for stage I-III colorectal adenocarcinoma at a single institution, between January 2010 and December 2017. Patients were grouped as follows: group A, normal preoperative and postoperative CEA levels (n = 152); group B, elevated preoperative CEA levels that returned to reference values after surgery (n = 69); and group C, elevated postoperative serum CEA levels (n = 52). Patients were also grouped according to their smoking history: group S (current smokers, n = 79) and group NS (never and former smokers, n = 194). Group A showed a higher 3-year disease-free survival (DFS) rate (84.9%) than groups B (75.4%) and C (62.0%) (p < 0.001). Postoperative serum CEA levels were significantly higher in the S group than in the NS group (2.6 vs. 3.1 ng/mL, p = 0.009), whereas preoperative levels were similar (3.8 vs. 4.1, p = 0.182). Further, smokers showed higher 3 year-DFS rates than nonsmokers in group C (83.3% vs. 43.9%, p = 0.029). This suggests that while elevated postoperative CEA levels are associated with lower DFS rates in never and former smokers, they are not associated with lower DFS rates in current smokers. We conclude that persistent smoking alters the prognostic value of postoperative serum CEA levels in colorectal cancer patients and that, consequently, alternative surveillance strategies need to be developed for colon cancer patients with smoking habits.
Highlights
Serum carcinoembryonic antigen (CEA) is the most widely used tumor marker for patients with colorectal cancer
In 2000, the Colorectal Working Group of the American Joint Committee on Cancer (AJCC) recommended modifications of the TNM staging system to differentiate between tumors of patients with normal vs. elevated serum CEA levels at presentation [6]
In addition to CEA status, we found that tumor stage and age were independent prognostic factors for disease-free survival (DFS) on multivariable analysis
Summary
Serum carcinoembryonic antigen (CEA) is the most widely used tumor marker for patients with colorectal cancer. In 2000, the Colorectal Working Group of the American Joint Committee on Cancer (AJCC) recommended modifications of the TNM staging system to differentiate between tumors of patients with normal vs elevated serum CEA levels at presentation [6]. High preoperative serum CEA levels do not return to reference values after surgery in approximately one-third of the patients with colorectal cancer. This indicates the presence of persistent disease and the need for further evaluation [7,8]. Consideration of both preoperative and postoperative serum CEA levels might effectively predict the prognosis of patients with colorectal cancer [9]
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