Prognostic value of preoperative carcinoembryogenic antigen: Is it useful in all stages of colorectal cancer?

Abstract

Abstract Introduction Recent reports have reopened discussion of the prognostic value of elevated pre-treatment carcinoembryonic antigen (CEA) levels in colorectal cancer. Due to the discrepancies in the published results, we aimed to analyze the possible predictive value of CEA, both overall and in different tumoral stages in our environment. Patients and methods We retrospectively studied 303 consecutive patients with colorectal cancer resected with curative intent by analysing tumour-related mortality. The frequency of patients with increased CEA levels (>5 mg/L) was registered. Univariate and multivariate analyses of survival curves were performed, comparing patients with increased CEA levels and those with CEA levels within normal limits, both in the overall series and in the different pTNM tumoral stages. Results Frequency of patients with CEA > 5 mg/L was 31%. The median clinical follow-up was 83 months. A poor survival rate was registered in the multivariate analysis of the whole series in patients with high CEA levels: hazard ratio (HR) = 1.81; 95% confidence interval (95% CI) = (1.15–3.10); p = 0.012. This predictive value was only maintained in stage II in the survival analysis of the distinct tumoral stages (n = 104): HR = 3.02; 95% CI = (1.22–7.45); p = 0.017. Conclusions Before treatment, 31% of our patients with colorectal cancer resected with curative intent had pathological CEA values. In the overall series, a high pretreatment CEA level showed an independent prognostic value for poor survival. When pTNM tumoral stages were analyzed separately, CEA level had predictive value only in pTNM II tumours.