Low Serum Carcinoembryonic Antigen Research Articles

Circulating exosomal PCAT1 as a complement of carcinoembryonic antigen for early colorectal cancer diagnosis

BackgroundsGiven the global prevalence of colorectal cancer (CRC), advancements in prompt and accurate diagnosis are crucial. Long non-coding RNAs (lncRNAs) in serum exosomes are emerging as potential diagnostic biomarkers. This study evaluated the feasibility of using serum exosomal lncRNAs for early-stage CRC diagnosis in clinical practice. MethodsCandidate serum exosomal lncRNAs were identified through an integrated analysis of two GEO datasets (GSE100206 and GSE100063) containing non-coding RNA expression profiles in serum exosomes. Exosomes isolated from participants' serum were validated using transmission electron microscopy (TEM) and immunoblotting. The expression levels of serum exosomal PCAT1 were measured by quantitative real-time polymerase chain reaction (qRT-PCR). Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. ResultsSerum exosomal PCAT1 levels were evaluated in 150 CRC patients, 66 patients with benign colorectal lesions, and 128 healthy controls. ROC analysis demonstrated high diagnostic efficacy of serum exosomal PCAT1 for CRC. Notably, the predictive performance was sufficient to distinguish early-stage CRC patients. Additionally, the diagnostic value was significant for CRC patients with low serum carcinoembryonic antigen (CEA) levels. Measuring serum exosomal PCAT1 could complement CEA assessment, enhancing CRC diagnostic accuracy. ConclusionsSerum exosomal PCAT1 can complement CEA assessment, aiding in early CRC diagnosis and helping to differentiate the disease, especially in patients with low CEA levels.

Prognostic Outcome of Pulmonary Resection for Pulmonary Metastases from Gastric Cancer.

Regardless of the devastating outcomes of pulmonary resection for metastases from gastric cancer, a handful of patients survive long after pulmonary metastasectomy. This study aimed to identify a good candidate for pulmonary resection for metastases from gastric cancer. Between 2005 and 2023, 564 patients underwent pulmonary metastasectomy in our department, of which 12 patients underwent pulmonary resection for metastases from gastric cancer. Variables evaluated were the number and size of metastatic lesions, surgical procedure, disease-free interval (DFI), and the serum carcinoembryonic antigen at pulmonary metastasectomy. The DFI following gastrectomy ≤12.5 months group had a significantly worse overall survival (OS) than the other group (p = 0.005). A comparison between DFI following gastrectomy ≤12.5 months group and DFI following gastrectomy >12.5 months group showed a significant difference in serum carcinoembryonic antigen (CEA) value at pulmonary metastasectomy (p = 0.048). The serum CEA value at pulmonary metastasectomy >5.8 ng/ml group had a significantly worse OS than the other group (p = 0.001). Pulmonary metastasectomy can be indicated in some patients with metastasis from gastric cancer who have longer DFI from gastrectomy and lower serum CEA at pulmonary metastasectomy.

Risk factors for symptomatic malignant pleural effusion recurrence in patients with actionable mutations in advanced lung adenocarcinoma.

Malignant pleural effusion (MPE) comes generally with high mortality and poor prognosis. Recurrence of symptomatic MPE is always accompanied by poor survival quality. In lung adenocarcinoma, researchers speculate whether patients with actionable mutation or without are applicable to different management models for MPE. Under the background of the high mutation probability and the encouraging therapeutic response in Asians, researches on the risk factors of MPE are in need. This retrospective review included 343 metastatic lung adenocarcinoma patients with MPE. Recurrence was defined as recurrent symptomatic MPE requiring the second thoracentesis to relieve symptoms within 300 days after the first thoracentesis. Univariable and multivariable Cox regression analysis were utilized to investigate independent risk factors for MPE recurrence. Of the 343 patients involved, 139 experienced MPE recurrence within 300 days; 34.3% in 201 patients with actionable mutations and 51.2% in 129 patients without actionable mutations are in the recurrence. The median recurrence-free survival (RFS) of the group without mutations was 161 days. The median RFS of the other group with mutations was 300 days. Patients with actionable mutations showed a significantly lower hazard of MPE recurrence on univariate analysis. The multivariate analysis indicated that receiving targeted therapy after the first thoracentesis within 30 days, lower neutrophil-to-lymphocyte ratio (NLR) level, lower serum lactate dehydrogenase (s-LDH) level, and lower serum carcinoembryonic antigen (s-CEA) level were independent protective factors. In subgroup analysis, risk factors differed. Receiving targeted therapy after the first thoracentesis within 30 days remained an independent factor in the mutated patients. The findings herein indicated the characteristics of specific patients at high risk for MPE recurrence in lung adenocarcinoma. Patients with actionable mutations benefit more in MPE recurrence and could benefit from targeted therapy and active intrapleural management.

Intraductal oncocytic papillary neoplasm of the pancreas: clinical and radiological features compared to those of intraductal papillary mucinous neoplasm

PurposeThis study aimed to characterize the clinical and imaging findings of intraductal oncocytic papillary neoplasm of the pancreas (IOPN-P) compared to those of intraductal papillary mucinous adenoma/carcinoma (IPMA/IPMC).MethodsThis multi-institutional retrospective study reviewed the clinical, imaging, and pathological findings of 21 patients with pathologically proven IOPN-P. Twenty-one computed tomography (CT) and magnetic resonance imaging, and seven 18F-fluorodeoxyglucose (FDG)-positron emission tomography were performed before surgery. The following findings were evaluated: preoperative blood test results, lesion size and location, pancreatic duct diameter, contrast-enhancement effect, bile duct and peripancreatic invasion, maximum standardized uptake (SUVmax) value, and pathological stromal invasion.ResultsSerum carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9) levels were significantly higher in the IPMN/IPMC group than in the IOPN-P group. Except in one patient, IOPN-P showed multifocal cystic lesions with solid components or a tumor in the main pancreatic duct (MPD) with dilatation. IOPN-P had a higher frequency of solid parts and a lower frequency of downstream MPD dilatation than IPMA. IPMC showed smaller overall cyst size, more radiological peripancreatic invasion, and worse recurrence-free and overall survival than IOPN-P. The average SUVmax value of IOPN-P was 7.5. Pathologically, 17 of the 21 IOPN-Ps had a malignant component, and six showed stromal invasion.ConclusionIOPN-P shows cystic-solid lesions similar to IPMC but has lower serum CEA and CA19-9 levels, larger overall cyst size, lower frequency of peripancreatic invasion, and more favorable prognosis than IPMC. Moreover, the high FDG uptake by IOPN-Ps may be a characteristic finding of this study.Graphical abstract

Abstract 3626: Genomic characterization of primary tumor in colorectal cancer according to serum carcinoembryonic antigen level

Abstract Background: Carcinoembryonic antigen (CEA) is one of the most widely used tumor markers in colorectal cancer (CRC). High preoperative concentrations of CEA correlate with poor survival outcomes. Serial CEA measurements have been used for detecting recurrent CRC. However, the genomic characteristics of primary CRC according to the blood CEA level are still not clear. Though patients with low CEA levels are associated with good prognosis, some of these patients have progression of their tumor. It would aid in applying careful surveillance to identify a subset of patients at high risk for poor prognosis among those with low CEA level. In this study, the different types of molecular profiles were compared between CRC with low and high serum CEA levels. In addition, we compared the genomic characteristics between CRC without progression and with progression among patients with low CEA levels. Methods: Using data acquired from The Cancer Genome Atlas (TCGA), we performed survival and genomic analyses on 381 CRC patient samples with serum CEA levels. Differential mRNA expression, miRNA expression and DNA methylation were examined between CRC with low serum CEA levels (low CEA group; ≤ 5 ng/mL) and high serum CEA levels (high CEA group; > 5 ng/mL). Among the 140 patients with low CEA levels, the same analyses were performed between CRC without progression and with progression. Results: High CEA group was associated with higher pathologic stage, more venous and lymphatic invasion. High CEA group had worse overall and progression-free survival than low CEA group (p <0.001 and p <0.001, respectively). A total of 28 genes were identified as significantly differentially expressed genes between low and high CEA group. Functional annotation and pathway analyses of the differentially expressed genes identified the possible association of cell adhesion, cytokine-cytokine receptor interaction and Wnt signaling network. Two differentially expressed miRNAs (mir-486 and mir-509-1) and 3 differential CpG sites (cg07530063, cg24216966 and cg11622162) were identified between low and high CEA group. Between CRC without progression and with progression in low CEA group, we identified 20 differentially expressed genes that were associated with epithelial to mesenchymal transition and transport of organic acid, metal ion and amine compounds. Four differentially expressed miRNAs (mir-483, mir-9-1, mir-9-2, and mir-31) and no differential CpG sites were identified between CRC with and without progression. Conclusions: In this study, we have identified different molecular features between primary CRC with low and high CEA levels. Notably, specific genomic profiles may contribute to discriminating patients with poor outcomes in CRC with low CEA level. Citation Format: Ji Won Park, Manu Shivakumar, Eun Kyung Choe, Dokyoon Kim. Genomic characterization of primary tumor in colorectal cancer according to serum carcinoembryonic antigen level [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3626.

Roles of Fascin mRNA expression in colorectal cancer: Meta-analysis and bioinformatics analysis.

Fascin (encoded by FSCN1) is a globular actin cross-linking protein that is required for the formation of actin-based cell surface processes, which are critical for cell migration and cell-matrix adhesion. In the present study, a systematic meta-analysis and bioinformatics analysis was used to identify clinicopathological or prognostic parameters in patients with colorectal cancer. A total of 17 articles were included in the present study obtained from PubMed, Web of Science, Wanfang data, SinoMed and CNKI databases. Odd ratios (ORs) and the corresponding 95% confidence intervals (CIs) were used to estimate the prognostic significance of Fascin expression in patients with colorectal cancer, and the association between Fascin expression and clinicopathological factors. There was a significant correlation between high Fascin expression and poor overall survival rates in patients with colorectal cancer (OR=0.48; 95% CI, 0.38-0.60; P<0.000001). The meta-analysis showed that the expression of Fascin was significantly higher in colorectal cancer tissue compared with the normal mucosa (OR=0.13; 95% CI, 0.10-0.16; P<0.000001) and adenoma (OR=0.23; 95% CI, 0.15-0.34; P<0.000001). Fascin expression was also associated with depth of invasion (OR=0.31; 95% CI, 0.19-0.50; P<0.000001), lymph node metastasis (OR=3.07; 95% CI, 1.72-5.46; P=0.0001), Dukes stage (OR=0.14; 95% CI, 0.04-0.46; P=0.001), Tumor-Node-Metastasis stage (OR=0.38; 95% CI, 0.21-0.71; P=0.003) and dedifferentiation (OR=0.42; 95% CI, 0.19-0.94; P=0.04). According to the bioinformatics analyses, FSCN1 mRNA expression levels were higher in colorectal cancer and adenoma tissues compared with the normal tissues (P<0.05). According to TCGA, FSCN1 mRNA expression was associated with a less favorable prognosis in patients with colorectal cancer as an independent factor (P<0.05), and positively correlated with depth of invasion, microsatellite instability and low serum carcinoembryonic antigen levels in colorectal cancer. Taken together, the results of the present study suggested that Fascin expression is a potential marker of tumorigenesis, aggressiveness and poor prognosis in patients with colorectal cancer.

CMET-08. CEREBROSPINAL FLUID CARCINOEMBRYONIC ANTIGEN PREDICT PROGNOSIS IN LEPTOMENINGEAL METASTASIS FROM NON-SMALL CELL LUNG CANCER

Abstract BACKGROUND Leptomeningeal metastasis (LM) is a detrimental complication of patients with non-small cell lung cancer (NSCLC) and its incidence has increased due to recent improvements in survival. The aim of this study was to identify the clinicopathological features and prognostic factors related to overall survival in NSCLC patients with LM. METHODS Seventy-four consecutive patients diagnosed with LM from NSCLC between 2009 and 2018 in Guangdong Sanjiu Brain Hospital were retrospectively reviewed. RESULTS Median KPS at diagnosis of LM were 60 (range, 20–90). Forty-seven (63.5%) patients harboring epidermal growth factor receptor (EGFR) or anaplasticlymphoma kinase (ALK) mutation while other twenty-seven patients (36.5%) were wild type or unknown status. Local treatment for LM consisted of whole-brain radiotherapy (WBRT) (52.7%), ventriculoperitoneal (VP) shunt (6.8%) and external drainage (6.8%). Systematic therapy for LM included EGFR or ALK tyrosine kinase inhibitors (TKI) (59.5%), chemotherapy (40.5%) and bevacizumab (8.1%). The median overall survival from diagnosis of LM to death was 8.1 months (95% confidence interval: 5.2 to 11.0). Patients with high Cerebrospinal Fluid (CSF) carcinoembryonic antigen (CEA) level (＞50ng/ml) had worse prognosis compared with those low CSF CEA level (≤50ng/ml) ones (p=0.02). However, there was no significant difference in survival between patients with high serum CEA and those with low serum CEA (p=0.645). EGFR/ALK mutation and EGFR/ALK TKI after LM were also identified as variables that had prognostic influence on survival, while KPS, concurrent brain metastasis, WBRT and chemotherapy had no prognostic value for survival. CONCLUSION Median overall survival was higher than historical experience in this retrospective analysis. It is CSF CEA level, but not serum CEA level that correlated with prognosis for LM from NSCLC.

1563P - Carcinoembryonic antigen of cerebrospinal fluid predict prognosis of leptomeningeal metastasis from non-small cell lung cancer

BackgroundLeptomeningeal metastasis (LM) is a detrimental complication of patients with non-small cell lung cancer (NSCLC) and its incidence has increased due to recent improvements in survival. The aim of this study was to identify the clinicolpathological features and prognostic factors related to overall survival in NSCLC patients with LM. MethodsSeventy-four consecutive patients diagnosed with LM from NSCLC between 2009 and 2018 in Guangdong Sanjiu Brain Hospital were retrospectively reviewed. ResultsMedian KPS at diagnosis of LM were 60 (range, 20-90). Forty-seven (63.5%) patients harboring epidermal growth factor receptor (EGFR) or anaplasticlymphoma kinase (ALK) mutation while other twenty-seven patients (36.5%) were wild type or unknown status. Local treatment for LM consisted of whole-brain radiotherapy (WBRT) (52.7%), ventriculoperitoneal (VP) shunt (6.8%) and external drainage (6.8%). Systematic therapy for LM included EGFR or ALK tyrosine kinase inhibitors (TKI) (59.5%), chemotherapy (40.5%) and bevacizumab (8.1%). The median overall survival from diagnosis of LM to death was 8.1 months (95% confidence interval: 5.2 to 11.0). Patients with high Cerebrospinal Fluid (CSF) carcinoembryonic antigen (CEA) level (>50ng/ml) had worse prognosis compared with those low CSF CEA level (≤50ng/ml) ones (p=0.02). However, there was no significant difference in survival between patients with high serum CEA and those with low serum CEA (p=0.645). EGFR/ALK mutation and EGFR/ALK TKI after LM were also identified as variables that had prognostic influence on survival, while KPS, concurrent brain metastasis, WBRT and chemotherapy had no prognostic value for survival. ConclusionsMedian overall survival was higher than historical experience in this retrospective analysis. It is CSF CEA level, but not serum CEA level that correlated with prognosis for LM from NSCLC. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

LPTO-07. CARCINOEMBRYONIC ANTIGEN OF CEREBROSPINAL FLUID PREDICT PROGNOSIS OF LEPTOMENINGEAL METASTASIS FROM NON-SMALL CELL LUNG CANCER

BACKGROUND: Leptomeningeal metastasis (LM) is a detrimental complication of patients with non-small cell lung cancer (NSCLC) and its incidence has increased due to recent improvements in survival. The aim of this study was to identify the clinicolpathological features and prognostic factors related to overall survival in NSCLC patients with LM. METHODS: Seventy-four consecutive patients diagnosed with LM from NSCLC between 2009 and 2018 in Guangdong Sanjiu Brain Hospital were retrospectively reviewed. RESULTS: Median KPS at diagnosis of LM were 60 (range, 20–90). Forty-seven (63.5%) patients harboring epidermal growth factor receptor (EGFR) or anaplasticlymphoma kinase (ALK) mutation while other twenty-seven patients (36.5%) were wild type or unknown status. Local treatment for LM consisted of whole-brain radiotherapy (WBRT) (52.7%), ventriculoperitoneal (VP) shunt (6.8%) and external drainage (6.8%). Systematic therapy for LM included EGFR or ALK tyrosine kinase inhibitors (TKI) (59.5%), chemotherapy (40.5%) and bevacizumab (8.1%). The median overall survival from diagnosis of LM to death was 8.1 months (95% confidence interval: 5.2 to 11.0). Patients with high Cerebrospinal Fluid (CSF) carcinoembryonic antigen (CEA) level (＞50ng/ml) had worse prognosis compared with those low CSF CEA level (≤50ng/ml) ones (p=0.02). However, there was no significant difference in survival between patients with high serum CEA and those with low serum CEA (p=0.645). EGFR/ALK mutation and EGFR/ALK TKI after LM were also identified as variables that had prognostic influence on survival, while KPS, concurrent brain metastasis, WBRT and chemotherapy had no prognostic value for survival. CONCLUSION: Median overall survival was higher than historical experience in this retrospective analysis. It is CSF CEA level, but not serum CEA level that correlated with prognosis for LM from NSCLC.

Preventive Potential of Resveratrol in Carcinogen-Induced Rat Thyroid Tumorigenesis.

Thyroid cancer (TC) is the most common endocrine malignancy without reliable preventive agent. Resveratrol possesses in vitro anti-TC activities; while its effect(s) on thyroid tumorigenesis remains unknown. This study aims to address this issue using DEN/MNU/DHPN-induced rat carcinogenesis model. 50 male Sprague-Dawley rats were separated into four groups as Group-1 (5 rats); normally fed; Group-2 (15 rats); DEN/MNU/DHPN treatment only; Group-3 (15 rats) and -4 (15 rats); DEN/MNU/DHPN treatment; followed by resveratrol intragastric (IG) injection and intraperitoneal (IP) injection; respectively; in two-day intervals for 30 weeks. The results revealed that the average resveratrol concentration in thyroid tissues was 1.278 ± 0.419 nmol/g in IG group and 1.752 ± 0.398 nmol/g in IP group. The final body weights of Group-3 and Group-4 were lighter than that (p > 0.05) of Group-1; but heavier than Group-2 (p < 0.05). TC-related lesions (hyperplasia and adenomas) were found in 53.3% of Group-2; 33.3% Group-3 and 26.7% Group-4. Lower serum carcino-embryonic antigen (CEA) and thyroglobulin (Tg) levels; down-regulated expression of IL-6 and cyclooxygenase-2 (COX-2); reduction of NF-κB/p65 nuclear translocation; and elevated IkBα expression were found in the thyroid tissues of Group-3 and Group-4 in comparison with that of Group-2. These results demonstrate that IG and IP administered resveratrol efficiently reduces the frequency and severity of DEN/MNU/DHPN-caused TC-related lesions and would be of values in thyroid tumor prevention.

Comparison of clinical and radiological characteristics between anaplastic lymphoma kinase rearrangement and epidermal growth factor receptor mutation in treatment naïve advanced lung adenocarcinoma.

Gene analysis could not be performed in all patients, especially in advanced non-small cell lung cancer (NSCLC). We aimed to find some clinical futures and CT or FDG-PET characteristics, which could be combined to help distinguish anaplastic lymphoma kinase (ALK) rearrangement form epidermal growth factor receptor (EGFR) mutations in treatment naïve advanced lung adenocarcinoma of Chinese patients. We retrospectively reviewed clinical and radiological characteristics of 145 patients with treatment naïve advanced lung adenocarcinoma. The one-way ANOVA, the Mann-Whitney test, chi-square test and logistic regression were used for comparison between patients with ALK rearrangement and those with EGFR mutation. Among 145 patients with advanced lung adenocarcinoma, only six patients had both ALK rearrangement and EGFR mutation, the sample size was too small to analysis. Univariate analysis revealed that patients with ALK rearrangement were younger (P=0.001) and with lower serum carcinoembryonic antigen (CEA) level (P=0.008) than those with EGFR mutation. More of tumors with ALK rearrangement were well defined (P=0.023) and have bubble lucency (P=0.026) compared with those with EGFR mutation (P=0.026). Lymphadenopathy was seen more frequently in patients with ALK rearrangement (P=0.167). Twenty-six patients received FDG-PET/CT, among this population, lesion standardized uptake values (SUV) >6.95 and lymph nodes SUVmax >6.25 were more often seen in ALK rearrangement group (P=0.011, both). In multivariate analysis, patients younger than 50 years (RR =9.878, 95% CI: 2.318-42.090, P=0.002), with lower CEA level than 4.95 µg/L (RR =8.166, 95% CI: 1.085-31.983, P=0.003) and without brain metastasis (RR =7.304, 95% CI: 1.099-48.558, P=0.040) were more likely to be ALK rearrangement than EGFR mutation. Tumor diameter less than 36 mm were prone to be EGFR mutation (RR =0.078, 95% CI: 0.017-0.356, P=0.001). Treatment naïve advanced lung adenocarcinomas with ALK rearrangement were more likely to have younger age, lower serum CEA level, larger tumor volume, well defined tumor border, and non-brain metastasis than those with EGFR mutation. Bubble lucency and higher FDG uptake of lesion and lymph nodes may help distinguish ALK rearrangement from EGFR mutation in the absence of genetic analysis.

Serum levels of CEA and CA 15-3 in triple-negative breast cancer at the time of diagnosis

To the Editor, Cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) are often used in follow up care of breast cancer and provide important clues to the clinicians for disease progression in metastatic and recurrent breast cancer. However, use of CA 15-3 and CEA levels are not recommended for surveillance after primary therapy of breast cancer at ASCO guideline [1]. Triple-negative breast cancers (TNBC) are frequently defined as a single group identifiable using routine clinical tests. They are negative for estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2), the so-called ‘triple-negative’ breast cancers. We retrospectively analyzed serum CEA and CA 15-3 levels of 544 consecutive non-metastatic breast cancer patients presenting at Hacettepe University Institute of Oncology. The 15.1% of the patients were TNBC. There were no statistically significant differences in clinical characteristics of the disease between TNBC and non-TNBC patients. At the time of diagnosis TNBC group have lower serum CEA (2.5 ± 5.9 vs. 4.0 ± 16.4; P = 0.35) and CA 15-3 (23.7 ± 14.6 vs. 37.1 ± 117; P = 0.021) levels compared to non-triple negative (non-TN) group (3). This may be explained in part by undifferentiated characteristics of triple negative breast cancers. In conclusion, serum levels of CEA and CA 15-3 may be different in breast cancer subgroups. Our findings need to be confirmed in further studies.

Comparison of serum levels of CEA and CA 15–3 in triple-negative breast cancer at the time of metastases and serum levels at the time of first diagnosis

e12017 Background: Cancer antigen 15–3 (CA 15–3) and carcinoembryonic antigen (CEA), are often used in follow up care of breast cancer and provide important clues to the clinicians for disease progression in metastatic and recurrent breast cancer. Triple-negative breast cancers are frequently defined as a single group identifiable using routine clinical tests. They are negative for estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER-2), the so-called triple-negative breast cancers. In this study we compared the tumor markers of triple negative breast cancer and non-triple negative patients. Methods: We retrospectively analyzed serum CEA and CA 15–3 levels of both triple negative and non-triple negative breast cancer patients at the time of first diagnosis and when they developed metastatic disease. Results: 544 consecutive nonmetastatic breast cancer patients presenting at Hacettepe University Institute of Oncology, Ankara, Turkey, with a median age of 49 were evaluated. 15.1% of the patients were triple negative breast cancer. At the time of diagnosis triple negative group had lower serum CEA (2.5 ± 5.9 vs 4.0 ±16.4 p = 0.35) and CA 15–3 (23.7 ± 14.6 vs 37.1 ± 117; p = 0.021) levels compared to non-triple negative group. In patients who developed metastasis during follow up; the CEA (3.2 ± 3.8 vs 29.6 ± 106.4 p = 0.022) and CA15–3 (46.9 ± 46.3 vs 203.2 ± 534 p = 0.008) levels were also significantly lower in triple negative breast cancer group compared to non-triple negative group.In non-triple negative breast cancer patients who developed metastasis, mean serum levels of CEA and CA15–3 significantly increased compared to baseline, whereas in triple negative group who developed metastasis CEA and CA 15–3 levels did not differ significantly. Conclusions: While being a good laboratory parameter in the follow-up of patients with breast cancer metastases, tumor markers may not show the increased tumor burden in the triple-negative breast cancer patients. No significant financial relationships to disclose.

Factors Influencing Long-Term Survival in Patients with T3 Gallbladder Adenocarcinoma

Purpose: This study aimed to identify the factors influencing the surgical outcome in patients with T3 gallbladder adenocarcinoma (GBA). Methods: Between 1996 and 2006, 100 GBA patients who underwent surgical treatment in Chang Gung Memorial Hospital, Taiwan, were retrospectively reviewed. Among them, 39 patients with pathological stage T3 GBA were analyzed statistically in terms of demographic data and clinicopathological features. Results: The 1-, 3- and 5-year survival rates for patients with T3 GBA undergoing surgical treatment were 53.5, 37.0 and 32.9%, respectively. Univariate survival analysis revealed male gender, low serum carcinoembryonic antigen (CEA) level, and curative resection as factors which predicted favorable overall survival for T3 GBA patients. Multivariate survival analysis revealed low preoperative CEA levels and curative resections independently predicted favorable outcomes. Conclusions: Negative resection margin and serum CEA levels were found to be the independent prognostic factors in predicting long-term survival in patients with T3 GBA, and the serum CEA level was also found to be an independent prognostic factor in predicting the long-term prognosis of T0–T4 GBA; however, the result is preliminary due to the limited number of patients. Further studies with a large number of patients are necessary to confirm our result.

Clinicopathological significance of fibrous tissue around fixed recurrent rectal cancer in the pelvis

Fibrous tissue around a locally recurrent rectal tumour is an interesting histological feature, but its clinicopathological significance has not been investigated. This retrospective study examined clinicopathological findings in 48 patients who underwent curative total pelvic exenteration with distal sacrectomy (TPES) between 1992 and 2004. Data were analysed with respect to fibrosis around the recurrent tumour, categorized into one of three groups: no fibrosis (f0), partial fibrosis (f1) or circumferential fibrosis (f2). Ten, 17 and 21 patients had f0, f1 and f2 fibrosis respectively, with 5-year survival of none, four and eight patients respectively. The overall survival of patients with circumferential fibrosis was significantly better than that in patients with no fibrosis (P = 0.003). Univariable analysis showed that a high level of sacrectomy (P = 0.036), absence of lymphatic invasion (P = 0.031) and circumferential fibrosis (P = 0.039) were significantly associated with better overall survival. In multivariable analysis, circumferential fibrosis (P = 0.031) and low serum carcinoembryonic antigen levels (P = 0.044) were independent factors for a favourable outcome. The outcome of patients with locally recurrent rectal cancer after curative TPES appears to be better when circumferential fibrosis is present around the tumour.

Postoperative serum carcinoembryonic antigen levels in patients with pathologic stage IA nonsmall cell lung carcinoma: subnormal levels as an indicator of favorable prognosis.

Elevated serum carcinoembryonic antigen (CEA) levels are sometimes attributable to the production of CEA by malignant cells, and in turn, the antigen itself can enhance the metastatic potential of malignant cells. The authors speculated that low serum CEA levels might be indicative of relatively low levels of malignant cells and a low probability of disease recurrence. This hypothesis led them to investigate whether low CEA levels in serum represented a useful prognostic factor for patients with pathologic Stage IA nonsmall cell lung carcinoma. Between 1993 and 2001, 724 patients underwent surgery for NSCLC at Toneyama National Hospital (Toyonaka, Japan). Of these patients, the 242 who were diagnosed with pathologic Stage IA disease were included in the current study. Smoking behavior, gender, age, tumor diameter, disease histology, and preoperative and postoperative serum CEA levels were chosen as study variables, with the cutoff level between subnormal and normal serum CEA levels set at 2.5 ng/mL and the cutoff level between normal and high serum CEA levels set at 5.0 ng/mL. Prognostic indicators were evaluated using a Cox hazard model. In addition, survival probabilities were calculated using the Kaplan-Meier method, and differences in survival were assessed by log-lank analysis. Subnormal postoperative serum CEA levels were found to be an independent prognostic indicator (hazard ratio, 2.3; 95% confidence interval, 1.1-4.7; P = 0.03 for comparison with patients who had normal CEA levels) on multivariate analysis. Furthermore, the 5-year survival rate was 87% for patients with subnormal postoperative CEA levels (n = 146), compared with 75% for patients with normal postoperative CEA levels (n = 80) and 53% for patients with high postoperative CEA levels (n = 16) (P < 0.0001). Among patients with pathologic Stage IA NSCLC, those who had an extremely favorable prognosis were distinguished by their subnormal postoperative serum CEA levels.

CORRELATION BETWEEN SERUM CARCINOEMBRYONIC ANTIGEN LEVEL IN PATIENTS WITH COLORECTAL CANCER AND TUMOR HISTOPATHOLOGY

Serum carcinoembryonic antigen (CEA) values were determined in 123 patients with colorectal carcinoma preoperatively. Serum CEA titers above 5.1 ng/ml were considered to indicate positive cases. Preoperatively 50.8% of all patietns had a positive test result. According to stage classification, the assay was positive in 9.1% of patients with stage I tumors, 50.9% with stage II, 38.9% with stage III, 33.3% with stage IV and 88.9% with stage V. Among cases of small cancers less than 2 cm in size, there were no positive results.Histopathological evaluation of the tumor included evidence of lymphatic vessel and venous invasion and degree of wall penetration. A low serum CEA level in colonic cancer cases suggested that the tumor was localized within the bowel wall and the patient underwent curative resection. The higherst values were found in patients with liver metastasis. Serum CEA levels tended to be elevated when hepatic metastasis, peritoneal dissemenation, serous invasion and wall penetration were present. However, CEA value was not directly correlated with either lymphatic vessel or venous invasion.

Imaging of human colorectal adenocarcinoma with indium-labeled anticarcinoembryonic antigen monoclonal antibody.

Twenty patients with 21 primary colorectal adenocarcinomas were studied with 2 mCl (7.6 X 10(7) becquerels) of indium-labeled monoclonal antibody (200 micrograms) specific for carcinoembryonic antigen (CEA). Fifteen lesions (71%) were visualized by gamma camera scintigraphy at 48 hours postinjection. Tumors that were identified by immunoscintigraphy were large (38.10 +/- 17.76 cm3 vs 6.00 +/- 1.65 cm3), had a grossly fungating component, had a high content of CEA by enzyme immunoassay (12.9 +/- 3.6 micrograms/g vs 3.3 +/- 1.7 micrograms/g), and had an apical and/or intraluminal staining pattern on immunohistologic section. Patients whose tumors were visualized had a low serum CEA level (1.9 +/- 0.4 ng/mL vs 14.6 +/- 8.0 ng/mL). Prospective selection of patients for follow-up imaging or therapy with radiolabeled monoclonal antibodies may be feasible using these measurements.

Prognostic factors in colon carcinoma: Correlation of serum carcinoembryonic Antigen Level and Tumor Histopathology

The results of histopathologic study and the preoperative circulating carclnoeiribryontc anttgen levels were correlated with each other and with the postoperative clinical course in 45 surgically treated patients with cancer of the colon. Histopathologic evaluation of the tumor included the depth of bowel wall involvement according to the Dukes classification, the histologic differentiation of cells on the basis of Broders' grades of malignancy, evidence of lymphocyte and plasma cell infiltration within and surrounding the primary tumor, and evidence of blood vessel, lymphatic, and perineural invasion. All these parameters, including the serum carcinoetnbryonic antigen level, had prognostic value. Low serum carcinoembryonic antigen levels in patients wiith colonic cancer suggested tumor localized within the bowel wall; the highest values were found in patients with tumors that had spread beyond the bowel wall. An inverse correlation was noted between the degree of tumor differentiation and carcino-embryonic antigen levels in the same patient. Carcinoembryonic antigen levels tended to be elevated when blood vessel, lymphatic, and perineural invasion was present. An inverse correlation was also noted between the preoperative carcinoembryonic antigen level and the degree of lymphocyte and plasma cell.