Preoperative CEA Research Articles

A persistent high neutrophil-to-lymphocyte ratio predicts poor prognosis in patients with colorectal cancer undergoing resection.

The prognostic role of the neutrophil-to-lymphocyte ratio (NLR) has been reported in colorectal cancer (CRC); however, its variation and corresponding predicative value in patients undergoing resection remain largely unknown. In the present study, data from 146 patients with CRC were retrospectively collected, optimal cut-off points for preoperative and postoperative low and high NLRs were set, and ΔNLR was calculated. Subsequently, patients were classified into low-low, low-high, high-low and high-high subgroups based on the cut-off points, and their progression-free survival (PFS) was determined. A Cox proportional hazard model was applied to calculate the prognostic value of all factors. The results demonstrated that both preoperative and postoperative NLRs (pre-NLR and post-NLR) but not ΔNLR could predict PFS with optimal cut-off points of 2.39 and 2.96, respectively. For predicting PFS, the pre-NLR had a sensitivity and specificity of 48.80 and 79.50%, respectively, and the post-NLR had a sensitivity and specificity of 63.20 and 56.20%, respectively. Significant differences were identified between low and high pre-NLRs in terms of histological grade (P<0.01) and tumor diameter (P<0.01); however, such differences were only found in terms of age (P<0.01) for low and high post-NLRs. The PFS of patients in the low-low, low-high, high-low and high-high subgroups was 50.30±21.36, 43.67±22.78, 31.06±25.56 and 29.87±24.13 months, respectively, and patients in the high-high subgroup had the worst PFS (P<0.01). Preoperative CEA level, invasive depth, node involvement, distant metastasis and preoperative NLR were independent prognostic factors. In conclusion, a persistently high NLR for patients with CRC undergoing resection was associated with poor prognosis.

Elevated carbohydrate antigen 125 post-operation as a prognostic marker in gastric cancer patients with stage II-III.

BackgroundGastric cancer is one of the high occurrence cancers among gastrointestinal tumor. Further research should be carried out to find more prognostic factors, screening patients with poor prognosis, who need stronger treatment.MethodsThe clinicopathologic characteristic, the levels of tumor markers and survival of 105 patients who underwent gastrectomy with a D2 lymph node dissection in Zhejiang Cancer Hospital were collected and analyzed.ResultsIn the 105 patients, there were 71 males, and the median age was 56 years (range, 21–83 years). In 105 patients, 77 patients were diagnosed with non-cardia cancer, 84.8% patients were diagnosed of poorly differentiated adenocarcinoma, more than half of the patients were diagnosed of T3–4, and 92 patients had lymph node metastasis, while the clinical stage III patients were accounted for 85%. Seventy point five percent patients were Borrmann III type. The median OS of the patients with increased preoperative serum CEA, CA125, CA19-9, AFP and combined were shorter than those patients with normal serum tumor markers, but without statistical significance (P=0.350, P=0.498, P=0.240, P=0.578 and P=0.219). The OS of patients with elevated levels of CEA, CA19-9, and AFP after operation were shorter than patients with decreased ones without statistical significance (P=0.321, P=0.118 and P=0.424). Elevated CA125 after operation was shorter than patients with decreased ones significantly (P<0.005).ConclusionsElevated of CA125 after operation was associated with poor OS in stage II–III GC patients.

Mo1638 ENDOSCOPIC RESECTION FOLLOWED BY SURGERY IN T1 COLORECTAL CANCER WITH HIGH RISK HISTOLOGICAL FEATURES DOES NOT AFFECT CANCER-RELATED LONG-TERM OUTCOMES

We aimed to identify if endoscopic resection of T1 colorectal cancer (CRC) before surgical resection (secondary surgery) unfavorably affects cancer-related long-term outcomes compared to surgery without prior endoscopic resection (primary surgery). We included patients who underwent surgery for T1 CRC with at least one high-risk histological features (poor differentiation, deep submucosal invasion, lympho-vascular invasion, and/or positive/indeterminate resection margins) at our institution between 2011-2016. Medical records, histology reports and results of endoscopic and radiologic examinations were reviewed retrospectively. Radical abdominal surgery was performed in 852 patients (388 primary and 464 secondary surgeries). Surgical trans-anal excision was performed in 21 patients (9 primary and 12 secondary surgeries). During follow-up periods of 51.4±18.3 months, cancer recurrence occurred in 20 patients. Five-year survival rates did not differ between primary and secondary abdominal surgery groups (97.3% vs. 98.5%, p = 0.294). Analyses stratified by nodal stages and number of high-risk histological features did not show any difference in cumulative survival rates. However, patients with secondary abdominal surgery showed higher 5-year survival rates compared to secondary trans-anal surgery (98.6% vs. 90.9%, p < 0.001). In multivariable Cox regression analysis, preoperative serum CEA level was an independent risk factor for cancer recurrence. Prior endoscopic resection was not an independent risk factor for cancer recurrence. Endoscopic resection of T1 CRC with high-risk histological features did not affect cancer-related long-term outcomes. Therefore, endoscopic resection of suspected T1 CRC can be performed without fear for worsening the oncological prognosis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Analysis on risk factors of the degree of radical resection and prognosis of patients with locally recurrent rectal cancer

Objective: To evaluate the factors affecting the degree of radical resection and the prognosis of patients with locally recurrent rectal cancer (LRRC). Methods: A retrospective case-control study was performed. Clinical data of 111 patients with LRRC undergoing operation at the General Surgery Department of Peking University First Hospital from January 2009 to August 2019 were analyzed retrospectively. The "Peking University First Hospital F typing" was performed according to the preoperative images of the pelvic involvement. The pelvis was assigned into four directions: the front wall, lateral sides of the pelvic wall and the sacrum. According to the degree of pelvic wall involvement, F typing included F0 type (no involvement of the pelvic wall, the cancer only involved the adjacent organs or invaded conteriorly the urinary tract, genital organs or small intestine), F1 type (cancer involved the pelvic wall in one direction, such as the sacrum, or one side of the pelvic wall), F2 type (cancer involved the pelvic wall in two directions) and F3 type (cancer involved the pelvic wall in three directions). Case inclusion criteria: (1) LRRC was confirmed by imaging and pathological examination of samples (puncture or endoscopic biopsy); (2) complete clinical and follow-up data; (3) informed consent of patient. Those with dysfunction of heart, lung, etc., intolerance of operation, F3 type indicated by image, and distant metastasis were excluded. The degree of radical resection was evaluated according to the postoperative pathological results. Patients were followed up every 12 months and related examinations were arranged. The univariate analysis of radical resection was performed by χ(2) test, and the multivariate analysis was performed by logistic methods. The survival rate was calculated by Kaplan-Meier method and the survival curve was drawn. The survival rate was compared by log-rank test. Cox proportional hazards model was used to analyze the factors affecting the prognosis of patients with LRRC. Results: A total of 111 patients were included in this study. Of 111 patients, 59 were male and 52 were female; recurrent age of 36 cases was ≥ 65 years old; CEA level of 48 cases was ≥15 μg/L. According to the "Peking University First Hospital F typing", 70 cases were F0 type, 38 F1 type and 3 F2 type. Surgical procedures were abdominoperineal resection (n=28), posterior pelvic exenteration (n=32), and total pelvic exenteration (n=51, including 1 case of TPE combined with sacrectomy). According to the postoperative pathological results, R0, R1 and R2 resections were 83, 20 and 8 cases, respectively. Univariate analysis showed that the degree of radical resection was associated with the secondary surgical procedure, F typing and lymph node metastasis (all P<0.05). Multivariate analysis showed that F typing (F1-F2) was an independent risk factor for non- R0 resection (OR=37.256, 95%CI:8.572 to 161.912, P<0.001). The morbidity of operative complications was 22.5% (25/111); the perioperative mortality was 1.8% (2/111); the local recurrence rate after the second operation was 37.8% (42/111). The 3- and 5-year overall survival rates were 41.2% and 21.9% respectively. The 3-year survival rates of patients with and without postoperative chemotherapy were 52.7% and 32.4% respectively (P=0.005). The 3-year survival rates of patients with lower (<15 μg/L) and higher CEA level (≥15 μg/L) were 52.9% and 24.3% respectively (P<0.001). The 3-year survival rates of patients with R0, R1 and R2 resection were 49.8%, 21.3% and 8.5% respectively (P=0.002). The 3-year survival rates of patients with F0, F1 and F2 type were 52.7%, 22.0% and 0 respectively (P<0.001). Cox analysis confirmed that the degree of radical resection (HR=2.088, 95%CI:1.095 to 3.979, P=0.025), the CEA level before the secondary operation (HR=1.857, 95%CI:1.157 to 2.980, P=0.010) and postoperative chemotherapy (HR=1.826, 95%CI:1.137 to 2.934, P=0.013) were independent factors affecting the prognosis. Conclusions: The indication of LRRC surgical treatments must be strictly limited. Evaluation of the fixation site to the pelvic wall is helpful for improving the rate of R0 resection. Lower preoperative CEA level, radical resection and postoperative chemotherapy are protective factors of prolonged overall survival time of patients with LRRC.

Prognostic stratification of pathological node-negative lung adenocarcinoma by carcinoembryonic antigen level.

Carcinoembryonic antigen (CEA) is a well-known tumour marker for lung adenocarcinoma (AC). This study was conducted to evaluate the clinical characteristics and prognosis of patients with pathological node-negative lung AC who have a high preoperative level of CEA. Among 2124 patients with lung AC between 2003 and 2016, 858 patients were enrolled. CEA levels were dichotomized as normal (≤5 ng/ml) or high (>5 ng/ml). According to the levels of CEA between 6 and 12 months after surgery, patients were divided into a normalized and a remained-high group. Propensity score matching was used to compare 80 patients without adjuvant chemotherapy (ACT) with 39 patients with ACT. Kaplan-Meier survival analysis with the log-rank test and Cox proportional hazards regression analysis were performed for recurrence-free survival (RFS) and overall survival (OS). The multivariable analysis showed that high maximum standardized uptake value and T2 stage were more common in patients with high levels of CEA. The median follow-up period was 52.8 months (range 6-169 months). The 5-year RFS and OS rates were 89.3% and 68.9% and 92.8% and 77.2% in normal patients and patients with high levels of CEA, respectively, with a statistically significant difference. The 5-year RFS was 79.4% and 39.2% in the normalized and remained-high groups after surgery, respectively (P = 0.011). The 5-year RFS and OS rates were 68.9% and 62.2% and 80.1% and 82.9% in patients without and with ACT, respectively. After propensity score matching, RFS was not significantly different between patients without and with ACT (P = 0.500); however, OS was significantly better in patients with ACT than in those without ACT (P = 0.001). The clinicopathological characteristics, RFS and OS of patients with lung AC might be well discriminated by preoperative CEA levels. In patients with node-negative disease and high CEA levels, those with normalized CEA levels had a significantly better prognosis than those with persistently high CEA levels.

The Impact of Preoperative CA19-9 and CEA on Outcomes of Patients with Intrahepatic Cholangiocarcinoma.

The objective of the current study was to assess the impact of serum CA19-9 and CEA and their combination on survival among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC). Patients who underwent curative-intent resection of ICC between 1990 and 2016 were identified using a multi-institutional database. Patients were categorized into four groups based on combinations of serum CA19-9 and CEA (low vs. high). Factors associated with 1-year mortality after hepatectomy were examined. Among 588 patients, 5-year OS was considerably better among patients with low CA19-9/low CEA (54.5%) compared with low CA19-9/high CEA (14.6%), high CA19-9/low CEA (10.0%), or high CA19-9/high CEA (0%) (P < 0.001). No difference in 1-year OS existed between patients who had either high CA19-9 (high CA19-9/low CEA:70.4%) or high CEA levels (low CA19-9/high CEA:72.5%) (P = 0.92). Although patients with the most favorable tumor marker profile (low CA19-9/low CEA) had the best 1-year survival (87.9%), 15.1% (n = 39) still died within a year of surgery. Among patients with low CA19-9/low CEA, a high neutrophil-to-lymphocyte ratio (NLR) (odds ratio 1.09; 95% confidence interval 1.03-1.64) and large size tumor (odds ratio 3.34; 95% confidence interval 1.40-8.10) were associated with 1-year mortality (P < 0.05). Patients with either a high CA19-9 and/or high CEA had poor 1-year survival. High NLR and large tumor size were associated with a greater risk of 1-year mortality among patients with favorable tumor marker profile.

Additional value of MRI-detected EMVI scoring system in rectal cancer: applicability in predicting synchronous metastasis.

Extramural vascular invasion (EMVI) has been recommended as an independent prognostic factor for poor overall survival rate in rectal cancer and can be used as a potential biomarker. Early prediction of prevalence of synchronous metastasis can elevate the disease-free survival rate. We aimed to evaluate the magnetic resonance imaging (MRI)-detected EMVI (mrEMVI) scoring system in predicting distant metastasis in T3 rectal cancer. Patients with postoperative histopathologically confirmed T3 rectal cancer without previous treatment from July 2014 to December 2015 were enrolled in this study. Two blinded radiologists evaluated mrEMVI status. mrEMVI was categorized as EMVI-positive or EMVI-negative in T2-weighted images using an mrEMVI scoring system. The results, along with other clinical characteristics (age, sex, tumor location, MRI-detected distance of mesorectal extension, lymphatic invasion, perineural invasion, mrEMVI score, and carcinoembryonic antigen [CEA]), were then correlated with synchronous metastases to determine the risk factors using univariate and multivariate analysis. Of 180 patients, 38 were confirmed to be mrEMVI-positive, 142 mrEMVI-negative. There were 34 patients with synchronous metastasis, of whom 25 were mrEMVI-positive and 9 were mrEMVI-negative. Three factors were significantly associated with synchronous metastasis: mrEMVI (p = 0.001; odds ratio = 8.665), histopathologic lymphatic invasion (p = 0.001; odds ratio = 12.940), and preoperative CEA (p = 0.026; odds ratio = 4.124). mrEMVI score 4 was more likely for synchronous metastasis (p = 0.044; odds ratio = 9.429) than mrEMVI score 3 in rectal cancer. mrEMVI positivity is an independent risk factor for synchronous distant metastasis in rectal cancer. mrEMVI score 4 is a stronger risk factor for synchronous metastasis than mrEMVI score 3 in rectal cancer.

Effect of Non-alcoholic Fatty Liver Disease on the Risk of Synchronous Liver Metastasis: Analysis of 451 Consecutive Patients of Newly Diagnosed Colorectal Cancer.

Background: The purpose of this study was to investigate the effect of non-alcoholic fatty liver disease (NAFLD) on the risk of synchronous colorectal liver metastasis (synCRLM).Methods: A retrospective analysis was performed on 451 consecutive patients with newly diagnosed colorectal cancer (CRC) from January 2014 to January 2019. According to the presence of NAFLD, the CRC patients were divided into two groups, NAFLD group (60 cases) and the control group (391 cases). The clinicopathological features and the prevalence of synCRLM between the two groups were compared. Logistic regression analysis was used to analyze the risk factors of synCRLM. Different non-invasive liver fibrosis scoring models were used to evaluate the effect of advanced fibrosis and cirrhosis stage in NAFLD on the prevalence of synCRLM.Results: The prevalence of synCRLM was significantly higher in patients with NAFLD than that in patients without NAFLD (18.33 vs. 7.42%; χ2 = 7.669, P = 0.006). A logistic regression analysis indicated that NAFLD, CEA, CA19-9, and lymph node status were risk factors for synCRLM, and NAFLD showed the highest hazard ratio (3.930 [95% confidence interval: 1.616 ~ 9.560]). In NAFLD patients, both fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) were significantly lower in those with synCRLM compared to those without synCRLM [FIB-4: 1.246 (0.833 ~ 1.276) vs. 1.436 (1.016 ~ 2.699), Z = −2.130, P = 0.033; NFS: −1.282 (−2.407 ~ −0.262) vs. −0.255 (−1.582 ~ 0.755), Z = −2.302, P = 0.021; Mann-Whitney test].Conclusion: NAFLD may be associated with increased liver metastasis, and for NAFLD-related advanced liver fibrosis and cirrhosis may be associated with reduced synchronous liver metastasis in CRC patients. However, the correlation between simple steatosis and steatohepatitis remains to be further determined. Certain factors such as NAFLD, lymph node metastasis, elevated levels of preoperative CEA and CA19-9 are suggesting a high risk of synCRLM.

Tumor markers CA15-3, CA125, CEA and breast cancer survival by molecular subtype: a cohort study

The burden of breast cancer has grown rapidly in China during recent decades. However, the association between tumor markers (CA15-3, CA125, and CEA) and breast cancer survival among certain molecular subtypes is unclear; we described this association in a large, population-based study. We conducted a cohort study including 10,836 women according to the Tianjin Breast Cancer Cases Cohort. Demographic and epidemiologic data were collected by a structured face-to-face questionnaire. Clinico-pathological parameters were abstracted from medical records, and follow-up information was obtained once a year by telephone. The primary endpoints were breast cancer-specific survival (BCSS) and disease-free survival (DFS). We utilized the Cox proportional hazard model to calculate hazard ratios (HRs) and 95% confidence intervals (CI). Among all patients, elevated CA15-3 and CEA exhibited consistently and statistically significant reduced BCSS compared with normal ones (CA15-3: HR 1.54, 95% CI 1.01-2.34; CEA: HR 2.45, 95% CI 1.40-4.30). Similar patterns of association were observed for DFS (CA15-3: HR 2.09, 95% CI 1.44-3.02; CEA: HR 2.71, 95% CI 1.71-4.27). Moreover, in luminal A subtype, high CA15-3 and CEA levels were associated with decreased BCSS (CA15-3: HR 4.47, 95% CI 2.04-9.81; CEA: HR 3.79, 95% CI 1.68-8.55) and DFS (CA15-3: HR 4.06, 95% CI 2.29-7.18, CEA: HR 3.41, 95% CI 1.75-6.64). In basal-like subtype, elevated CEA conferred reduction for BCSS (HR 5.13, 95% CI 1.65-15.9). However, no association was observed between CA125 and breast cancer outcome. Preoperative CA15-3 and CEA levels differ in breast cancer molecular subtypes and yield strong prognostic information in Chinese women with breast cancer. Measuring CA15-3 and CEA levels before surgery may have the potential in predicting breast cancer survival and offering patients' personalized treatment strategy among luminal A and basal-like subtypes.

Prognostic value of the controlling nutritional status (CONUT) score in intrahepatic cholangiocarcinoma patients especially who had long-time alcohol consumption.

Our study is to investigate the preoperative prognostic value of the Controlling Nutritional Status score in intrahepatic cholangiocarcinoma patients after curative resection. One hundred and sixty-seven patients admitted to our hospital between January 2012 and December 2018 were included retrospectively. Time-dependent receiver operating characteristic (ROC) curve analysis was conducted to evaluate the ability of the Controlling Nutritional Status score to predict recurrence and survival. Patients with high Controlling Nutritional Status score (≥3) had significantly poorer RFS compared to those with low Controlling Nutritional Status score (low: <3) (p = 0.000) in Kaplan–Meier survival curve. Multivariate analyses identified Controlling Nutritional Status score, lymph node metastasis, tumor numbers and preoperative CEA as independent prognostic factors for RFS. Lymph node metastasis was the independent risk factor of OS. The Cox regression model with Controlling Nutritional Status score had better prognostic value for recurrence than the Cox regression model without Controlling Nutritional Status score in long-time alcohol consumption intrahepatic cholangiocarcinoma patients (AUC: 0.760 vs 0.706, p = 0.036). CONUT score may be a more powerful prognostic biomarker, which is tightly associated with other tumor characteristics, to predict recurrence but not survival, especially in long-time alcohol consumption intrahepatic cholangiocarcinoma patients after curative-intent surgery.

Hs-CRP, albumin and CA19-9 after neoadjuvant therapy predict postoperative survival in borderline resectable pancreatic ductal adenocarcinoma

Background: Systemic inflammation and tumor markers have shown prognostic value in resectable pancreatic ductal adenocarcinoma (PDAC). This study aimed at assessing preoperative laboratory values as prognostic factors in borderline resectable patients treated with neoadjuvant therapy (NAT). Methods: Between 2000 and 2015, 399 consecutive PDAC patients underwent surgery at Helsinki University Hospital. Borderline resectable patients (n=94) received NAT. Resectable propensity scored patients (n=182) underwent upfront surgery (US). NAT included folfirinox, single gemcitabine or combined with cisplatin, capecitabine or nab-paclitaxel with or without radiation. Preoperative high-sensitivity CRP (hs-CRP, mg/l), leukocytes (E9/l), albumin (g/l), bilirubin (g/l), platelets (E9/l), CA19-9 (kU/l)and CEA (μg/l) were assessed. Survival was estimated with Kaplan-Meier and Cox Regression. Results: In both NAT and US patients, hs-CRP <3 presented with longer survival than hs-CRP =3 (NAT 49 vs. 24 months, p<0.001; US 30 vs. 23 months, p=0.032). Additionally, albumin =35 (33 vs. 17 months, p=0.002) and CA19-9 =37 (43 vs. 18 months, p<0.001) associated with survival. Combining hs-CRP and CA19-9 together predicted survival better than either one alone: those with hs-CRP <3 and CA19-9 =37 had a median survival of 54 months compared to those with either hs-CRP or CA19-9 over the reference limit (27 months) and those with both values over the reference limit (16 months, p<0.001). In NAT patients, those recurring within one year after surgery had higher hs-CRP (4.2 vs. 1.9, p=0.038) and CA19-9 (209 vs. 22, p<0.001) and lower albumin (36.5 vs. 38.8, p=0.005) than not recurred patients. Both Hs-CRP =3 and CA19-9 >37 predicted worse survival (HR 5.52, p=0.007) and adjuvant therapy better survival (HR 0.40, p=0.006) in multivariate analysis in NAT patients. Only one NAT patient with hs-CRP =3 (total n=52) survived more than five years (hs-CRP=3.93). Conclusion: Hs-CRP, albumin and CA19-9 after NAT predicted postoperative survival in borderline resectable PDAC patients.

Clinical relevance of para-aortic nodes involvement in resectable pancreatic cancer. A single center experience

Background: according to 8th edition of AJCC classification, para-aortic nodes (PALNs) involvement in pancreatic cancer (PC) is considered as metastatic disease and, therefore, surgical resection is not recommended. However, as some series reported favourable survival results after radical surgery even in presence of metastatic PALNs (PALNs+), the matter still remains debated. Material & Methods: A retrospective analysis of our database was performed between the date September 2015 and February 2018, searching for patients undergoing pancreaticoduodenectomy for PC. Primary and secondary endpoints were overall survival (OS) and progression free-survival (PFS). Survival analysis was carried out using the Kaplan-Meier method with the log-rank test. A p-value <0.05 was considered as statistically significant. Results: 141 patients were retrieved, of whom 79 male (54.1%) and 67 female (45.9%). Mean age was 65 years (SD±10) while median preoperative CEA and CA19.9 level were 2.6 ng/mL (range: 0.4-19.7) and 109.4 U/mL (range: 0.6-974), respectively. PALNs were removed in 46 (32.6%) patients and resulted site of metastases in 13 cases (28.2%). At univariate analyses both OS and PFS resulted significantly poorer in presence of node metastases (OS: 24 vs 33 months; p=0.016; PFS: 13 vs 18 months; p=0.05) and high tumor grading (G3 vs G1-2; OS: 20 vs 34 months; p=0.033; PFS: 5 vs 13 months; p=0.034). Within the PALNs+ subgroup, median OS and PFS were 15 and 5.5 months, respectively, and the data is statistically significant if compared with PALNs- counterpart (OS: 23 months; p< 0.0001; PFS: 17 months; p=0.001) and the subgroup of patients not undergoing PALNs sampling (OS: 28 months; p=0.004; PFS: 13 months: p=0.006). Conclusions: Metastatic PALNs for PC showed to strongly correlates with a poor prognosis in our series. Frozen section analyses of PALNs should be considered before proceeding to radical surgery especially for those patients at high risk for major complications.

POM121 overexpression is related to a poor prognosis in colorectal cancer

ABSTRACTBackground: Nuclear pore membrane protein 121 (POM121) plays a crucial role in nucleocytoplasmic transport, but its significance in tumorigenesis and the progression of colorectal cancer (CRC) remains unknown. The aim of this study was to evaluate the relationship between POM121 and CRC.Methods: POM121 expression in colorectal tissues was analyzed at both the gene and protein levels. We investigated the connection between POM121 expression and clinicopathological features, as well as overall survival. A gene set enrichment analysis (GSEA) was performed, and a protein-protein interaction (PPI) network was constructed to determine the mechanism of POM121 in CRC.Results: CRC tissues displayed a striking increase in POM121 expression compared with colonitis and pericarcinomatous mucosa tissues (66.61% vs 24.36% vs 24.11%, respectively, p < 0.0167). POM121 overexpression was significantly associated with lymph node metastasis, distant metastasis, TNM stage, venous invasion, perineural invasion, preoperative CEA and CA19-9 levels, and Ki67 expression. CRC patients with high POM121 levels tended to have poor overall survival rates. POM121 may participate in the regulation of the cell cycle and DNA repair in CRC.Conclusions: Our results suggest that POM121 has the potential to serve as a novel prognostic biomarker in CRC patients.

Changes of Serum CEA Level after Resection of Colorectal Carcinoma

Introduction :Carcinoembryonic antigen is the most commonly used tumour associatedantigen in the management of patients with colorectal carcinoma. The test appearsuseful to determine prognosis and to monitor patients with colorectal carcinoma for earlyrecurrence, persistent elevation of CEA for a month after operation suggests thepresence of occult metastatic disease.&#x0D; Objective: The study was done to compare pre and postoperative CEA level in colorectalcarcinoma patient and to analyze the relationship of CEA and different Dukes stage inpre operative period of colorectal carcinoma patients.&#x0D; Methods: This cross-sectional and cohort study was performed to look at the change inCEA level among 97 colorectal carcinoma patients in pre and post operative state in thedepartment of surgical oncology, NICRH from January 2010 to June 2012.&#x0D; Results :Statistically significant changes was found in pre and postoperative CEA levelin colorectal carcinoma patient (p &lt;.001). Preoperative CEA level was raised in Dukes8(40%) and Dukes C(54%).&#x0D; Conclusion :Postoperative CEA level was significantly reduced after resection of colorectalcarcinoma and neck neoplasm.&#x0D; Journal of Surgical Sciences (2016) Vol. 20 (1) : 3-6

112P - A retrospective analysis of the association between perioperative, post adjuvant carcinoembryonic antigen level and prognosis in stage III colorectal cancer

BackgroundCarcinoembryonic antigen (CEA) is the most widespread tumour marker of colorectal cancer, however, it is not helpful to judge for recurrence of the disease because of low sensitivity and specificity. It is recommended for patients who were diagnosed with pStage III colorectal cancer to receive adjuvant chemotherapy after curative resection and to measure CEA every 3 months. Moreover, It is reported that postoperative CEA level is more informative than preoperative CEA level about the impact for prognosis but the association between postoperative, post adjuvant CEA level and the prognosis is still unclear. This study aimed to evaluate whether perioperative and post adjuvant CEA level was useful for estimation of the prognosis in stage III CRC. MethodsThis retrospective study was conducted at the Cancer Institute Hospital of JFCR. A total of 567 consecutive patients who underwent curative resection for stage III colon adenocarcinoma and adjuvant chemotherapy in our hospital from March 2005 to December 2013 were identified. The patients who received bevacizumab as adjuvant chemotherapy and didn’t measure CEA were excluded. ResultsThe 3-year DFS rate in patients with normal preoperative CEA is superior to patients with high preoperative CEA (HR:1.59;95%CI:1.10-2.31, p = 0.014). There was no significant difference in the 5-year OD between the two groups (HR1.17;95%CI:0.62–2.20, p = 0.63). The 3-year DFS rate and 5-year OS rate in patients with normal postoperative CEA were superior to patients with high postoperative CEA (HR:2.18;95%CI:1.23–3.88, p = 0.0079, and HR:2.40;95%CI:1.02–5.69, p = 0.046). The 3-year DFS in patients with normal postadjuvant CEA was superior to patients with high postadjuvant CEA(HR1.79;95%CI:1.23–3.88, p = 0.022), whereas regarding the 5-year OS there was no significant difference between the two groups (HR2.10;95%CI:0.98–4.53, p = 0.057).In the multivariate analysis, the histological type and N-stage were predictive factors of OS. ConclusionsHigh postoperative and post adjuvant CEA level may be negative prognosis factors for OS in patients who underwent curative resection for stage III CRC. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

463P - Prediction of invasiveness in lung adenocarcinoma using machine learning algorithm based on 3D-CT imaging

BackgroundT factor depends on consolidation diameter in lung adenocarcinoma. Adenocarcinoma with short consolidation diameter could be indicated for sublobar resection. However, measurement of consolidation diameter under lung window in 2D-CT could be problematic, as the outline is not clear. We evaluated the relationship between consolidation lesion under mediastinal window in 3D-CT and pathological invasiveness, and aimed to predict invasiveness using machine learning algorithm. MethodsNinety-five patients who underwent surgical resection of lung adenocarcinoma that is less than 20 mm in diameter and has consolidation were analyzed retrospectively, in our Hospital from 2010 to 2016. The total tumor diameter and the volume and diameter of consolidation were analyzed using thin-slice CT and 3D-CT. Preoperative FDG-PET and serum CEA were also measured. Preinvasive lesion and minimally invasive adenocarcinoma were classified as pathologically non-invasive group, and invasive adenocarcinoma was classified as pathologically invasive group. The statistical differences were assessed by the Mann-Whitney U test or chi-square test. We used two machine learning algorithm. Three logistic regression (LR) models were trained based on sex, total tumor diameter, SUVmax, CEA, and (1) consolidation diameter (LR-Cd), (2) consolidation volume (LR-Cv), (3) consolidation diameter and volume (LD-Cd+Cv). Similarly, three random forest (RF) models were trained (RF-Cd, RF-Cv, RF-Cd+Cv). Patients were split into a training set (n = 76) and test set (n = 19). Model performance was measured area under the curve (AUC), and compared using receiver-operating characteristics curve analysis on the test set. ResultsTwenty-six non-invasive adenocarcinomas and 69 invasive adenocarcinomas were evaluated. The consolidation diameter and volume, and SUVmax of invasive group were significantly greater than those of non-invasive group (p < 0.001). On the test set, AUC of LR-Cd, RF-Cd, LR-Cv, RF-Cv, LR-Cd+Cv and RF-Cd+Cv were 0.687, 0.703,0.628, 0.744, 0.628 and 0.744 respectively. ConclusionsThe pathological invasiveness could be predicted by using machine learning algorithm. Especially, higher AUCs were obtained in RF-Cv and RF-Cd+Cv model. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

High hnRNP AB expression is associated with poor prognosis in patients with colorectal cancer.

Heterogeneous ribonucleoprotein AB (hnRNP AB) is a member of the heterogeneous nuclear ribonucleoprotein family, which serves important functions in gene expression and signal transduction. However, the expression and clinicopathological significance of hnRNP AB in colorectal cancer (CRC) remain to be elucidated. To investigate the expression and clinical significance of hnRNP AB in CRC, hnRNP AB expression levels were analysed in two independent cohorts of patients with CRC. The results of reverse transcription-quantitative PCR, immunohistochemistry and western blot analysis demonstrated that hnRNP AB was upregulated in CRC tissues compared with the corresponding adjacent normal tissues. Immunohistochemical analyses indicated that a high expression of hnRNP AB was significantly associated with preoperative carcinoembryonic antigen (CEA; P<0.001) and carbohydrate antigen 19-9 (P=0.014) levels, tumour size (P=0.022) and infiltration (P=0.026), lymph node metastasis (P<0.001) and Tumour-Node-Metastasis stage (P<0.001). Univariate and multivariate Cox survival analyses revealed that hnRNP AB expression and preoperative CEA levels were significant independent factors affecting overall survival in patients with CRC (P<0.05). According to the Kaplan-Meier model, patients with CRC with high hnRNP AB expression exhibited significantly poorer prognosis compared with those with low hnRNP AB expression (P<0.001). In conclusion, the results of the present study demonstrated that hnRNP AB expression may serve an important role in the progression of CRC and that hnRNP AB may be considered a predictor of prognosis for patients with CRC.

276P - The prognostic significance of preoperative tumour marker (CEA, CA15-3) elevation in breast cancer patients

BackgroundTumour markers are widely used for screening and monitoring cancers. CA 15-3 and CEA are FDA-approved tumour markers for monitoring breast cancer. However, the prognostic efficacy of preoperative elevation of CEA and CA15-3 levels in breast cancer remains controversial. MethodsWe retrospectively analyzed the clinicopathological parameters and preoperative serum CEA and CA 15-3 level of 149,238 patients of Korean Breast Cancer Society Registry (KBCSR) Database who underwent surgery between January 2000 and December 2015. ResultsThe patients with elevated CA 15-3/CEA level had shown more advanced T stage and N stage, ER negativity, PR negativity and HER2 positivity compared the patients with normal CA15-3/CEA levels. The patients with elevated CA 15-3/CEA level had worse OS than the patients with normal CA 15-3/CEA level. In survival analysis, both elevated group had worst prognosis compared other groups. In subgroup analysis by subtypes, in luminal A, both elevated group had hazard ratio (HR) 2.14 (95% CI 1.01-4.55), only CA 15-3 elevated had HR 2.38 (95% CI 1.58-3.58) and only CEA elevated group had HR 1.79 (95% CI, 1.20-2.68), compared normal group. In luminal B, both elevated group had HR 3.99 (95% CI 2.23-7.16), only CA 15-3 elevated had HR 2.38 (95% CI 1.58-3.58) and only CEA elevated group had HR 1.79 (95% CI, 1.20-2.68), compared normal group. In HER2 subtype group, elevated CEA level was the only independent prognostic factor. However, in TNBC, elevated preoperative CEA and CA 15-3 level were not a significant prognostic factor for OS. ConclusionsThe elevation of preoperative tumor markers was associated with aggressive characteristic and worse overall survival. Preoperative tumor markers predicted the prognosis of the patients and showed differences according to subtypes. In luminal breast cancer, the CA 15-3 elevation has higher hazard ratio than the CEA elevation and the patients with both tumor markers showed the worst prognosis. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Identification of the Risk Factors for Recurrence of Stage III Colorectal Cancer

This study aimed to identify risk factors for recurrence of patients with stage III colorectal cancer by assessing clinicopathological features. The study included 231 patients with stage III colorectal cancer who underwent curative resection between 2006 and 2012 at the Department of Surgery of the Jikei University Hospital, Tokyo, Japan. Clinicopathological data of the patients were retrospectively evaluated. The recurrence rate was 27.7% (64/231) in the study group. The univariate analysis for recurrence identified five risk factors: site of primary tumor (rectal cancer), surgical procedure (open surgery), preoperative serum CEA level (>5 ng/ml), preoperative serum CA19-9 level (>37 U/ml), and number of metastatic lymph nodes (over three metastases). The multivariate analysis for recurrence identified three risk factors: rectal cancer, preoperative serum CEA level >5.0 ng/ml 95%, and more than three metastatic lymph nodes. The risk factors for stage III colorectal cancer recurrence seem to be rectal cancer, preoperative serum CEA level >5.0 ng/ml, and more than three metastatic lymph nodes.

Carcinoembryonic Antigen (CEA) dan Neutrofil-to-Limfosit Ratio (NLR) sebagai Faktor Prediktif Kanker Kolorektal

Colorectal cancer is a cancer that attacks the colon to the rectum. This cancer is the fourth most cancer in the world, and the second most cancer in western countries, and the third most common cause of cancer that occurs in men and women in 2012 in Indonesia. 72.4% of colorectal cancer patients have increased preoperative CEA levels, and increased NLR has been reported as a valuable predictive indicator of various types of cancer, including colorectal cancer. This study aims to analyze the correlation between CEA examination and NLR in colorectal cancer using secondary data with cross-sectional design. The sample of this study was all colorectal cancer patients in Tarakan Hospital, Central Jakarta, who examined CEA and complete hematology in 2014 - 2018. Based on the results of the study, it could be concluded that there was a correlation between CEA with NLR in colorectal cancer with a value of p = 0.000 smaller than alpha = 0.05, and the value of r = 0.78, meaning a strong correlation between CEA and NLR in colorectal cancer, so if there is an increase in CEA, it is accompanied by an increase in NLR.