Value Of Serum Carcinoembryonic Antigen Levels Research Articles

Predictive value of preoperative routine examination for the prognosis of patients with pT2N0M0 or pT3N0M0 colorectal cancer.

In recent years, the incidence of colorectal cancer (CRC) has been increasing. With the popularization of endoscopic technology, a number of early CRC has been diagnosed. However, despite current treatment methods, some patients with early CRC still experience postoperative recurrence and metastasis. To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations. A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study. Results of blood routine test, liver and kidney function tests and tumor markers were collected before surgery. Patients were followed up through disease-specific database and telephone interviews. Tumor recurrence, metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis. We comprehensively compared the predictive value of preoperative blood routine, blood biochemistry and tumor markers for disease-free survival (DFS) and overall survival (OS) of CRC. Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS [hazard ratio (HR) = 0.995, 95% confidence interval (CI): 0.991-0.999, P = 0.015], while serum carcinoembryonic antigen (CEA) level (HR = 1.008, 95%CI: 1.001-1.016, P = 0.027) and serum total cholesterol level (HR = 1.538, 95%CI: 1.026-2.305, P = 0.037) were independent risk factors for OS. The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL. Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level, the difference between the two groups was not statistically significant (P = 0.075). For patients with T2N0M0 or T3N0M0 CRC, preoperative platelet count was a protective factor for DFS, while serum CEA level was an independent risk factor for OS. Given that these measures are easier to detect and more acceptable to patients, they may have broader applications.

Risk factors for lymph node metastasis and surgical scope in patients with cN0 non-small cell lung cancer: a single-center study in China

BackgroundIt is difficult to determine the lymph node metastasis of patients with clinically negative lymph nodes (cN0) non-small cell lung cancer (NSCLC) before surgery. The purpose of this study is to investigate risk factors of lymph node metastasis in cN0 NSCLC, thereby to identify the surgical indications for lymph node dissection in cN0 NSCLC.MethodsWe conducted a retrospective study of patients with tumor size ≤ 30 mm who underwent radical resection of NSCLC. Binary logistic regression analysis was applied to predict risk factors for lymph node metastasis, and subject operating characteristics (ROC) curve was used to evaluate the independent risk factors.ResultsOverall, 44 patients (6.8%) with cN0 NSCLC had lymph node metastasis. Factors of tumor consolidation diameter (p < 0.001) and preoperative serum carcinoembryonic antigen (CEA) level (p = 0.017) are independent risk factors lymph node metastasis in cN0 NSCLC. The ROC curve showed that the cut-off value of consolidation diameter was 16.5 mm, and the area under the curve (AUC) was 0.825 (p < 0.001, 95% CI 0.780–0.870); the cut-off value of serum CEA level was 1.765 μg/L, and the AUC was 0.661 (p < 0.001, 95% CI: 0.568–0.754). Moreover, 8 of 461 patients with tumor parenchyma ≤ 16.5 mm had lymph node metastasis, and 36 of 189 patients with tumor parenchyma > 16.5 mm had lymph node metastasis.ConclusionTumor consolidation diameter and preoperative serum CEA are independent factors to predict cN0 NSCLC with tumor size ≤ 30 mm. For patients with tumor parenchyma > 16.5 mm, the probability of lymph node metastasis is higher and lymph node dissection is recommended. For patients with tumor parenchyma ≤ 16.5 mm, the probability of lymph node metastasis is lower and lymph node sampling is feasible.

Prognostic value of postoperative serum carcinoembryonic antigen levels in colorectal cancer patients who smoke.

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.

Predictive value of serum CEA level combined with PET/CT metabolic parameters MTV and TLG in primary liver metastases from colorectal cancer

Objective To analyze the predictive value of serum carcinoembryonic antigen(CEA) level combined with primary PET/CT metabolic parameters, metabolic tumor volume(MTV) and total glycolysis(TLG) in liver metastasis of colorectal cancer. Methods The clinical data of 86 patients with colorectal cancer who underwent PET/CT examination in the People's Hospital of Zhejiang Province from January 2013 to December 2017 were retrospectively analyzed.Univariate and multivariate logistic regression was used to analyze the relationship between clinicopathological parameters, MTV, TLG and liver metastasis. Results Of the 86 patients, there were 17 cases(19.77%) of liver metastases.Univariate analysis showed that there were significant differences in T stage(χ2=8.83), tumor location(χ2=5.43) and serum CEA content(t=11.65) between the liver metastasis group and the non-liver metastasis group(all P<0.05). The levels of TLG[(101.94±20.14)g] and MTV[(14.09±3.25)cm3] in the liver metastasis group were significantly lower than those in the non-liver metastasis group[(135.95±22.63)g, (25.09±4.33)cm3](t=5.66, 9.80, all P<0.01). Multivariate logistic regression analysis showed that T stage(OR=3.56, 95%CI: 1.06-12.00), tumor location(OR=1.38, 95% CI: 1.05-1.81), TLG(OR=1.68, 95% CI: 1.11-2.54), MTV(OR=3.86, 95% CI: 1.63-9.14) and serum CEA(OR=2.95, 95% CI: 1.60-5.41) were the influencing factors of liver metastases in patients with colorectal cancer(all P<0.05). Conclusion T stage, tumor location, primary PET/CT metabolic parameters(TLG, MTV) and serum CEA levels are the influencing factors of liver metastasis in patients with colorectal cancer, suggesting that the detection of serum CEA level combined with primary PET/CT metabolic parameters has certain predictive value for liver metastasis of colorectal cancer. Key words: Colorectal cancer; Liver metastasis; Positron emission computed tomography; Carcinoembryonic antigen; Metabolic tumor volume; Total glycolysis; Multivariate analysis; Influencing factor

Prognostic value of pretreatment level of carcinoembryonic antigen on tumour downstaging and early occurring metastasis in locally advanced rectal cancer following neoadjuvant radiotherapy (30 Gy in 10 fractions)

To evaluate the role of carcinoembryonic antigen (CEA) in predicting the response to and prognosis for locally advanced rectal cancer treated with 30Gy neoadjuvant radiotherapy (nRT) in 10 fractions (30Gy/10f). This retrospective study involved 240 patients with locally advanced rectal cancer who underwent 30Gy/10f nRT (biologically equivalent dose 36Gy) followed by total mesorectal excision between August 2003 and 2009. Serum CEA level was determined before administration of nRT. The prognostic value of serum CEA level on tumour downstaging and 3-year disease-free survival was analysed. Ninety out of 240 (37.5%) patients had elevated CEA levels before nRT. The incidence of T downstaging in patients decreased significantly as the pretreatment CEA levels became more elevated (<5ng/ml, 50.7%; 5-10ng/ml, 39.5%; >10ng/ml, 17.3%; P=0.00014). Downstaging to ypCR or ypStage I occurred in 46.7% (66/150) of patients with a CEA level of <5ng/ml and 34.2% (13/38) of patients with a CEA level of 5-10ng/ml. In contrast, just 13.5% (7/52) of those with a CEA level>10ng/ml downstaged to ypStage I and none of them achieved ypCR, with statistical difference (P=0.001). A significantly higher incidence of early metastasis (within 6 postoperative months) was observed with increasing CEA level: 2.0% (3/150), 5.4% (2/38) and 11.5% (6/52) in patients with CEA level<5ng/ml, 5-10ng/ml or >10ng/ml, respectively (P=0.018). Pretreatment CEA level cannot only predict tumour downstaging and ypTNM stage for rectal cancer following 30Gy/10f nRT, but also promisingly suggests a high incidence of early occurring distant metastasis. These findings may be used to select patients with nRT resistance and occult metastasis and make alternative treatment strategies.

The predictive role of consecutive measurements of serum CEA for treatment efficacy in advanced non-small cell lung cancer patients harboring epidermal growth factor receptor mutations treated with gefitinib or erlotinib.

e19029 Background: Patients with non-small cell lung cancers (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations dramatically respond to EGFR tyrosine kinase inhibitors (TKIs) with approximately 70% response rate. Carcinoembryonic antigen (CEA) has been suggested to be associated with tumor recurrence, treatment efficacy and prognosis in some specific tumors. However, the role of CEA in NSCLC with EGFR mutations remains unclear. Therefore, we sought to elucidate whether the determination of serum CEA levels can predict the efficacy of EGFR TKIs in NSCLC harboring EGFR mutations. Methods: Medical records of 326 consecutive patients with advanced NSCLC between January 2007 and November 2012 were reviewed and a total of 104 patients with NSCLC harboring EGFR mutations treated with gefitinib or erlotinib ³2 weeks and with available data of serum CEA were identified for analysis. Results: Female, never smokers, adenocarcinoma histology and cases with pretreatment serum CEA ³ 5 ng/ml presented 63%, 76%, 96% and 68% of 104 eligible cases with mean age of 65.4 ± 13.7 years, respectively. The response rate of EGFR TKIs in patients with pretreatment CEA ³ 5 ng/ml was not significantly different (70% vs 91%, P = 0.339), and it was higher in those with reduction of CEA level after treatment than those without (94% vs 35%, RR=2.7, P &lt;0.001). The average change of pre- and post-treatment CEA in respondents and non-respondents was negative 112 ± 181 ng/ml and positive 368 ± 514 ng/ml, P &lt;0.001, respectively. In details, the pre- and post- treatment CEA levels in respondents were 246 and 71 ng/ml, P &lt; 0.001, respectively, and those in non-respondents were 157 and 268 ng/ml, P= 0.019, respectively. Furthermore, the post-treatment CEA level increased by 14% in non-respondents and decreased by 52% in respondents. Conclusions: Reduction or elevation of post-treatment serum CEA can predict the treatment efficacy in NSCLC patients with EGFR mutations treated with gefitinib or erlotinib. Further studies aiming to investigate the value of serum CEA levels in tumor progression and survival are warranted.

Individualized Cutoff Value of the Serum Carcinoembryonic Antigen Level According to TNM Stage in Colorectal Cancer

See Article on Page 106-114 Serum carcinoembryonic antigen (CEA) is the most widely used tumor marker for the management of colorectal cancer. The preoperative serum CEA level has been reported to be one of prognostic parameters for the recurrence of colorectal cancers [1, 2]. Postoperative monitoring of the serum CEA level has been commonly used in the follow-up for colorectal cancers [3]. However, whether the preoperative serum CEA level has a prognostic significance according to individual stages in patients with colorectal cancer is controversial [4-7]. Harrison et al. [6] analyzed a large cohort of node-negative colon cancer patients (T1-4, N0, M0) to determine prognostic factors. The study demonstrated that the preoperative serum CEA elevation (>5 ng/mL) had a poor prognostic value in node-negative patients (T1-4, N0, M0). Another study showed that 5 ng/mL, as cutoff value for serum CEA, had no significant prognostic value within the different Dukes' stages and had borderline prognostic value in the Dukes' C stage [7]. Those trials to identify the prognostic value of serum CEA elevation within individual stages have some limitations. The biochemical characters of serum CEA are not well known. For those trials, hypotheses are necessary. Serum CEA has other biochemical characters, but not as a marker to predict increasing size of tumor or metastasis to lymph nodes. Serum CEA might be a sensitive marker, represents size and metastasis. Few studies have reported optimal cutoff values for serum CEA levels in patients with colorectal cancer. Reiter et al. [8] reported the results of a multivariate analysis of the prognostic value of serum CEA level in colorectal cancer. For preoperative serum CEA levels of ≥4 ng/mL vs. 4 ng/mL and 10 ng/mL vs. 17 ng/mL) (P < 0.001). According to stage, a significant difference in survival was observed only in patients with stage III tumors (P = 0.007). In this study, the authors tried to determine the individual optimal cutoff value of CEA according to TNM stage [10]. The conventional cutoff value of CEA (5 ng/mL) has no significant prognostic value in stage T1-2, N0 and stage T1-4, N2. Optimal cutoff values from the receiver operating characteristic curve were 7.4, 5.5 and 4.5 ng/mL for TNM stages I, II and III, respectively. Those for stages N0, N1 and N2 were 5.5, 4.8 and 3.5 ng/mL, respectively. The 5-year disease free survivals were significantly different with these cutoff values for each TNM and N stages. However, one has to consider that a sub-normal CEA level may be a cutoff value that can be used as a prognostic marker.

Serum carcinoembryonic antigen (CEA) levels and prognosis in early and advanced non-small cell lung cancer (NSCLC).

e21054 Background: The usefulness of tumor markers in NSCLC is not well defined. High levels of CEA are considered a negative prognostic factor in early-stages NSCLC but its role in advanced disease is yet to be defined. The aim of the study is to analyze the prognostic value of basal level of CEA in unselected NSCLC patients. Methods: 320 NSCLC patients diagnosed in our institution between April 2004 and March 2009 were retrospectively reviewed. Baseline prognostic factors analyzed were gender, histology, clinical stage and brain metastases. Overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS) were calculated by the Kaplan-Meier method. The cutoff value of serum CEA level was 5 ng/mL. Results: Baseline patients characteristics: median age 63 (30-82 years), males 84.4%, stage I: 7.2%, II: 6.3%, III: 33% and IV 53%; squamous carcinoma 23.8%, adenocarcinoma 39.7%, large cell carcinoma 19.4% and undifferentiated carcinoma 15%. High levels of CEA were detected in 179 (56.5%) patients. Significant higher levels of CEA at baseline were present in adenocarcinoma (p = 0.03) and patients with advanced disease (p = 0.01) but not difference according sex or brain metastases were detected. After a follow-up of 9.7 months, 256 patients relapsed and 202 patients had died. In the 275 patients with advanced disease, the PFS was 5.3 months vs 7.4 months for patients with high and normal CEA (p = 0.011) and the OS 10.0 months vs 14.0 months in patients with high and normal CEA (p = 0.085). In early stages (I-II) the DFS was 14.2 vs 20.3 months (p = 0.141) and OS 35 vs 47.7 months (p = 0.045) for patients with high and normal CEA. In the multivariate analysis only high levels of CEA, histology and stage were significant correlated with worse prognostic. Conclusions: In our analysis, high levels of CEA at baseline are correlated with worse survival in stage I-IV NSCLC patients. No significant financial relationships to disclose.

Preoperative Serum Carcinoembryonic Antigen Level is a Prognostic Factor in Women With Early Non–Small-Cell Lung Cancer

Carcinoembryonic antigen (CEA) is one of the markers evaluated in patients with non-small cell lung cancer (NSCLC). The significance of the preoperative serum CEA level in female patients with NSCLC is seldom discussed. In this study, we conducted a retrospective review to investigate the prognostic significance of the preoperative CEA level in female patients with stage I NSCLC. In this study, we looked at 163 female patients with stage I NSCLC. Patient charts were reviewed to collect patient data, including the age of the patient, tumor location, tumor size, visceral pleural invasion, the stage of disease, and the preoperative serum CEA level. The cutoff value of serum CEA level was 6.0 ng/mL. The significance of preoperative CEA level in the prognosis of female patients with stage I NSCLC was evaluated. Among the 163 female patients with stage I NSCLC, 47 patients (28.8%) had abnormal preoperative serum CEA level (>6 ng/mL). Diagnosis of adenocarcinoma and bronchoalveolar carcinoma accounted for 83.4% of these 163 female patients. In-hospital mortality was encountered in 1 patient. Univariate analysis of survival in the other 162 female patients with stage I NSCLC showed that age, stage, tumor size, and preoperative CEA level were prognostic factors. Visceral pleural invasion had no impact on the prognosis of these patients. Multivariate analysis revealed that tumor size and preoperative CEA level were independent prognostic factors in female patients with stage I NSCLC. Preoperative serum CEA level and tumor size are independent prognostic factors in female patients with stage I NSCLC. In contrast, visceral pleural invasion was not associated with the prognosis. Importantly, these results suggest that female patients with abnormally high preoperative CEA level and tumor size larger than 3 cm may need a thorough preoperative evaluation and careful postoperative follow-up to rule out occult metastasis of early NSCLC.

Effect of histologic type and smoking status on interpretation of serum carcinoembryonic antigen value in non–small cell lung carcinoma

Background Serum carcinoembryonic antigen (CEA) has all of the properties desired for a biologic measure to be used as a prognostic indicator in the clinical evaluation of lung cancer. Carcinoembryonic antigen value appears to be related to tumor histologic type and patients' smoking status, which has yet to be intensively analyzed as reports available thus far have consisted of a limited number of patients. This study was undertaken to determine whether the prognostic value of CEA differs according to histologic type in a large group of patients with clinical early-stage lung cancer, and how smoking influences its value. Methods Two series of 694 and 260 consecutive patients who underwent resection for clinical stage I lung adenocarcinoma and squamous cell carcinoma, respectively, were evaluated. We measured serum CEA before and after surgery, and analyzed its prognostic significance in relation to histologic type and its correlation with smoking status. Results We found significantly higher CEA levels in patients with adenocarcinomas than in those with squamous cell carcinomas (7.8 versus 5.5 ng/mL; p = 0.0018), but a higher percentage of CEA-positive patients among those with squamous cell carcinoma (109 of 260, 41.9%) than those with adenocarcinoma (245 of 694, 35.3%). Clinical stage I patients with a high preoperative CEA level had a poor prognosis, and for pathologically confirmed stage I patients with a high postoperative CEA level the prognosis was worse. The prognostic value of serum CEA level was thus significantly greater for adenocarcinoma than for squamous cell carcinoma. This was probably because of a much higher proportion of smokers among patients with squamous cell carcinoma. In adenocarcinoma, the growth of which was generally less influenced by smoking, the proportion of CEA-positive smokers (49.3%, 170 of 345) was greater than that of CEA-positive nonsmokers (21.5%, 75 of 349, p < 0.0001). Additionally, in patients with adenocarcinoma, survival of nonsmokers was more greatly influenced by CEA level than that of smokers. Conclusions Although serum CEA values measured before and after surgery are important in identifying patients at high risk of poor survival, its specificity is higher for adenocarcinoma than for squamous cell carcinoma. When serum CEA levels are checked, smoking status of patients, particularly of those with squamous cell carcinoma, should be taken into account.