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Clinical Significance of Preoperative Serum Carcinoembryonic Antigen Within the Normal Range in Colorectal Cancer Patients Undergoing Curative Resection

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Serum carcinoembryonic antigen (CEA) is a widely used tumor marker in colorectal cancer (CRC), but within normal range of preoperative CEA levels the clinical significance of CEA is unknown.

Objective

The aim of this study was to evaluate the usefulness of CEA within the normal range as a prognosticator of non-metastatic CRC.

Methods

This retrospective cohort study included 2021 CRC patients with normal preoperative CEA who underwent elective curative surgery (discovery group). We determined the optimal cut-off value for disease-free survival (DFS) discrimination using the Contal and O’Quigley method. We also assessed the prognostic significance of the cut-off value in a prospective cohort of 171 stage III colon cancer patients treated with oxaliplatin-based adjuvant chemotherapy (validation group).

Results

The optimal cut-off CEA value was 2.1 ng/mL in the discovery group. The DFS rates were significantly poorer in patients with high-normal preoperative CEA levels (2.1–5.0 ng/mL) than in those with low-normal CEA levels (< 2.1 ng/mL) in both groups. A high-normal CEA level was an independent risk factor for DFS in both groups, and was associated with inferior DFS in patients with stage II and III disease and in never or former smokers. The correlation between DFS and CEA levels was more distinct in left-sided colon and rectal cancer.

Conclusions

A high-normal preoperative CEA level (≥ 2.1 ng/mL), even within the normal range, was an independent prognosticator for poor DFS in CRC. The usefulness of CEA was influenced by smoking status and tumor location in addition to tumor stage.

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Acknowledgment

This study was supported by a Grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1420270).

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Authors and Affiliations

  1. Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea

    Seung-Hoon Beom MD, Sang Joon Shin MD, PhD, Chang Gon Kim MD, Jee Hyung Kim MD & Joong Bae Ahn MD, PhD

  2. Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyuk Hur MD, PhD, Byung Soh Min MD, PhD, Kang-Young Lee MD, PhD & Nam Kyu Kim MD, PhD

Authors
  1. Seung-Hoon Beom MD
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  2. Sang Joon Shin MD, PhD
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Correspondence to Joong Bae Ahn MD, PhD.

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Disclosure

Seung-Hoon Beom, Sang Joon Shin, Chang Gon Kim, Jee Hyung Kim, Hyuk Hur, Byung Soh Min, Kang-Young Lee, Nam Kyu Kim, and Joong Bae Ahn have declared no conflict of interest.

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Beom, SH., Shin, S.J., Kim, C.G. et al. Clinical Significance of Preoperative Serum Carcinoembryonic Antigen Within the Normal Range in Colorectal Cancer Patients Undergoing Curative Resection. Ann Surg Oncol 27, 2774–2783 (2020). https://doi.org/10.1245/s10434-020-08256-5

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  • DOI: https://doi.org/10.1245/s10434-020-08256-5

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