Carbohydrate antigen 19-9 is a valuable prognostic factor in colorectal cancer patients with normal levels of carcinoembryonic antigen and may help predict lung metastasis
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We retrospectively analyzed preoperative levels of carbohydrate antigen (CA) 19-9 in colorectal cancer (CRC) patients to determine the prognostic value of CA19-9 in CRC patients with normal carcinoembryonic antigen (CEA) levels.
A total of 639 patients who underwent curative surgery at Taipei Veterans General Hospital between 2002 and 2006 were enrolled. We excluded 254 patients (39.7 %) with high preoperative CEA levels and analyzed 385 patients with normal CEA levels. The measured endpoint was the postoperative disease-free survival (DFS). The prognostic value of CA19-9 was determined using log-rank test and Cox regression analysis.
High CA19-9 levels were significantly associated with advanced disease and were detected in 5.8 % of patients with stage I disease, 11.7 % of those with stage II disease, and 22.5 % of those with stage III disease (P < 0.001). The 5-year DFS in patients with normal CA19-9 levels was 82.0 %, which was significantly higher than that in patients with high CA19-9 levels (68 %; P < 0.001). In a multivariate analysis, the most important independent factor affecting the 5-year DFS was tumor–node–metastasis stage (95 % CI, 1.26–2.36; HR = 1.72). After stratification by other factors, high CA19-9 level remained an independent prognostic factor for patients with normal CEA levels. Patients with high CA19-9 levels also showed a higher incidence of lung metastasis (23.1 %) than those with normal CA19-9 levels (7.2 %).
CA19-9 may be a prognostic factor for CRC patients with normal CEA levels. An aggressive follow-up protocol for lung metastasis should be used for these patients.
KeywordsCEA CA19-9 Colorectal cancer Prognosis
This study was supported by a grant from Taipei Veterans General Hospital. (VGH100C-007, VGH100E2-008).
- 1.The Department of Health, the Executive Yuan, Taiwan (2007) Cancer registry annual report (December 2007). The Department of Health, the Executive Yuan, TaiwanGoogle Scholar
- 2.Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, Hammond ME, Henson DE, Hutter RV, Nagle RB, Nielsen ML, Sargent DJ, Taylor CR, Welton M, Willett C (2000) Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124:979–994PubMedGoogle Scholar
- 5.Bast RC Jr, Ravdin P, Hayes DF, Bates S, Fritsche H Jr, Jessup JM, Kemeny N, Locker GY, Mennel RG, Somerfield MR (2001) 2000 update of recommendations for the use of tumor markers in breast and colorectal cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 19:1865–1878PubMedGoogle Scholar
- 9.Lin JK, Lin CC, Yang SH, Wang HS, Jiang JK, Lan YT, Lin TC, Li AF, Chen WS, Chang SC (2011) Early postoperative CEA level is a better prognostic indicator than is preoperative CEA level in predicting prognosis of patients with curable colorectal cancer. Int J Colorectal Dis 26:1135–1141PubMedCrossRefGoogle Scholar
- 14.Greene FLPD, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M (2002) AJCC cancer staging manual, 6th edn. Springer, ChicagoGoogle Scholar
- 19.Redson M (2001) Carcinogenesis in the GI tract: from morphology to genetics and back again. Mod Pathol 230:309–318Google Scholar
- 22.Engstrom PF, Arnoletti JP, Benson AB 3rd, Chen YJ, Choti MA, Cooper HS et al (2009) NCCN Clinical Practice Guidelines in Oncology: colon cancer. Natl Compr Cancer Netw 7:778–831Google Scholar