International Journal of Colorectal Disease

, Volume 27, Issue 10, pp 1333–1338 | Cite as

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

  • Pei-Ching Lin
  • Jen-Kou Lin
  • Chun-Chi Lin
  • Huann-Sheng Wang
  • Shung-Haur Yang
  • Jeng-Kai Jiang
  • Yuan-Tzu Lan
  • Tzu-Chen Lin
  • Anna Fen-Yau Li
  • Wei-Shone Chen
  • Shih-Ching ChangEmail author
Original Article



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.


CEA CA19-9 Colorectal cancer Prognosis 



Carcinoembryonic antigen


Colorectal cancer


Disease-free survival



This study was supported by a grant from Taipei Veterans General Hospital. (VGH100C-007, VGH100E2-008).

Supplementary material

384_2012_1447_MOESM1_ESM.doc (32 kb)
Supplement Table 1 (DOC 32 kb)


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Pei-Ching Lin
    • 1
  • Jen-Kou Lin
    • 2
  • Chun-Chi Lin
    • 2
  • Huann-Sheng Wang
    • 2
  • Shung-Haur Yang
    • 2
  • Jeng-Kai Jiang
    • 2
  • Yuan-Tzu Lan
    • 2
  • Tzu-Chen Lin
    • 2
  • Anna Fen-Yau Li
    • 3
  • Wei-Shone Chen
    • 2
  • Shih-Ching Chang
    • 2
    Email author
  1. 1.Department of Clinical Pathology, Yang-Ming CampusTaipei City HospitalTaipeiTaiwan
  2. 2.Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalNational Yang-Ming UniversityTaipeiTaiwan
  3. 3.Department of Pathology, Taipei Veterans General HospitalNational Yang-Ming UniversityTaipeiTaiwan

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