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.
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This study was supported by a grant from Taipei Veterans General Hospital. (VGH100C-007, VGH100E2-008).
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Lin, PC., Lin, JK., Lin, CC. et al. 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. Int J Colorectal Dis 27, 1333–1338 (2012). https://doi.org/10.1007/s00384-012-1447-1
- Colorectal cancer