Abstract
Background
To investigate the prognostic significance of preoperative carcinoembryonic antigen (CEA) status in stage I colorectal classical adenocarcinoma (CCA) and mucinous adenocarcinoma (MUC), and to construct a nomogram model of stage I CCA.
Methods
The SEER database was used to collect 14,226 patients diagnosed with stage I colorectal adenocarcinoma (CA) from 2010 to 2015. The prognostic significance of preoperative CEA status in stage I CA and MUC was examined by propensity-matching score (PSM). We analyzed the factors affecting the prognosis of patients with stage I CCA, and constructed and verified the prognostic model.
Results
After PSM, the cancer-specific survival rate (CCS) of CEA-positive patients in stage T1 and T2 CCA was significantly lower than that of CEA-negative patients in stage T1 and T2 [HR = 0.37 (0.29–0.48), P < 0.001], [HR = 0.52 (0.41–0.65), P < 0.001]. However, there was no significant difference in CSS between CEA-positive and CEA-negative patients in T1 and T2 MUC [HR = 0.58 (0.43–0.79), P = 0.096], [HR = 0.76 (0.36–1.62), P = 0.477]. A nomogram was constructed based on the results of the multivariate COX regression model. Based on the AUC of ROC analysis, calibration plot and decision curve analysis (DCA), we concluded that the risk and prognosis model of CCA showed excellent performance.
Conclusion
Elevated CEA is a risk factor for stage I CCA, but not for MUC. And the nomogram is accurate enough to predict the risk and prognostic factors of CCA.
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Availability of data and materials
Study data was publicly available in the SEER database (https://seer.cancer.gov).
References
Amri R, Berger DL (2015) Elevation of pretreatment carcinoembryonic antigen level as a prognostic factor for colon cancer: incorporating a C stage in the AJCC TNM classification. JAMA Surg 150:755–756. https://doi.org/10.1001/jamasurg.2015.0901
Argilés G et al (2020) Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 31:1291–1305. https://doi.org/10.1016/j.annonc.2020.06.022
Bagante F et al (2018) Impact of histological subtype on the prognosis of patients undergoing surgery for colon cancer. J Surg Oncol 117:1355–1363. https://doi.org/10.1002/jso.25044
Carmeliet P (2005) Angiogenesis in life, disease and medicine. Nature 438:932–936
Chen L et al (2015) Predictive value of preoperative detection of CEA and CA199 for prognosis in patients with stage II–III colorectal cancer. Chin J Gastrointest Surg 18:914–919
Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP (2000) American Joint committee on cancer prognostic factors consensus conference: colorectal working group. Cancer 88:1739–1757
Hammarström S (1999) The carcinoembryonic antigen (CEA) family: structures, suggested functions and expression in normal and malignant tissues. Semin Cancer Biol 9:67–81
Han D, Wei Y, Wang X, Wang G, Chen Y (2017) Association of peripheral nerve invasion with clinicopathological factors and prognosis of colorectal cancer. Chin J Gastrointest Surg 20:62–66
Hu Z et al (2019) Quantitative evidence for early metastatic seeding in colorectal cancer. Nat Genet 51:1113–1122. https://doi.org/10.1038/s41588-019-0423-x
Huang S-H et al (2019) Preoperative carcinoembryonic antigen as a poor prognostic factor in stage I–III colorectal cancer after curative-intent resection: a propensity score matching analysis. Ann Surg Oncol 26:1685–1694. https://doi.org/10.1245/s10434-019-07184-3
Kammerer R, von Kleist S (1994) CEA expression of colorectal adenocarcinomas is correlated with their resistance against LAK-cell lysis. Int J Cancer 57:341–347
Kim H et al (2019) Preoperative neutrophil-lymphocyte ratio and CEA is associated with poor prognosis in patients with synchronous colorectal cancer liver metastasis. Ann Surg Treat Res 96:191–200. https://doi.org/10.4174/astr.2019.96.4.191
Lin J-K et al (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 26:1135–1141. https://doi.org/10.1007/s00384-011-1209-5
Loughrey MB et al (2020) Impact on colorectal cancer pathology reporting practice of migration from TNM 5 to TNM 8. Histopathology 77:210–222. https://doi.org/10.1111/his.14116
Prager GW et al (2014) Baseline carcinoembryonic antigen (CEA) serum levels predict bevacizumab-based treatment response in metastatic colorectal cancer. Cancer Sci. https://doi.org/10.1111/cas.12451
Sung H et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA a Cancer J Clin 71:209–249. https://doi.org/10.3322/caac.21660
Teka MA, Yesuf A, Hussien FM, Hassen HY (2021) Histological characteristics, survival pattern and prognostic determinants among colorectal cancer patients in Ethiopia: a retrospective cohort study. Heliyon 7:e06366. https://doi.org/10.1016/j.heliyon.2021.e06366
Thirunavukarasu P et al (2011) C-stage in colon cancer: implications of carcinoembryonic antigen biomarker in staging, prognosis, and management. J Natl Cancer Inst 103:689–697. https://doi.org/10.1093/jnci/djr078
Tong G et al (2018) The role of tissue and serum carcinoembryonic antigen in stages I to III of colorectal cancer—A retrospective cohort study. Cancer Med 7:5327–5338. https://doi.org/10.1002/cam4.1814
Zhang C et al (2020) Mapping the spreading routes of lymphatic metastases in human colorectal cancer. Nat Commun 11:1993. https://doi.org/10.1038/s41467-020-15886-6
Acknowledgements
We would like to thank the SEER database and the 900TH Hospital of Joint Logistics Support Force database for providing high-quality clinical data on colorectal cancer.
Funding
This work was supported by the Foundation of 900TH Hospital of Joint Logistics Support Force, Fujian, Fuzhou, P.R. China (2021SM13).
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Chen, Z., Lin, Z. Prognosis of carcinoembryonic antigen (CEA) in stage I colorectal adenocarcinoma and development of a prediction model: a retrospective study based on the SEER database. J Cancer Res Clin Oncol 149, 16623–16633 (2023). https://doi.org/10.1007/s00432-023-05410-w
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DOI: https://doi.org/10.1007/s00432-023-05410-w