Annals of Surgical Oncology

, Volume 23, Issue 5, pp 1554–1561 | Cite as

Evaluating the Prognostic Role of Elevated Preoperative Carcinoembryonic Antigen Levels in Colon Cancer Patients: Results from the National Cancer Database

  • Adan Z. Becerra
  • Christian P. Probst
  • Mohamedtaki A. Tejani
  • Christopher T. Aquina
  • Maynor G. González
  • Bradley J. Hensley
  • Katia Noyes
  • John R. Monson
  • Fergal J. Fleming
Colorectal Cancer



Carcinoembryonic antigen (CEA) is a reliable tumor marker for the management and surveillance of colon cancer. However, limitations in previous studies have made it difficult to elucidate whether CEA should be established as a prognostic indicator. This study examines the association between elevated preoperative CEA levels and overall survival in colon cancer patients using a national population-based registry.


Stage I–III colon cancer patients were identified from the 2004–2006 National Cancer Database. A multivariable Cox proportional hazards model was used to estimate the association between elevated CEA levels and overall survival after controlling for important patient, hospital, and tumor characteristics. A Monte Carlo Markov Chain was used to impute the large degree of missing CEA data. All models controlled for the propensity score in order to account for selection bias.


A total of 137,381 patients met the inclusion criteria. Overall, 34 % of patients had an elevated CEA level and 66 % had a normal CEA level, with a median survival of 70 and 100 months, respectively. Patients with an elevated CEA level had a 62 % increase in the hazard of death (HR 1.62, 95 % CI 1.53–1.74) compared with patients with a normal CEA level.


Preoperative CEA was an independent predictor of overall survival across all stages. The results support recommendations to include CEA levels as another high-risk feature that clinicians can use to counsel patients on adjuvant chemotherapy, especially for stage II patients.


Propensity Score Colon Cancer Patient National Cancer Database Signet Ring Cell Adenocarcinoma High Pathological Stage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Financial Support

Adan Z. Becerra, Christian P. Probst, Mohamedtaki A. Tejani, Christopher T. Aquina, Maynor G. González, Bradley J. Hensley, Katia Noyes, John R. Monson, and Fergal J. Fleming have no research support or other disclosures to declare.


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Adan Z. Becerra
    • 1
  • Christian P. Probst
    • 1
  • Mohamedtaki A. Tejani
    • 2
  • Christopher T. Aquina
    • 1
  • Maynor G. González
    • 1
  • Bradley J. Hensley
    • 1
  • Katia Noyes
    • 1
  • John R. Monson
    • 1
  • Fergal J. Fleming
    • 1
  1. 1.Department of Surgery, Surgical Health Outcomes and Research EnterpriseUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Department of Medicine, Hematology/OncologyUniversity of Rochester Medical CenterRochesterUSA

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