Evaluating the Prognostic Role of Elevated Preoperative Carcinoembryonic Antigen Levels in Colon Cancer Patients: Results from the National Cancer Database
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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.
KeywordsPropensity Score Colon Cancer Patient National Cancer Database Signet Ring Cell Adenocarcinoma High Pathological Stage
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.
- 2.American Cancer Society. Colorectal cancer facts & figures 2011–2013. Atlanta: American Cancer Society; 2011.Google Scholar
- 24.American College of Surgeons. Facility Oncology Registry Data Standards: December 18, 2012. Available at: https://www.facs.org/quality-programs/cancer/ncdb/registrymanuals/cocmanuals/fordsmanual. Accessed 2 June 2015.
- 26.Little RJA, Rubin DB. Statistical analysis with missing data. New York: Wiley & Sons; 1987.Google Scholar
- 27.Gilks WR, Richardson S, Spiegelhalter DJ (eds.) Markov Chain Monte Carlo in practice. London: Chapman & Hall; 1996.Google Scholar
- 31.National Comprehensive Cancer Network. http://www.nccn.org (2015). Accessed 16 Jan 2015.
- 35.Fakih MG, Padmanabhan A. CEA monitoring in colorectal cancer. What you should know. Oncology (Williston Park). 2006;20(6):579–87.Google Scholar
- 37.Le Voyer TE, Sigurdson ER, Hanlon AL, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089.Google Scholar