Preoperative Carcinoembryonic Antigen as a Poor Prognostic Factor in Stage I–III Colorectal Cancer After Curative-Intent Resection: A Propensity Score Matching Analysis
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Preoperative carcinoembryonic antigen (CEA) has yet to be used as a prognostic or adjuvant chemotherapy factor for colorectal cancer (CRC).
This retrospective cohort study included all stage I–III CRC patients with different preoperative serum CEA levels (≤ 5, 5–10, and > 10 ng/ml) at a single center between 1995 and 2010. Propensity score matching was performed in a 1:1 ratio between the two elevated CEA groups (5–10 ng/ml and > 10 ng/ml) and in a 1:2 ratio between the elevated and non-elevated groups (≤ 5 ng/ml), with a caliper of 0.05.
After exclusion and matching, 3857 patients had preoperative CEA levels ≤ 5 ng/ml, 1121 patients had CEA levels between 5 and 10 ng/ml, and 1121 patients had CEA levels > 10 ng/ml. Elevated preoperative CEA showed an increased risk of overall survival (5–10 ng/ml: hazard ratio [HR] 1.376; > 10 ng/ml: HR 1.523; both p < 0.001), cancer-specific survival (5–10 ng/ml: HR 1.404; > 10 ng/ml: HR 1.712; both p < 0.001), and recurrence free interval (5–10 ng/ml: HR 1.190; > 10 ng/ml: HR 1.468; both p < 0.05). Patients with negative lymph node staging (LNs) and CEA > 10 ng/ml, as well as those with positive LNs and CEA ≤ 5 ng/ml, showed similar overall survival (5-year survival: 72% vs. 69%; p = 0.542) and recurrence free intervals (19.9 vs. 21.72 months; p = 0.662).
A preoperative CEA level can be an independent prognostic factor for stage I–III CRC after curative resection. Patients with negative LNs and preoperative CEA level > 10 ng/ml should be considered for intensive follow-up or adjuvant chemotherapy.
WST and SHH had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: WST Acquisition of data: All authors. Drafting of the manuscript: WST and SHH. Critical revision of the manuscript for important intellectual content: WST and SHH. Statistical analysis: WST and SHH. Administrative, technical, or material support: WST. Study supervision: WST.
This work was supported by the Chang Gung Medical Research Fund (CORPG3F032).
Part of the data included in this study was presented as an oral presentation at the International Digestive Disease Forum held in Hong Kong, 9–10 June 2018.
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