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Predictive Value of CEA for Survival in Stage I Rectal Cancer: a Population-Based Propensity Score-Matched Analysis

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The aim of the study was to assess whether preoperative carcinoembryonic antigen (CEA) level is an independent predictor of overall- and cancer-specific survival in stage I rectal cancer.

Methods

Stage I rectal cancer patients were identified in the Surveillance, Epidemiology, and End Results database between 2004 and 2011. The impact of an elevated preoperative CEA level (C1-stage) compared with a normal CEA level (C0-stage) on overall and cancer-specific survival was assessed using risk-adjusted Cox proportional hazard regression models and propensity score methods.

Results

Overall, 1932 stage I rectal cancer patients were included, of which 328 (17 %) patients had C1-stage. The 5-year overall and cancer-specific survival for patients with C0-stage were 85.7 % (95 % CI 83.2–88.2 %) and 94.7 % (95 % CI 93.1–96.3 %), versus 76.8 % (95 % CI 70.9–83.1 %) and 88.1 % (95 % CI 83.3–93.2 %) for patients with C1-stage (P < 0.001 and P = 0.001). The negative impact of C1-stage on overall and cancer-specific survival was confirmed by risk-adjusted Cox proportional hazard regression analysis (hazard ratio [HR] = 1.57, 95 % CI = 1.15–2.16, P = 0.007 and 2.04, 95 % CI = 1.25–3.33, P = 0.006), and after propensity score matching (overall survival [OS]: HR = 1.46, 95 % CI = 1.02–2.08, P = 0.044 and cancer-specific survival [CSS]: HR = 3.28, 95 % CI = 1.78–6.03, P < 0.001).

Conclusion

This is the first population-based investigation of a large cohort of exclusively stage I rectal cancer patients providing compelling evidence that elevated preoperative CEA level is a strong predictor of worse overall and cancer-specific survival.

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Acknowledgments

The authors thank the National Cancer Institute for providing the Surveillance, Epidemiology, and End Results (SEER) data set.

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Authors and Affiliations

  1. Department of General, Abdominal and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Ignazio Tarantino, Markus Mieth, Markus W. Büchler & Alexis Ulrich

  2. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Rene Warschkow & Bruno M. Schmied

  3. Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany

    Rene Warschkow

  4. Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Ulrich Güller & Thomas Cerny

  5. University Clinics for Visceral Surgery and Medicine, University Hospital Berne, 3010, Berne, Switzerland

    Ulrich Güller

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  1. Ignazio Tarantino
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Correspondence to Alexis Ulrich.

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The authors declare that they have no competing interests.

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Tarantino, I., Warschkow, R., Schmied, B.M. et al. Predictive Value of CEA for Survival in Stage I Rectal Cancer: a Population-Based Propensity Score-Matched Analysis. J Gastrointest Surg 20, 1213–1222 (2016). https://doi.org/10.1007/s11605-016-3137-8

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  • DOI: https://doi.org/10.1007/s11605-016-3137-8

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