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Prothrombin time (PT) and CEA as prognostic predictive biomarkers for postoperative recurrence after curative resection in patients with stage I–III colorectal cancer: a retrospective cohort study

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Abstract

There are no ideal biomarkers including the TNM stage that can accurately predict the recurrence of colorectal cancer (CRC) and the benefit of chemotherapy for stage II patients. Here, 451 CRC patients were divided into three groups according to preoperative levels of prothrombin time (PT) and CEA to analyze the value of these indexes in predicting postoperative recurrence in different TNM stages. Preoperatively elevated levels of PT and CEA were significantly associated with a high 5-year cumulative recurrence rate (CRR) and short recurrence-free survival (RFS). According to PT and CEA levels, the 5-year CRR and RFS differed significantly among the High-risk (PT ≥ 12.65 s and CEA ≥ 10.175 ng/ml), Middle-risk (PT ≥ 12.65 s or CEA ≥ 10.175 ng/ml), and Low-risk (PT < 12.65 s and CEA < 10.175 ng/ml) groups (p < 0.001). In the same TNM stage, the 5-year CRR of the High-risk group was significantly higher and the RFS was markedly shorter than those in the Low-risk and even those in stage III (p < 0.001). In the subgroup of early stage (stage I and II), the 5-year CRR of the High-risk group was significantly higher and the RFS was significantly shorter than those in stage IIIA and IIIB (p < 0.001), which is similar to IIIC. In conclusion, preoperatively elevated levels of serum PT and CEA were reliable predictors of postoperative high-risk recurrence in CRC and combined with TNM stage precisely identify postoperative recurrence CRC patients in stage I–III and the benefit of adjuvant chemotherapy for patients with stage II CRC.

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Funding

This work was supported by the National Natural Science Foundation of China (81502039), the Natural Science Foundation of Fujian Province (2016J01616 and 2020J011214), the Health and Family Planning Commission of Fujian Province for Youth Research Project (2015-2-49), the Scientific Research Foundation for Returned Scholars from Ministry of Human Resources and Social Security (2015142), and the Digestive Center of Xiamen University Foundation.

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Author notes

  1. Lulu Ma, Wenya Li and Ningquan Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China

    Lulu Ma, Wenya Li, Ningquan Liu, Zhijie Ding, Jianchun Cai & Yiyao Zhang

  2. Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China

    Lulu Ma, Wenya Li, Ningquan Liu, Zhijie Ding, Jianchun Cai & Yiyao Zhang

  3. Medical College of Xiamen University, Xiamen, 361000, China

    Lulu Ma, Wenya Li, Ningquan Liu, Zhijie Ding, Jianchun Cai & Yiyao Zhang

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Contributions

All authors listed had made a substantial contribution to the work. YYZ and JCC contributed to project design, data analysis, and manuscript writing. MLL, WYL, ZJD, and NQL were responsible for clinical data collection and follow-up. All authors had discussed the results, reviewed the manuscript, and approved the final manuscript.

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Correspondence to Yiyao Zhang.

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This study was approved by the Ethics Review Committee of Zhongshan Hospital of Xiamen University and the informed consent of the patients was obtained.

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We have performed an observational retrospective study in which we have not modified the usual treatment of this disease, so disclosures about human research (in the sense of a clinical trial) are not applicable. No animal has been involved in this study.

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Ma, L., Li, W., Liu, N. et al. Prothrombin time (PT) and CEA as prognostic predictive biomarkers for postoperative recurrence after curative resection in patients with stage I–III colorectal cancer: a retrospective cohort study. Updates Surg 74, 999–1009 (2022). https://doi.org/10.1007/s13304-022-01268-8

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