Carcinoembryonic antigen (CEA) level, CEA ratio, and treatment outcome of rectal cancer patients receiving pre-operative chemoradiation and surgery.

Abstract

BACKGROUND:

To investigate serum carcinoembryonic antigen (CEA) as a prognostic factor for rectal cancer patients receiving pre-operative chemoradiotherapy (CRT).

METHODS:

Between 2000 and 2009, 138 patients with advanced rectal cancer receiving CRT before surgery at our hospital were retrospectively classified into 3 groups: pre-CRT CEA <6 ng/ml (group L; n = 87); pre-CRT CEA ≥ 6 ng/ml and post-CRT CEA <6 ng/ml (group H-L; n = 32); and both pre- and post-CRT CEA ≥ 6 ng/ml (group H-H; n = 19). CEA ratio (defined as post-CRT CEA divided by pre-CRT CEA), post-CRT CEA level and other factors were reviewed for prediction of pathologic complete response (pCR).

RESULTS:

Five-year disease-free survival (DFS) was better in groups L (69.0%) and H-L (74.5%) than in group H-H (44.9%) (p = 0.024). Pathologic complete response was observed in 19.5%, 21.9% and 5.3% of groups L, H-L and H-H respectively (p = 0.281). Multivariate analysis showed that ypN stage and pCR were independent prognostic factors for DFS and that post-CRT CEA level was independently predictive of pCR. As a whole, post-CRT CEA <2.61 ng/ml predicted pCR (sensitivity 76.0%; specificity 58.4%). For those with pre-CRT CEA ≥6 ng/ml, post-CRT CEA and CEA ratio both predicted pCR (sensitivity 87.5%, specificity 76.7%).

CONCLUSIONS:

In patients with pre-CRT serum CEA ≥6 ng/ml, those with "normalized" CEA levels after CRT may have similar DFS to those with "normal" (<6 ng/ml) pre-CRT values. Post-CRT CEA level is a predictor for pCR, especially in those with pre-CRT CEA ≥6 ng/ml.

• Authors: Kai-Lin Yang, Shung-Haur Yang, Wen-Yih Liang, Ying-Ju Kuo, Jen-Kou Lin, Tzu-Chen Lin, Wei-Shone Chen, Jeng-Kae Jiang, Huann-Sheng Wang, Shih-Ching Chang, Lee-Shing Chu, Ling-Wei Wang
• Journal: Radiation oncology (London, England) (Radiat Oncol) Vol. 8 Pg. 43 (Mar 01 2013) ISSN: 1748-717X [Electronic] England
• PMID: 23452434 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Biomarkers, Tumor
• Carcinoembryonic Antigen
• Tegafur
• Uracil
• Leucovorin

Topics

• Adenocarcinoma (blood, mortality, therapy)
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Biomarkers, Tumor (blood)
• Carcinoembryonic Antigen (blood)
• Chemoradiotherapy
• Female
• Follow-Up Studies
• Humans
• Leucovorin (administration & dosage)
• Male
• Middle Aged
• Neoplasm Staging
• Preoperative Care
• Prognosis
• Rectal Neoplasms (blood, mortality, therapy)
• Remission Induction
• Retrospective Studies
• Survival Rate
• Tegafur (administration & dosage)
• Uracil (administration & dosage)