Postoperative CEA and Other Non-traditional Risk Factors for Colon Cancer Recurrence: Findings from Swedish Population-Based Data

Excerpt

Adjuvant chemotherapy after curative resection of colon cancer is a critical intervention in our efforts to decrease cancer-specific mortality. Selection of the correct population for treatment is the subject of ongoing investigation and is particularly controversial in high-risk stage II patients. In this issue of Annals of Surgical Oncology, Osterman et al.1 use population-based data from Uppsala County in Sweden to investigate ‘emerging’ risk factors for colon cancer recurrence and mortality. ‘Emerging’ predictor variables [sidedness, pT3 and pT4 subclassification, lymph node (LN) ratio, tumor deposits, pre- and postoperative carcinoembryonic antigen (CEA) and C-reactive protein (CRP) levels] were distinguished from ‘classic’ risk factors (emergency surgery, pT and pN classification, low LN yield, malignancy grade, vascular and perineural invasion, and adjuvant treatment). Underpinning their study is the use of population-based data with granular detail, few missing data, and long duration (median 5.5 years) follow-up. Their cohort included 416 patients treated in Uppsala County in the modern era. In an adjusted analysis, after controlling for ‘classic’ risk factors, postoperative CEA > 5 ng/mL, right-sided tumors, and nodal subclassification stages (pN1a, pN1b, etc.) were associated with recurrence. …