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World Journal of Surgery
Published in: World Journal of Surgery 1/2013

01-01-2013

Elevated Preoperative Carcinoembryonic Antigen (CEA) and Ki67 Is Predictor of Decreased Survival in IIA Stage Colon Cancer

Authors: Yifan Peng, Lin Wang, Jin Gu

Published in: World Journal of Surgery | Issue 1/2013

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Abstract

Background

The present study was designed to investigate the prognostic factors of stage IIA (pT3N0M0) colon cancer.

Methods

We retrospectively reviewed consecutive patients with stage IIA colon cancer treated with curative surgery alone from January 2004 to June 2008 in Peking University Cancer Hospital. Patient demographics, and clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were carried out to identify prognostic factors associated with 3-year disease-free survival (DFS).

Results

For the 84 valid cases reviewed in this study, the 3-year DFS was 88.1 %. That for a group with elevated CEA was 77.1 % and for a group with a normal CEA level, it was 95.9 %, with statistical difference (p = 0.007). Multivariate analysis demonstrated that CEA level (p = 0.012, OR = 8.013, 1.573–40.817), expression of Ki67 (p = 0.099, OR = 3.298, 0.799–3.610), male gender (p = 0.024, OR = 7.212, 1.293–40.237), and anemia (p = 0.011, OR = 6.461, 1.537–27.151) were the independent prognostic factors for 3-year DFS. Stratified analysis revealed that an elevated CEA level combined with high expression of Ki67 was associated with poorer prognosis (3-year DFS 70 %).

Conclusions

An elevated preoperative serum level of CEA and high expression of Ki67 in tumor tissue were predictors of poor prognosis for patients with stage IIA colon cancer. These patients should therefore be considered candidates for receiving intensive surveillance. Future clinical trials using multicenter patient cohorts should be prospectively performed to evaluate whether these high-risk patients could benefit from adjuvant chemotherapy to improve prognosis.
Literature
1.
Edge SB, Byrd DR (2010) AJCC cancer staging manual, 7th edn. Springer, New York 648
2.
3.
Sato H, Maeda K, Koide Y (2011) Prognostic factor of stage II colon cancer. Nihon Rinsho 69(Suppl 3):189–192PubMed
4.
Betge J, Langner C, Rehak P (2011) Adjuvant chemotherapy improves survival in patients with American Joint Committee on Cancer stage II colon cancer. Cancer 118:2184PubMedCrossRef
5.
Kopetz S, Freitas D, Calabrich AFC et al (2008) Adjuvant chemotherapy for stage II colon cancer. Oncology (Williston Park) 22:260–270 discussion 270, 273, 275
6.
Martin RC (2006) Adjuvant treatment of stage II colon cancer: is there a true no-chemotherapy group? Ann Surg Oncol 13:766–767PubMedCrossRef
7.
Wille-Jorgensen P (2005) No clear evidence for adjuvant therapy in people with stage II colon cancer. Cancer Treat Rev 31:147–150PubMedCrossRef
8.
Benson AB 3rd, Schrag D, Somerfield MR et al (2004) American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22:3408–3419PubMedCrossRef
9.
O’Connor ES, Greenblatt DY, LoConte NK et al (2011) Adjuvant chemotherapy for stage II colon cancer with poor prognostic features. J Clin Oncol 29:3381–3388PubMedCrossRef
10.
Ochs AM, Wong L, Kakani V et al (2004) Expression of vascular endothelial growth factor and HER2/neu in stage II colon cancer and correlation with survival. Clin Colorectal Cancer 4:262–267PubMedCrossRef
11.
Grossman SR, Lyle S, Resnick MB et al (2007) p66 Shc tumor levels show a strong prognostic correlation with disease outcome in stage IIA colon cancer. Clin Cancer Res 13:5798–5804
12.
Hohenberger W, Weber K, Matzel K et al (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis 11:354–364 Discussion 364–365PubMedCrossRef
13.
Jakob C, Liersch T, Meyer W et al (2008) Predictive value of Ki67 and p53 in locally advanced rectal cancer: correlation with thymidylate synthase and histopathological tumor regression after neoadjuvant 5-FU-based chemoradiotherapy. World J Gastroenterol 14:1060–1066PubMedCrossRef
14.
Figueredo A, Charette ML, Maroun J et al (2004) Adjuvant therapy for stage II colon cancer: a systematic review from the Cancer Care Ontario Program in evidence-based care’s gastrointestinal cancer disease site group. J Clin Oncol 22:3395–3407PubMedCrossRef
15.
Gill S, Loprinzi CL, Sargent DJ et al (2004) Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 22:1797–1806PubMedCrossRef
16.
Ogata Y, Murakami H, Sasatomi T et al (2009) Elevated preoperative serum carcinoembrionic antigen level may be an effective indicator for needing adjuvant chemotherapy after potentially curative resection of stage II colon cancer. J Surg Oncol 99:65–70PubMedCrossRef
17.
Burdy G, Panes Y, Alves A et al (2001) Identifying patients with T3–T4 node-negative colon cancer at high risk of recurrence. Dis Colon Rectum 44:1682–1688PubMedCrossRef
18.
Compton CC, Fielding LP, Burghart LJ et al (2000) Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124:979–994PubMed
19.
Poincloux L, Durando X, Seitz JF et al (2009) Loss of Bcl-2 expression in colon cancer: a prognostic factor for recurrence in stage II colon cancer. Surg Oncol 18:357–365PubMedCrossRef
20.
Schetter AJ, Leung SY, Sohn JJ et al (2008) MicroRNA expression profiles associated with prognosis and therapeutic outcome in colon adenocarcinoma. JAMA 299:425–436PubMedCrossRef
21.
Bates RC, Bellovin DI, Brown C et al (2005) Transcriptional activation of integrin beta6 during the epithelial-mesenchymal transition defines a novel prognostic indicator of aggressive colon carcinoma. J Clin Invest 115:339–347PubMed
22.
Nakamura T, Mitomi H, Kanazawa H et al (2008) Tumor budding as an index to identify high-risk patients with stage II colon cancer. Dis Colon Rectum 51:568–572
23.
Logan-Collins JM, Lowy AM, Robinson-Smith TM et al (2008) VEGF expression predicts survival in patients with peritoneal surface metastases from mucinous adenocarcinoma of the appendix and colon. Ann Surg Oncol 15:738–744PubMedCrossRef
24.
AJCC Cancer Staging Handbook (2010), AJCC cancer staging handbook. 7th edn. New York, Springer
25.
Burgess RE (1986) Carcinoembryonic antigen. Ann Intern Med 104:888 (letter to the editor)
26.
Compton C, Fenoglio-Preiser CM, Pettigrew N et al (2000) American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer 88:1739–1757PubMedCrossRef
27.
Locker GY, Hamilton S, Harris J et al (2006) ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol 24:5313–5327PubMedCrossRef
28.
QUASAR Collaborative Group (2000) Comparison of flourouracil with additional levamisole, higher-dose folinic acid, or both, as adjuvant chemotherapy for colorectal cancer: a randomised trial. Lancet 355(9215):1588–1596CrossRef
29.
Andre T, Boni C, Navarro M et al (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 27:3109–3116PubMedCrossRef
30.
Van Cutsem E, Labianca R, Bodoky G et al (2009) Randomized phase III trial comparing biweekly infusional fluorouracil/leucovorin alone or with irinotecan in the adjuvant treatment of stage III colon cancer: PETACC-3. J Clin Oncol 27:3117–3125PubMedCrossRef
31.
32.
Sener SF, Imperato JP, Chmiel J et al (1989) The use of cancer registry data to study preoperative carcinoembryonic antigen level as an indicator of survival in colorectal cancer. CA Cancer J Clin 39:50–57PubMedCrossRef
33.
Yeh CY, Hsieh PS, Chiang JM et al (2011) Preoperative carcinoembryonic antigen elevation in colorectal cancer. Hepatogastroenterology 58:1171–1176PubMedCrossRef
34.
Yang XQ, Chen C, Wang F-B et al (2011) Preoperative serum carcinoembryonic antigen, carbohydrate antigen19-9 and carbohydrate antigen 125 as prognostic factors for recurrence-free survival in colorectal cancer. Asian Pac J Cancer Prev 12:1251–1256PubMed
35.
Huh JW, Oh BR, Kim HR et al (2010) Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer. J Surg Oncol 101:396–400PubMed
36.
Sun LC, Chu KS, Cheng SC et al (2009) Preoperative serum carcinoembryonic antigen, albumin and age are supplementary to UICC staging systems in predicting survival for colorectal cancer patients undergoing surgical treatment. BMC Cancer 9:288PubMedCrossRef
37.
Takagawa R, Fujii S, Mitsuoyshi O et al (2008) Preoperative serum carcinoembryonic antigen level as a predictive factor of recurrence after curative resection of colorectal cancer. Ann Surg Oncol 15:3433–3439PubMedCrossRef
38.
Roselli M, Guadagni F, Martini F et al (2003) Association between serum carcinoembryonic antigen and endothelial cell adhesion molecules in colorectal cancer. Oncology 65:132–138PubMedCrossRef
39.
Tabuchi Y, Deguchi H, Imanishi K et al (1987) Comparison of carcinoembryonic antigen levels between portal and peripheral blood in patients with colorectal cancer. Correlation with histopathologic variables. Cancer 59:1283–1288PubMedCrossRef
40.
Padilla D, Cubo T, Villarejo P et al (2007) Molecular profile of node-negative colorectal cancer of poor prognosis using immunohistochemical determination of p53, Ki67, VEGF, and metalloproteinase-9. Rev Esp Enferm Dig 99:424–425PubMedCrossRef
41.
Allegra CJ, Palk S, Colangelo LH et al (2003) Prognostic value of thymidylate synthase, Ki-67, and p53 in patients with Dukes’ B and C colon cancer: A National Cancer Institute-National Surgical Adjuvant Breast and Bowel Project collaborative study. J Clin Oncol 21:241–250PubMedCrossRef
42.
Ishida H, Miwa H, Tatsuta M et al (2004) Ki-67 and CEA expression as prognostic markers in Dukes’ C colorectal cancer. Cancer Lett 207:109–115PubMedCrossRef
43.
Visco V, Belleudi F, Marchese C et al (2004) Differential response to keratinocyte growth factor receptor and epidermal growth factor receptor ligands of proliferating and differentiating intestinal epithelial cells. J Cell Physiol 200:31–44PubMedCrossRef
44.
Graziano F, Cascinu S (2003) Prognostic molecular markers for planning adjuvant chemotherapy trials in Dukes’ B colorectal cancer patients: how much evidence is enough? Ann Oncol 14:1026–1038PubMedCrossRef
45.
Maksimovic S (2005) Laboratory-immunology indicators according as prognostic factors of patients with colon and rectum cancer. Med Arh 59:7–10PubMed
46.
Sato H, Maeda K, Sugihara K et al (2011) High-risk stage II colon cancer after curative resection. J Surg Oncol 104:45–52PubMedCrossRef
47.
Prandi M, Lionetto R, Bini A et al (2002) Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg 235:458–463PubMedCrossRef
48.
Nanni O, Volpi A, Frassineti GL et al (2002) Role of biological markers in the clinical outcome of colon cancer. Br J Cancer 87:868–875PubMedCrossRef
49.
Caro JJ, Salas M, Ward A et al (2001) Anemia as an independent prognostic factor for survival in patients with cancer: a system[at]ic, quantitative review. Cancer 91:2214–2221PubMedCrossRef
Metadata
Title
Elevated Preoperative Carcinoembryonic Antigen (CEA) and Ki67 Is Predictor of Decreased Survival in IIA Stage Colon Cancer
Authors
Yifan Peng
Lin Wang
Jin Gu
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 1/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-012-1814-7

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