Published in:
01-01-2015 | Original Article
Clinicopathologic features and oncologic outcomes of colorectal cancer patients with extremely high carcinoembryonic antigen
Published in: International Journal of Colorectal Disease | Issue 1/2015
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Purpose
The aim of this study is to investigate the clinicopathologic features and oncologic outcomes of colorectal cancer patients with extremely elevated (≥50 ng/mL) preoperative serum carcinoembryonic antigen (CEA) levels.
Methods
We enrolled 756 primary colorectal cancer patients with elevated preoperative CEA levels (≥5 ng/mL) who underwent surgery between 2004 and 2010 and compared clinicopathologic features according to preoperative CEA levels of 5–50 ng/mL (n = 676) and ≥50 ng/mL (n = 80). The impact of extremely elevated CEA on overall survival (OS) and disease-free survival (DFS) was analyzed using Kaplan-Meier analysis and the Cox proportional hazards model.
Results
The median follow-up period was 43 months (range, 0–121). Patients with preoperative CEA ≥50 ng/mL demonstrated higher rates of advanced T stage (97.3 vs. 88.6 %, p = 0.016) and distant metastasis (33.8 vs. 17.9 %, p = 0.002), but not lymph node metastasis (54.1 vs. 52.2 %, p = 0.807). The 5-year OS rate was 69.1 %, and the 3-year DFS rate of curatively resected patients (n = 641; 84.8 %) was 68.9 %. In multivariate analysis, preoperative CEA ≥50 ng/mL, as well as age, N stage, vascular invasion, perineural invasion, post/preoperative CEA ratio ≥0.32, and palliative resection, was an independent predictor of OS. However, for patients treated with curative resection, preoperative CEA ≥50 ng/mL was not significantly associated with DFS or OS (p = 0.053 and 0.157, respectively).
Conclusions
Colorectal cancer patients with extremely elevated (≥50 ng/mL) preoperative CEA had advanced disease more frequently but comparable oncologic outcomes if curative resection was performed.