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International Journal of Colorectal Disease

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01-06-2019 | Colon Cancer | Original Article

Preoperative serum carcinoembryonic antigen elevation in stage I colon cancer: improved risk of mortality in stage T1 than in stage T2

Authors: Feng Shen, Junhui Cui, Xia Hong, Feng Yu, Xiangdong Bao

Published in: International Journal of Colorectal Disease | Issue 6/2019

Abstract

Purpose

This study aimed to investigate the implications of preoperative serum carcinoembryonic antigen (CEA) elevation in cause-specific survival (CSS) of patients diagnosed with stage I (T1N0M0 and T2N0M0) colon cancer.

Methods

Eligible patients diagnosed with stage I colon cancer from the Surveillance, Epidemiology, and End Results (SEER) database from January 2004 to December 2010 were included in this respective and propensity score–matched (PSM) study. Some Cox proportional hazards models were constructed to identify prognostic factors associated with oncologic outcomes of colon cancer. Pearson’s chi-squared tests and Kaplan–Meier methods were performed.

Results

The median follow-up time of the whole cohort was 79 months. A total of 16,659 patients diagnosed with stage I colon cancer were identified from the SEER database. Multivariate Cox analyses showed that stage T1N0M0 in the context of serum CEA elevation (T1, CEA+) presented up to 158.4% increased risk of colon cancer-specific mortality compared with stage T1N0M0 in the context of normal serum CEA [hazard ratio (HR) = 2.584, 95% confidence interval (CI) = 2.167–3.082, P < 0.001]. After PSM, Kaplan–Meier survival curves of stage T1N0M0 colon cancer showed that 5-year CSS rates of normal and elevated CEA were 94.8% and 96.6% (P < 0.001).

Conclusions

This large population-based and propensity score–matched study with long follow-up time provides the first evidence that stage T1N0M0 colon cancer with the elevation of preoperative serum CEA would be a surrogate of aggressive tumor biology and predict poor prognosis. In addition, this subgroup of colon cancer might need to be paid more attention of clinicians.

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Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69(1):7–34CrossRefPubMed

Puppa G, Sonzogni AR, Pelosi G (2010) TNM staging system of colorectal carcinoma: a critical appraisal of challenging issues. Arch Pathol Lab Med 134(6):837PubMed

Liu Q, Luo D, Cai S, Li Q, Li X (2018) Real-world implications of nonbiological factors with staging, prognosis and clinical management in colon cancer. Cancers (Basel) 10(8)

Thirunavukarasu P, Sukumar S, Sathaiah M, Mahan M, Pragatheeshwar KD, Pingpank JF, Zeh H, Bartels CJ, Lee KKW, Bartlett DL (2011) C-stage in colon cancer: implications of carcinoembryonic antigen biomarker in staging, prognosis, and management. J Natl Cancer Inst 103(8):689–697CrossRefPubMed

Hammarström S (1999) The carcinoembryonic antigen (CEA) family: structures, suggested functions and expression in normal and malignant tissues ☆. Semin Cancer Biol 9(2):67–81CrossRefPubMed

Gold P, Freedman SO (1965) Demonstration of tumor-specific antigens in human colonic carcinomata by immunological tolerance and absorption techniques. J Exp Med 121:439–462CrossRefPubMedPubMedCentral

Chen VW, Hsieh MC, Charlton ME, Ruiz BA, Karlitz J, Altekruse SF et al (2014) Analysis of stage and clinical/prognostic factors for colon and rectal cancer from SEER registries: AJCC and collaborative stage data collection system Cancer 120(23):3793–806

Morrow PK (2012) Effect of very small tumor size on cancer-specific mortality in node-positive breast cancer. J Clin Oncol 23(1):32–33

Muralidhar V, Mahal BA, Nezolosky MD, Beard CJ, Feng FY, Martin NE et al (2016) Association between very small tumour size and increased cancer-specific mortality after radical prostatectomy in lymph node-positive prostate cancer. BJU international 118(2):279–85

10.

Muralidhar V, Nipp RD, Ryan DP, Hong TS, Nguyen PL, Wo JY (2016) Association between very small tumor size and increased cancer-specific mortality in node-positive colon cancer. Dis Colon Rectum 59(3):187–193CrossRefPubMed

11.

Jessup JM, Giavazzi R, Campbell D et al (1988) Growth potential of human colorectal carcinomas in nude mice: association with the preoperative serum concentration of carcinoembryonic antigen in patients. Cancer Res 48(6):1689–1692PubMed

12.

Tibbetts LM, Doremus CM, Tzanakakis GN et al (2015) Liver metastases with 10 human colon carcinoma cell lines in nude mice and association with carcinoembryonic antigen production. Cancer 71(2):315–321CrossRef

13.

Wanebo HJ, Rao B, Pinsky CM, Hoffman RG, Stearns M, Schwartz MK, Oettgen HF (1978) Preoperative carcinoembryonic antigen level as a prognostic indicator in colorectal cancer. N Engl J Med 299(9):448–451CrossRefPubMed

14.

Ozawa H, Kotake K, Hosaka M et al (2017) Incorporation of serum carcinoembryonic antigen levels into the prognostic grouping system of colon cancer. Int J Color Dis 32(6):1–9CrossRef

15.

Tarantino I, Warschkow R, Schmied BM, Güller U, Mieth M, Cerny T, Büchler MW, Ulrich A (2016) Predictive value of cea for survival in stage i rectal cancer: a population-based propensity score-matched analysis. J Gastrointest Surg 20(6):1213–1222CrossRefPubMed

16.

Thirunavukarasu P, Talati C, Munjal S, Attwood K, Edge SB, Francescutti V (2015) Effect of incorporation of pretreatment serum carcinoembryonic antigen levels into AJCC staging for colon cancer on 5-year survival. JAMA Surg 150(8):747–755CrossRefPubMed

17.

Liu Q, Lian P, Luo D, Cai S, Li Q, Li X (2018) Combination of carcinoembryonic antigen with the American Joint Committee on Cancer TNM staging system in rectal cancer: a real-world and large population-based study. Onco Targets Ther 11:5827–5834CrossRefPubMedPubMedCentral

18.

Huber S, Dietrich JF, Nagengast B, Moeller K (2017) Using propensity score matching to construct experimental stimuli. Behav Res Methods 49(3):1107–1119CrossRefPubMed

19.

Norton L, Massague J (2006) Is cancer a disease of self-seeding? Nat Med 12(8):875–878CrossRefPubMed

20.

Compton C, Fenoglio-Preiser CM, Pettigrew N et al (2015) American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer 88(7):1739–1757CrossRef

21.

Cai K, Mulatz K, Ard R et al (2014) Increased diacylglycerol kinase ζ expression in human metastatic colon cancer cells augments rho GTPase activity and contributes to enhanced invasion. BMC Cancer 14(1):1–10CrossRef

22.

David M, Naudin C, Letourneur M, Polrot M, Renoir JM, Lazar V, Dessen P, Roche S, Bertoglio J, Pierre J (2014) Suppressor of cytokine signaling 1 modulates invasion and metastatic potential of colorectal cancer cells. Mol Oncol 8(5):942–955CrossRefPubMedPubMedCentral

23.

Fritzmann J, Morkel M, Besser D, Budczies J, Kosel F, Brembeck FH, Stein U, Fichtner I, Schlag PM, Birchmeier W (2009) A colorectal cancer expression profile that includes transforming growth factor β inhibitor BamBi predicts metastatic potential. Gastroenterology 137(1):165–175CrossRefPubMed

24.

Piao C, Cai L, Qiu S, Jia L, Song W, du J (2015) Complement 5a enhances hepatic metastases of colon cancer via monocyte chemoattractant protein-1-mediated inflammatory cell infiltration. J Biol Chem 290(17):10667–10676CrossRefPubMedPubMedCentral

25.

Yan W, Wu K, Herman JG, Brock MV, Fuks F, Yang L, Zhu H, Li Y, Yang Y, Guo M (2013) Epigenetic regulation of DaCh1, a novel Wnt signaling component in colorectal cancer. Epigenetics 8(12):1373–1383CrossRefPubMedPubMedCentral

Title: Preoperative serum carcinoembryonic antigen elevation in stage I colon cancer: improved risk of mortality in stage T1 than in stage T2
Authors: Feng Shen
Junhui Cui
Xia Hong
Feng Yu
Xiangdong Bao
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Colon Cancer
Colon Cancer
Published in: International Journal of Colorectal Disease / Issue 6/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03298-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative serum carcinoembryonic antigen elevation in stage I colon cancer: improved risk of mortality in stage T1 than in stage T2

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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