Skip to main content
Top
Published in: Surgery Today 8/2023

27-01-2023 | Colorectal Cancer | Original Article

The T-CEA score: a useful prognostic indicator based on postoperative CEA and pathological T4 levels for patients with stage II–III colorectal cancer

Authors: Hiromichi Sonoda, Takeshi Yamada, Akihisa Matsuda, Yasuyuki Yokoyama, Ryo Ohta, Seiichi Shinji, Kazuhide Yonaga, Takuma Iwai, Kohki Takeda, Koji Ueda, Sho Kuriyama, Toshimitsu Miyasaka, Shintaro Kanaka, Nobuhiko Taniai, Hiroshi Yoshida

Published in: Surgery Today | Issue 8/2023

Login to get access

Abstract

Purpose

To investigate a prognostic score for stage II–III colorectal cancer (CRC) based on post-CEA and pT4 levels.

Methods

Two cohorts of stage II–III CRC patients who underwent curative surgery between 2011 and 2017 were included. The prognostic score (T-CEA score) was calculated as follows: T-CEA-0, post-CEA ≤ 5 ng/mL and pT1–3; T-CEA-1, post-CEA > 5 ng/mL or pT4; T-CEA-2, post-CEA > 5 ng/mL and pT4.

Results

The T-CEA scores of the 587 patients were as follows: T-CEA-0 (n = 436; 74%), T-CEA-1 (n = 129; 22%), and T-CEA-2 (n = 10; 2%). The 5-year recurrence-free survival (RFS) rates of the T-CEA-0, 1, and 2 groups were 80.3%, 54.8%, and 0%, respectively (P < 0.01), and the 5-year overall survival (OS) rates were 90.9%, 74.2%, and 0%, respectively (T-CEA-0 vs T-CEA-1: P < 0.01, T-CEA-1 vs T-CEA-2: P = 0.04). Multivariate analysis revealed that an elevated T-CEA score of 1 or 2 was a significant risk factor for poor RFS (HR: 2.89, P < 0.01) and OS (HR: 2.85, P < 0.01).

Conclusion

The T-CEA score is a reliable and convenient prognostic score for stage II–III CRC.
Literature
1.
go back to reference Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2000;25(1):1–42.CrossRef Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2000;25(1):1–42.CrossRef
2.
go back to reference Chiba S, Okayama H, Noda M, Saito K, Nakajima T, Aoto K, et al. Stromal VCAN expression as a potential prognostic biomarker for disease recurrence in stage II–III colon cancer. Carcinogenesis. 2016;37(9):878–87.CrossRef Chiba S, Okayama H, Noda M, Saito K, Nakajima T, Aoto K, et al. Stromal VCAN expression as a potential prognostic biomarker for disease recurrence in stage II–III colon cancer. Carcinogenesis. 2016;37(9):878–87.CrossRef
3.
go back to reference Ujiie D, Okayama H, Saito K, Ashizawa M, Min AKT, Endo E, et al. KRT17 as a prognostic biomarker for stage II colorectal cancer. Carcinogenesis. 2020;41(5):591–9.CrossRefPubMed Ujiie D, Okayama H, Saito K, Ashizawa M, Min AKT, Endo E, et al. KRT17 as a prognostic biomarker for stage II colorectal cancer. Carcinogenesis. 2020;41(5):591–9.CrossRefPubMed
4.
go back to reference Weiser MR, Landmann RG, Kattan MW, Gonen M, Shia J, Chou J, et al. Individualized prediction of colon cancer recurrence using a nomogram. J Clin Oncol. 2008;26:380–5.CrossRefPubMed Weiser MR, Landmann RG, Kattan MW, Gonen M, Shia J, Chou J, et al. Individualized prediction of colon cancer recurrence using a nomogram. J Clin Oncol. 2008;26:380–5.CrossRefPubMed
5.
go back to reference Weiser MR, Gönen M, Chou JF, Kattan MW, Schrag D. Predicting survival after curative colectomy for cancer: individualizing colon cancer staging. J Clin Oncol. 2011;29:4796–802.CrossRefPubMedPubMedCentral Weiser MR, Gönen M, Chou JF, Kattan MW, Schrag D. Predicting survival after curative colectomy for cancer: individualizing colon cancer staging. J Clin Oncol. 2011;29:4796–802.CrossRefPubMedPubMedCentral
6.
go back to reference Kanemitsu Y, Shida D, Tsukamoto S, Ueno H, Ishiguro M, Ishihara S, et al. Nomograms predicting survival and recurrence in colonic cancer in the era of complete mesocolic excision. BJS Open. 2019;3:539–48.CrossRefPubMedPubMedCentral Kanemitsu Y, Shida D, Tsukamoto S, Ueno H, Ishiguro M, Ishihara S, et al. Nomograms predicting survival and recurrence in colonic cancer in the era of complete mesocolic excision. BJS Open. 2019;3:539–48.CrossRefPubMedPubMedCentral
7.
go back to reference Sonoda H, Yamada T, Matsuda A, Ohta R, Shinji S, Yokoyama Y, et al. Elevated serum carcinoembryonic antigen level after curative surgery is a prognostic biomarker of stage II–III colorectal cancer. Eur J Surg Oncol. 2021;47(11):2880–7.CrossRef Sonoda H, Yamada T, Matsuda A, Ohta R, Shinji S, Yokoyama Y, et al. Elevated serum carcinoembryonic antigen level after curative surgery is a prognostic biomarker of stage II–III colorectal cancer. Eur J Surg Oncol. 2021;47(11):2880–7.CrossRef
8.
go back to reference Snaebjornsson P, Coupe VMH, Jonasson L, Meijer GA, van Grieken NC, Jonasson JG. pT4 stage II and III colon cancers carry the worst prognosis in a nationwide survival analysis. Shepherd’s local peritoneal involvement revisited. Int J Cancer. 2014;135:467–78.CrossRefPubMed Snaebjornsson P, Coupe VMH, Jonasson L, Meijer GA, van Grieken NC, Jonasson JG. pT4 stage II and III colon cancers carry the worst prognosis in a nationwide survival analysis. Shepherd’s local peritoneal involvement revisited. Int J Cancer. 2014;135:467–78.CrossRefPubMed
9.
go back to reference Park JH, Fuglestad AJ, Køstner AH, Oliwa A, Graham J, Horgan PG, et al. Systemic inflammation and outcome in 2295 patients with stage I-III colorectal cancer from Scotland and Norway: first results from the Scotscan colorectal cancer group. Ann Surg Oncol. 2020;27:2784–94.CrossRefPubMedPubMedCentral Park JH, Fuglestad AJ, Køstner AH, Oliwa A, Graham J, Horgan PG, et al. Systemic inflammation and outcome in 2295 patients with stage I-III colorectal cancer from Scotland and Norway: first results from the Scotscan colorectal cancer group. Ann Surg Oncol. 2020;27:2784–94.CrossRefPubMedPubMedCentral
10.
go back to reference Takagi K, Buettner S, Ijzermans JNM. Prognostic significance of the controlling nutritional status (CONUT) score in patients with colorectal cancer: a systematic review and meta-analysis. Int J Surg. 2020;78:91–6.CrossRef Takagi K, Buettner S, Ijzermans JNM. Prognostic significance of the controlling nutritional status (CONUT) score in patients with colorectal cancer: a systematic review and meta-analysis. Int J Surg. 2020;78:91–6.CrossRef
11.
go back to reference Song W, Wang K, Zhang RJ, Zou SB. Prognostic value of the lymphocyte monocyte ratio in patients with colorectal cancer: a meta-analysis. Medicine (Baltimore). 2016;95(49): e5540.CrossRefPubMed Song W, Wang K, Zhang RJ, Zou SB. Prognostic value of the lymphocyte monocyte ratio in patients with colorectal cancer: a meta-analysis. Medicine (Baltimore). 2016;95(49): e5540.CrossRefPubMed
12.
go back to reference Zhang J, Zhang HY, Li J, Shao XU, Zhang CX. The elevated NLR, PLR and PLT may predict the prognosis of patients with colorectal cancer: a systematic review and meta-analysis. Oncotarget. 2017;8(40):68837–46.CrossRefPubMedCentral Zhang J, Zhang HY, Li J, Shao XU, Zhang CX. The elevated NLR, PLR and PLT may predict the prognosis of patients with colorectal cancer: a systematic review and meta-analysis. Oncotarget. 2017;8(40):68837–46.CrossRefPubMedCentral
13.
go back to reference Okugawa Y, Toiyama Y, Yamamoto A, Shigemori T, Ide S, Kitajima T, et al. Lymphocyte-C-reactive protein ratio as promising new marker for predicting surgical and oncological outcomes in colorectal cancer. Ann Surg. 2020;272:342–51.CrossRefPubMed Okugawa Y, Toiyama Y, Yamamoto A, Shigemori T, Ide S, Kitajima T, et al. Lymphocyte-C-reactive protein ratio as promising new marker for predicting surgical and oncological outcomes in colorectal cancer. Ann Surg. 2020;272:342–51.CrossRefPubMed
14.
go back to reference Ito K, Hibi K, Ando H, Hidemura K, Yamazaki T, Akiyama S, et al. Usefulness of analytical CEA doubling time and half-life time for overlooked synchronous metastases in colorectal carcinoma. Jpn J Clin Oncol. 2002;32(2):54–8.CrossRefPubMed Ito K, Hibi K, Ando H, Hidemura K, Yamazaki T, Akiyama S, et al. Usefulness of analytical CEA doubling time and half-life time for overlooked synchronous metastases in colorectal carcinoma. Jpn J Clin Oncol. 2002;32(2):54–8.CrossRefPubMed
15.
go back to reference National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: colon cancer. Version 4.2020. Fort Washington: NCCN; 2020. National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: colon cancer. Version 4.2020. Fort Washington: NCCN; 2020.
16.
go back to reference Argiles G, Tabernero J, Labianca R, Hochhauser D, Salazar R, Iveson T, et al. Localized colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(10):1291–305.CrossRefPubMed Argiles G, Tabernero J, Labianca R, Hochhauser D, Salazar R, Iveson T, et al. Localized colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(10):1291–305.CrossRefPubMed
17.
go back to reference Gill S, Loprinzi CL, Sargent DJ, Thomé SD, Alberts SR, Haller DG, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol. 2004;22(10):1797–806.CrossRefPubMed Gill S, Loprinzi CL, Sargent DJ, Thomé SD, Alberts SR, Haller DG, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol. 2004;22(10):1797–806.CrossRefPubMed
18.
go back to reference Merkel S, Wein A, Günther K, Papadopoulos T, Hohenberger W, Hermanek P. High-risk groups of patients with Stage II colon carcinoma. Cancer. 2001;92:1435–43.CrossRefPubMed Merkel S, Wein A, Günther K, Papadopoulos T, Hohenberger W, Hermanek P. High-risk groups of patients with Stage II colon carcinoma. Cancer. 2001;92:1435–43.CrossRefPubMed
19.
go back to reference Gunderson LL, Jessup JM, Sargent DJ. Revised TN categorization for colon cancer based on national survival outcome data. J Clin Oncol. 2010;28(2):264–71.CrossRefPubMed Gunderson LL, Jessup JM, Sargent DJ. Revised TN categorization for colon cancer based on national survival outcome data. J Clin Oncol. 2010;28(2):264–71.CrossRefPubMed
20.
go back to reference Tie J, Wang Y, Tomasetti C, Li L, Springer S, Kinde I, et al. Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer. Sci Transl Med. 2016;8(346):346ra92.CrossRefPubMedPubMedCentral Tie J, Wang Y, Tomasetti C, Li L, Springer S, Kinde I, et al. Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer. Sci Transl Med. 2016;8(346):346ra92.CrossRefPubMedPubMedCentral
21.
go back to reference Tie J, Cohen JD, Wang Y, Christie M, Simons K, Lee M, et al. Circulating tumor DNA analyses as markers of recurrence risk and benefit of adjuvant therapy for stage III colon cancer. JAMA Oncol. 2019;5(12):1710–7.CrossRefPubMedPubMedCentral Tie J, Cohen JD, Wang Y, Christie M, Simons K, Lee M, et al. Circulating tumor DNA analyses as markers of recurrence risk and benefit of adjuvant therapy for stage III colon cancer. JAMA Oncol. 2019;5(12):1710–7.CrossRefPubMedPubMedCentral
22.
go back to reference Reinert T, Henriksen TV, Christensen E, Sharma S, Salari R, Sethi H, et al. Analysis of plasma cell-free DNA by ultradeep sequencing in patients with stages I to III colorectal cancer. JAMA Oncol. 2019;5(8):1124–31.CrossRefPubMedPubMedCentral Reinert T, Henriksen TV, Christensen E, Sharma S, Salari R, Sethi H, et al. Analysis of plasma cell-free DNA by ultradeep sequencing in patients with stages I to III colorectal cancer. JAMA Oncol. 2019;5(8):1124–31.CrossRefPubMedPubMedCentral
23.
go back to reference Iwai T, Yamada T, Takahashi G, Takeda K, Koizumi M, Shinji S, et al. Circulating cell-free long DNA fragments predict post-hepatectomy recurrence of colorectal liver metastases. Eur J Surg Oncol. 2020;46(1):108–14.CrossRefPubMed Iwai T, Yamada T, Takahashi G, Takeda K, Koizumi M, Shinji S, et al. Circulating cell-free long DNA fragments predict post-hepatectomy recurrence of colorectal liver metastases. Eur J Surg Oncol. 2020;46(1):108–14.CrossRefPubMed
24.
go back to reference Lonardi S, Montagut C, Pietrantonio F, Elez E, Sartore-Bianchi A, Tarazona N, et al. The PEGASUS trial: Post-surgical liquid biopsy-guided treatment of stage III and high-risk stage II colon cancer patients. J Clin Oncol. 2020;38(15):suppl.TPS124. Lonardi S, Montagut C, Pietrantonio F, Elez E, Sartore-Bianchi A, Tarazona N, et al. The PEGASUS trial: Post-surgical liquid biopsy-guided treatment of stage III and high-risk stage II colon cancer patients. J Clin Oncol. 2020;38(15):suppl.TPS124.
25.
go back to reference Shirasu H, Taniguchi H, Matsuhashi N, Kotaka M, Nakamura Y, Oki E, et al. A randomized, double-blind, phase III study comparing trifluridine/tipiracil hydrochloride therapy versus placebo in resected colorectal cancer patients who are positive for blood circulating tumor DNA after standard adjuvant therapy (EPOC 1905): ALTAIR trial in CIRCULATE-Japan (trial in progress). J Clin Oncol. 2022;40(4):suppl.TPS215.CrossRef Shirasu H, Taniguchi H, Matsuhashi N, Kotaka M, Nakamura Y, Oki E, et al. A randomized, double-blind, phase III study comparing trifluridine/tipiracil hydrochloride therapy versus placebo in resected colorectal cancer patients who are positive for blood circulating tumor DNA after standard adjuvant therapy (EPOC 1905): ALTAIR trial in CIRCULATE-Japan (trial in progress). J Clin Oncol. 2022;40(4):suppl.TPS215.CrossRef
26.
go back to reference Moretto R. Exploiting circulating tumour DNA to intensify the postoperative treatment resected colon cancer patients (ERASE-CRC). ClinicalTrials.gov NCT05062889. Moretto R. Exploiting circulating tumour DNA to intensify the postoperative treatment resected colon cancer patients (ERASE-CRC). ClinicalTrials.gov NCT05062889.
Metadata
Title
The T-CEA score: a useful prognostic indicator based on postoperative CEA and pathological T4 levels for patients with stage II–III colorectal cancer
Authors
Hiromichi Sonoda
Takeshi Yamada
Akihisa Matsuda
Yasuyuki Yokoyama
Ryo Ohta
Seiichi Shinji
Kazuhide Yonaga
Takuma Iwai
Kohki Takeda
Koji Ueda
Sho Kuriyama
Toshimitsu Miyasaka
Shintaro Kanaka
Nobuhiko Taniai
Hiroshi Yoshida
Publication date
27-01-2023
Publisher
Springer Nature Singapore
Published in
Surgery Today / Issue 8/2023
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-023-02644-6

Other articles of this Issue 8/2023

Surgery Today 8/2023 Go to the issue