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International Journal of Colorectal Disease

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01-04-2013 | Original Article

Preoperative elevation of carcinoembryonic antigen predicts poor tumor response and frequent distant recurrence for patients with rectal cancer who receive preoperative chemoradiotherapy and total mesorectal excision: a multi-institutional analysis in an Asian population

Authors: Jong Hoon Lee, Sung Hwan Kim, Hong Seok Jang, Hyuk Jun Chung, Seong Taek Oh, Doo Seok Lee, Jun-Gi Kim

Published in: International Journal of Colorectal Disease | Issue 4/2013

Abstract

Purpose

This study was conducted to evaluate the significance of carcinoembryonic antigen (CEA) level as a predictor for tumor response to chemoradiotherapy (CRT) and a prognosticator for survival in Asian patients with advanced rectal cancer.

Materials and methods

We enrolled 345 patients with primary rectal cancer who had undergone preoperative CRT and total mesorectal excision. We analyzed clinicopathological factors that could be associated with pathologically complete response (ypCR) and disease-free survival (DFS).

Results

A cutoff level of 5 ng/mL (p = 0.002) for CEA was found to be significant for prediction of ypCR. Increased CEA level (p = 0.025) was a significant negative predictor of ypCR after CRT in patients with rectal cancer. The 5-year DFS rate was significantly higher in the CEA ≤5-ng/mL group than in the CEA >5-ng/mL group (73.2 vs. 60.9 %, p = 0.002). This is mainly due to the higher chance of distant recurrence (p = 0.013), not locoregional recurrence (p = 0.732), in the CEA >5-ng/mL group.

Conclusions

Elevated CEA (>5 ng/mL) is a negative predictor of ypCR and has a negative impact on DFS in Asian rectal cancer patients who underwent preoperative CRT and surgery due to an increased chance of distant recurrences.

Jung KW, Park S, Kong HJ et al (2011) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2009. Cancer Res Treat 44:11–24

Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRef

Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123PubMedCrossRef

Lee JH, Kim SH, Kim JG et al (2011) Preoperative chemoradiotherapy (CRT) followed by laparoscopic surgery for rectal cancer: predictors of the tumor response and the long-term oncologic outcomes. Int J Radiat Oncol Biol Phys 81:431–438PubMedCrossRef

Rodel C, Martus P, Papadoupolos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696PubMedCrossRef

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

Das P, Skibber JM, Rodriguez-Bigas MA et al (2007) Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer 109:1750–1755PubMedCrossRef

Yoon SM, Kim DY, Kim TH et al (2007) Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 69:1167–1172PubMedCrossRef

Giralt J, Eraso A, Armengol M et al (2002) Epidermal growth factor receptor is a predictor of tumor response in locally advanced rectal cancer patients treated with preoperative radiotherapy. Int J Radiat Oncol Biol Phys 54:1460–1465PubMedCrossRef

10.

Zlobec I, Steele R, Compton CC (2005) VEGF as a predictive marker of rectal tumor response to preoperative radiotherapy. Cancer 104:2517–2521PubMedCrossRef

11.

Chang HJ, Jung KH, Kim DY et al (2005) Bax, a predictive marker for therapeutic response to preoperative chemoradiotherapy in patients with rectal carcinoma. Hum Pathol 36:364–371PubMedCrossRef

12.

Edge SB, Byrd DR, Compton CC et al (2009) AJCC cancer staging manual, 7th edn. Springer, New York

13.

Park YA, Sohn SK, Seong J et al (2006) Serum CEA as a predictor for the response to preoperative chemoradiation in rectal cancer. J Surg Oncol 93:145–150PubMedCrossRef

14.

Kim YW, Kim NK, Min BS et al (2009) Factors associated with anastomotic recurrence after total mesorectal excision in rectal cancer patients. J Surg Oncol 99:58–64PubMedCrossRef

15.

Park JW, Lim SB, Kim DY et al (2009) Carcinoembryonic antigen as a predictor of pathologic response and a prognostic factor in locally advanced rectal cancer patients treated with preoperative chemoradiotherapy and surgery. Int J Radiat Oncol Biol Phys 74:810–817PubMedCrossRef

16.

Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312PubMedCrossRef

17.

Gérard JP, Azria D, Gourgou-Bourgade S et al (2010) Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 28:1638–1644PubMedCrossRef

18.

Lee JH, Kim DY, Nam TK et al (2012) Long-term follow-up of preoperative pelvic radiation therapy and concomitant boost irradiation in locally advanced rectal cancer patients: a multi-institutional phase II study (KROG 04-01). Int J Radiat Oncol Biol Phys 84:955–961

19.

Kim CJ, Yeatman TJ, Coppola D et al (2001) Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg 234:352–358PubMedCrossRef

20.

Schell SR, Zlotecki RA, Mendenhall WM et al (2002) Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy. J Am Coll Surg 194:584–590PubMedCrossRef

21.

Lee JH, Jang HS, Kim JG et al (2012) Lymphovascular invasion is a significant prognosticator in rectal cancer patients who receive pre-operative chemoradiotherapy followed by total mesorectal excision. Ann Surg Oncol 19:1213–1221PubMedCrossRef

22.

Dworak O, Keilholz L, Hoffmann A (1997) Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 12:19–23PubMedCrossRef

Title: Preoperative elevation of carcinoembryonic antigen predicts poor tumor response and frequent distant recurrence for patients with rectal cancer who receive preoperative chemoradiotherapy and total mesorectal excision: a multi-institutional analysis in an Asian population
Authors: Jong Hoon Lee
Sung Hwan Kim
Hong Seok Jang
Hyuk Jun Chung
Seong Taek Oh
Doo Seok Lee
Jun-Gi Kim
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 4/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-012-1584-6

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Preoperative elevation of carcinoembryonic antigen predicts poor tumor response and frequent distant recurrence for patients with rectal cancer who receive preoperative chemoradiotherapy and total mesorectal excision: a multi-institutional analysis in an Asian population

Abstract

Purpose

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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