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Annals of Surgical Oncology

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01-10-2012 | Colorectal Cancer

Inflammation-Based Prognostic System Predicts Postoperative Survival of Colorectal Cancer Patients with a Normal Preoperative Serum Level of Carcinoembryonic Antigen

Authors: Mitsuru Ishizuka, MD, Hitoshi Nagata, MD, Kazutoshi Takagi, MD, Yoshimi Iwasaki, MD, Keiichi Kubota, MD

Published in: Annals of Surgical Oncology | Issue 11/2012

Abstract

Background

Although carcinoembryonic antigen (CEA) is a valuable indicator for estimating the progression of colorectal cancer (CRC), some patients with advanced CRC show no elevation of the CEA level. On the other hand, inflammation-based prognosis, assessed by the Glasgow Prognostic Score (GPS), has been established as one of the important prognostic factors of survival after surgery for several types of cancer. We estimated the postoperative survival of CRC patients with a normal preoperative serum level of CEA on the basis of the GPS.

Methods

Among 491 patients who had undergone elective CRC surgery, 271 with a normal preoperative serum CEA level (≤5.0 ng/ml) were enrolled. Uni- and multivariate analyses were performed to evaluate the relationship to overall survival. Kaplan–Meier analysis and log rank test were used to compare the survival curves between patients with GPS 0 (group A), and 1 or 2 (group B).

Results

Univariate analyses using clinical characteristics revealed that lymphatic invasion, lymph node metastasis, platelet count, the serum levels of CEA and C-reactive protein, tumor, node, metastasis staging system (stage 0, I, II/III, IV), and the GPS (0/1, 2) were associated with overall survival. Among these characteristics, multivariate analysis demonstrated that the GPS and platelet count were associated with overall survival. Kaplan–Meier analysis and log rank test demonstrated a significant difference in overall survival between groups A and B (P < 0.001).

Conclusions

Even if CRC patients have a normal preoperative serum level of CEA before surgery, the GPS is able to predict their postoperative survival.

Takagawa R, Fujii S, Ohta M, Nagano Y, Kunisaki C, Yamagishi S, et al. Preoperative serum carcinoembryonic antigen level as a predictive factor of recurrence after curative resection of colorectal cancer. Ann Surg Oncol. 2008;15:3433–9.PubMedCrossRef

Park IJ, Choi GS, Lim KH, Kang BM, Jun SH. Serum carcinoembryonic antigen monitoring after curative resection for colorectal cancer: clinical significance of the preoperative level. Ann Surg Oncol. 2009;16:3087–93.PubMedCrossRef

Yamashita K, Watanabe M. Clinical significance of tumor markers and an emerging perspective on colorectal cancer. Cancer Sci. 2009;100:195–9.PubMedCrossRef

Chen CC, Yang SH, Lin JK, Lin TC, Chen WS, Jiang JK, et al. Is it reasonable to add preoperative serum level of CEA and CA19-9 to staging for colorectal cancer? J Surg Res. 2005;124:169–74.PubMedCrossRef

Wang JY, Tang R, Chiang JM. Value of carcinoembryonic antigen in the management of colorectal cancer. Dis Colon Rectum. 1994;37:272–7.PubMedCrossRef

Nakagoe T, Sawai T, Tsuji T, Jibiki MA, Nanashima A, Yamaguchi H, et al. Preoperative serum level of CA19-9 predicts recurrence after curative surgery in node-negative colorectal cancer patients. Hepatogastroenterology. 2003;50:696–9.PubMed

Hara M, Kanemitsu Y, Hirai T, Komori K, Kato T. Negative serum carcinoembryonic antigen has insufficient accuracy for excluding recurrence from patients with Dukes C colorectal cancer: analysis with likelihood ratio and posttest probability in a follow-up study. Dis Colon Rectum. 2008;51:1675–80.PubMedCrossRef

Hara M, Sato M, Takahashi H, Takayama S, Takeyama H. Does serum carcinoembryonic antigen elevation in patients with postoperative stage II colorectal cancer indicate recurrence? Comparison with stage III. J Surg Oncol. 2010;102:154–7.PubMedCrossRef

Ishizuka M, Nagata H, Takagi K, Horie T, Kubota K. Inflammation-based prognostic score is a novel predictor of postoperative outcome in patients with colorectal cancer. Ann Surg. 2007;246:1047–51.PubMedCrossRef

10.

Ramsey S, Lamb GW, Aitchison M, Graham J, McMillan DC. Evaluation of an inflammation-based prognostic score in patients with metastatic renal cancer. Cancer. 2007;109:205–12.PubMedCrossRef

11.

Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dagg K, Scott HR. A prospective longitudinal study of performance status, an inflammation-based score (GPS) and survival in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2005;92:1834–6.PubMedCrossRef

12.

McMillan DC. An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc. 2008;67:257–62.PubMedCrossRef

13.

Morita S, Nomura T, Fukushima Y, Morimoto T, Hiraoka N, Shibata N. Does serum CA19-9 play a practical role in the management of patients with colorectal cancer? Dis Colon Rectum. 2004;47:227–32.PubMedCrossRef

14.

Nozoe T, Mori E, Takahashi I, Ezaki T. Preoperative elevation of serum C-reactive protein as an independent prognostic indicator of colorectal carcinoma. Surg Today. 2008;38:597–602.PubMedCrossRef

15.

Lai CC, You JF, Yeh CY, Chen JS, Tang R, Wang JY, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis. 2011;26:473–81.PubMedCrossRef

16.

Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. Br J Cancer. 2004;90:1704–6.PubMed

17.

Tournigand C, Andre T, Achille E, Lledo G, Flesh M, Mery-Mignard D, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004;22:229–37.PubMedCrossRef

18.

de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.PubMed

19.

Twelves C, Wong A, Nowacki MP, Abt M, Burris H 3rd, Carrato A, et al. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med. 2005;352:2696–704.PubMedCrossRef

20.

McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12:223–6.PubMedCrossRef

21.

Roxburgh CS, Wallace AM, Guthrie GK, Horgan PG, McMillan DC. Comparison of the prognostic value of tumour- and patient-related factors in patients undergoing potentially curative surgery for colon cancer. Colorectal Dis. 2010;12:987–94.PubMedCrossRef

22.

Roxburgh CS, Salmond JM, Horgan PG, Oien KA, McMillan DC. Comparison of the prognostic value of inflammation-based pathologic and biochemical criteria in patients undergoing potentially curative resection for colorectal cancer. Ann Surg. 2009;249:788–93.PubMedCrossRef

23.

Van Cutsem E, Kohne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med. 2009;360:1408–17.PubMedCrossRef

24.

Saltz LB, Clarke S, Diaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol. 2008;26:2013–9.PubMedCrossRef

25.

Van Cutsem E, Peeters M, Siena S, Humblet Y, Hendlisz A, Neyns B, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol. 2007;25:1658–64.PubMedCrossRef

26.

Bakalakos EA, Burak WE Jr, Young DC, Martin EW Jr. Is carcino-embryonic antigen useful in the follow-up management of patients with colorectal liver metastases? Am J Surg. 1999;177:2–6.PubMedCrossRef

27.

Carriquiry LA, Pineyro A. Should carcinoembryonic antigen be used in the management of patients with colorectal cancer? Dis Colon Rectum. 1999;42:921–9.PubMedCrossRef

28.

Kawamura YJ, Tokumitsu A, Mizokami K, Sasaki J, Tsujinaka S, Konishi F. First alert for recurrence during follow-up after potentially curative resection for colorectal carcinoma: CA 19-9 should be included in surveillance programs. Clin Colorectal Cancer. 2010;9:48–51.PubMedCrossRef

29.

Fiocchi F, Iotti V, Ligabue G, Malavasi N, Luppi G, Bagni B, et al. Role of carcinoembryonic antigen, magnetic resonance imaging, and positron emission tomography-computed tomography in the evaluation of patients with suspected local recurrence of colorectal cancer. Clin Imaging. 2011;35:266–73.PubMedCrossRef

30.

Sobhani I, Tiret E, Lebtahi R, Aparicio T, Itti E, Montravers F, et al. Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer. Br J Cancer. 2008;98:875–80.PubMedCrossRef

31.

Schaefer O, Langer M. Detection of recurrent rectal cancer with CT, MRI and PET/CT. Eur Radiol. 2007;17:2044–54.CrossRef

32.

BrennerDJ, Hall EJ. Computed tomography—an increasing source of radiation exposure.N Engl J Med. 2007;357:2277–84.CrossRef

33.

Walleser S, Griffiths A, Lord SJ, Howard K, Solomon MJ, Gebski V.What is the value of computed tomography colonography in patients screening positive for fecal occult blood? A systematic review and economic evaluation. ClinGastroenterol Hepatol. 2007;5:1439–46.CrossRef

34.

Bamba Y, Itabashi M, Kameoka S. Clinical use of PET/CT in peritoneal carcinomatosis from colorectal cancer. Hepatogastroenterology. 2011;59. doi:10.5754/hge11640.

35.

Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al.Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment for colorectal cancer. Int J Clin Oncol. 2012;17:1–29.PubMedCrossRef

36.

Ishizuka M, Nagata H, Takagi K, Kubota K.Influence of inflammation-based prognostic score on mortality of patients undergoing chemotherapy for far advanced or recurrent unresectable colorectal cancer. Ann Surg. 2009;250:268–72.PubMedCrossRef

Title: Inflammation-Based Prognostic System Predicts Postoperative Survival of Colorectal Cancer Patients with a Normal Preoperative Serum Level of Carcinoembryonic Antigen
Authors: Mitsuru Ishizuka, MD
Hitoshi Nagata, MD
Kazutoshi Takagi, MD
Yoshimi Iwasaki, MD
Keiichi Kubota, MD
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 11/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2384-5

At a glance: The STEP trials

Springer Medicine

Inflammation-Based Prognostic System Predicts Postoperative Survival of Colorectal Cancer Patients with a Normal Preoperative Serum Level of Carcinoembryonic Antigen

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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