Prognostic impact of carcinoembryonic antigen and carbohydrate antigen 19-9 in stage IV colorectal cancer patients after R0 resection

• Published in: The Journal of surgical research 2016-10, Vol.205 (2), p.384-392
• Main Authors: Abe, Shinya, Kawai, Kazushige, Ishihara, Soichiro, Nozawa, Hiroaki, Hata, Keisuke, Kiyomatsu, Tomomichi, Tanaka, Toshiaki, Watanabe, Toshiaki
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; CA-19-9 Antigen - blood; Carbohydrate antigen 19-9; Carcinoembryonic antigen; Carcinoembryonic Antigen - blood; Colorectal cancer; Colorectal Neoplasms - blood; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - diagnosis; Neoplasm Staging; Outcomes; Prognosis; Recurrence; Retrospective Studies; Survival Analysis
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2016.06.078

Although preoperative carcinoembryonic antigen (pre-CEA) and carbohydrate antigen 19-9 (pre-CA 19-9) are reportedly prognostic indicators for colorectal cancer (CRC), the prognostic roles of postoperative CEA (post-CEA) and CA 19-9 (post-CA 19-9) shortly after surgery have not been clarified in patients with curatively resected stage IV CRC. The aim of this study was to evaluate the predictive abilities of post-CEA and post-CA 19-9. A total of 129 consecutive patients who had stage IV CRC and underwent R0 resection were retrospectively analyzed. Pre-CEA and post-CEA and CA 19-9 levels were measured within 1 mo before and 3 mo after surgery, respectively. Relapse-free survival (RFS) and overall survival were estimated using the Kaplan–Meier method, and multivariate analysis was performed using the Cox proportional hazards model. Pre-CEA was elevated (≥5.0 ng/mL) in 73.6% of the patients and remained elevated after surgery in 32.7% of the patients. Elevated post-CA 19-9 (≥50 U/mL) was observed in 9.5% of the patients. Neither elevated pre-CEA nor elevated pre-CA 19-9 was significantly associated with RFS but both elevated post-CEA and elevated post-CA 19-9 were associated with markedly reduced RFS (P = 0.0002 and P = 0.0004, respectively). When considered in combination, post-CEA and post-CA 19-9 significantly stratified RFS and was an independent predictive factor for recurrence (P = 0.0035), as was lymphatic invasion (P = 0.0015). Post-CA 19-9 was the only evident independent predictive factor for overall survival (P = 0.0336). In patients with stage IV CRC who underwent curative resection, the combination of post-CEA and post-CA 19-9 at 3 mo after surgery was a potent prognostic indicator for recurrence.