J Korean Med Sci.  2005 Aug;20(4):624-627. 10.3346/jkms.2005.20.4.624.

Cutoff Values of Preoperative s-CEA Levels for Predicting Survivals after Curative Resection of Colorectal Cancer

• Park IJ
• Kim HC
• Yu CS
• Yoo JH
• Kim JC

• KMID: 1712744
• DOI: http://doi.org/10.3346/jkms.2005.20.4.624

Abstract

Serum carcinoembryonic antigen (s-CEA) is used to detect recurrence and predict prognosis in colorectal cancer. However, the cutoff values of s-CEA for prognosis have not been determined. We therefore tried to determine the preoperative s-CEA levels predictive of survivals in colorectal cancer patients. We retrospectively analyzed the medical records of 989 patients who underwent curative resection for colorectal cancer between July 1990 and December 1997, with a mean followup of 46 months (range, 3-129 months). When patients were divided into four subgroups with the cutoff values of s-CEA at 3,6, and 17 ng/mL, their 5-yr diseasefree survival rates were 85.3% (<3.0 ng/mL), 70.0% (3-6 ng/mL), 64.2% (6-17 ng/mL), and 55.2% (>17 ng/mL) (p<0.001). Multivariate analysis showed that factors predictive of survival included age (p=0.028), tumor stage (p<0.001), cell differentiation (p=0.016), and gross type (p=0.007), location (p=0.003) and preoperative s-CEA (p<0.001). Using the above-described cutoff levels, a significant difference in survival was observed only in patients with stage III tumors (p=0.007) when analyses were performed by stage. We can suggest the new cutoff values of s-CEA used in the present study.

Keyword

Carcinoembryonic Antigen; Prognosis; Colonic Neoplasm

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoembryonic Antigen/*blood
Colorectal Neoplasms/blood/*pathology/surgery
Female
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasm Staging
Predictive Value of Tests
Preoperative Care
Prognosis
Survival Analysis

Figure

• 

  Fig. 1 Disease-free survival curves of colorectal cancer patients relative to preoperative s-CEA levels. Survival is significantly related to preoperative s-CEA levels.

• 

  Fig. 2 Preoperative s-CEA levels and disease-free survival rate of stage III colorectal cancer patients.

Reference

1. Gold P, Freedman SO. Specific carcinoembryonic antigens of the human digestive system. J Exp Med. 1965. 122:467–481.

2. Bendardaf R, Lamlum H, Pyrhonen S. Prognostic and predictive molecular markers in colorectal carcinoma. Anticancer Res. 2004. 24:2519–2530.

3. Palmqvist R, Engaras B, Lindmark G, Hallmans G, Tavelin B, Nilsson O, Hammarstrom S, Hafstrom L. Prediagnostic levels of carcinoembryonic antigen and CA 242 in colorectal cacner: a matched case-control study. Dis Colon Rectum. 2003. 46:1538–1544.

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

5. Moertel CG, O'Fallon JR, Go VL, O'Connell MJ, Thynne GS. The preoperative carcinoembryonic antigen test in the diagnosis, staging, and prognosis of colorectal cancer. Cancer. 1986. 58:603–610.

6. Carriquiry LA, Pineyro A. Should carcinoembryonic antigen be used in the management of patients with colorectal cancer? Dis Colon Rectum. 1999. 42:921–929.

7. Wiratkapun S, Karemer M, Sheow-Choen F, Ho YH, Eu KW. High preoperative serum carcinoembryonic antigen predicts metastatic recurrence in potentially curative colonic cancer: results of a five-year study. Dis Colon Rectum. 2001. 44:231–235.

8. Kim JC, Hwang DY, Kim BS, Min YL, Lee MH, Park KC. Changes of serum Careinoembryonic antigen in patients with colorectal cancer. J Korean Cancer Assoc. 1992. 24:880–884.

9. Wolmark N, Fisher B, Wieand HS, Henry RS, Lerner H, Legault-Poisson S, Deckers PJ, Dimitrov N, Gordon PH, Jochimsen P. The prognostic significance of preoperative carcinoembryonic antigen levels in colorectal cancer. Results from NSABP (National Surgical Adjuvant Breast and Bowel Project) clinical trials. Ann Surg. 1984. 199:375–382.

10. Kim DW, Ryu MH, Kim TY, Heo DS, Bang YJ, Park JK, Kim NK. A multivariate analysis of prognostic factors in colorectal cancer. J Korean Med Assoc. 2003. 46:268–274.

11. Harrison LE, Guillem JG, Paty P, Cohen AM. Preoperative carcinoembryonic antigen predicts outcomes in node-negative colon cancer patients: a multivariate analysis of 572 patients. J Am Coll Surg. 1997. 185:55–59.

12. Prall F, Nollau P, Neumaier M, Haubeck HD, Drzeniek Z, Helmchen U, Loning T, Wagener C. CD66a (BGP) an adhesion molecule of the carcinoembryonic antigen family, is expressed in epithelium, endothelium, and myeloid cells in a wide range of normal human tissues. J Histochem Cytochem. 1996. 44:35–41.

13. Bjerner J, Lebedin Y, Bellanger L, Kuroki M, Shively JE, Varaas T, Nustad K, Hammarstrom S, Bormer OP. Protein epitopes in carcinoembryonic antigen. Report of the ISOBM TD8 Workshop. Tumour Biol. 2002. 23:249–262.

14. Benchimol S, Fuks A, Jothy S, Beauchemin N, Shirota K, Stanners CP. Carcinoembryonic antigen, a human tumor marker, functions as an intercellular adhesion molecule. Cell. 1989. 57:327–334.

15. Pignatelli M, Durbin H, Bodmer WF. Carcinoembryonic antigen functions as an accessory adhesion molecule mediating colon epithelial cell-collagen interactions. Proc Natl Acad Sci USA. 1990. 87:1541–1545.

16. Obrink B. CEA adhesion molecules: Multifunctional proteins with signal regulatory properties. Curr Opin Cell Biol. 1997. 9:616–626.

17. Prado IB, Laudanna AA, Carneiro CR. Susceptibility of colorectal-carcinoma cells to natural-killer-mediated lysis: relationship to CEA expression and degree of differentiation. Int J Cancer. 1995. 61:854–860.

18. Kim JC, Rho SA, Park KC. Adhesive function of carcinoembryonic antigen in the liver metastasis of KM-12c colon carcinoma cell line. Dis Colon Rectum. 1997. 40:946–953.

19. Stanners CP, DeMarte L, Rojas M, Gold P, Fuks A. Opposite functions for two classes of genes of the human carcinoembryonic antigen family. Tumour Biol. 1995. 16:23–31.

20. von Kleist S, Miguel I, Halla B. Possible function of CEA as cell-contact inhibitory molecule. Anticancer Res. 1995. 15:1889–1894.

21. Goslin R, Steele G Jr, MacIntyre J, Mayer R, Sugarbaker P, Cleghorn K, Wilson R, Zamcheck N. The use of preoperative plasma CEA levels for the stratification of patients after curative resection of colorectal cancers. Ann Surg. 1980. 192:747–751.