Ann Surg Treat Res.  2016 Oct;91(4):165-171. 10.4174/astr.2016.91.4.165.

The prognostic significance and treatment modality for elevated pre- and postoperative serum CEA in colorectal cancer patients

• Yang KM
• Park IJ
• Kim CW
• Roh SA
• Cho DH
• Kim JC

• KMID: 2354323
• DOI: http://doi.org/10.4174/astr.2016.91.4.165

Abstract

PURPOSE
The purpose of this study was to evaluate the prognostic significance of serum CEA (s-CEA) changes in colorectal cancer (CRC) patients with sustained elevated postoperative s-CEA levels.
METHODS
Between January 1999 and December 2008, 9,380 CRC patients underwent surgery. Curative resection was performed in 1,242 CRC patients with high preoperative s-CEA levels (>6 ng/mL). High s-CEA levels were normalized in 924 patients (74.4%) within 2 weeks from surgery, whereas high s-CEA levels were persistent in 318 patients (25.6%). Patients were divided into 2 groups according to their postoperative s-CEA levels: group 1 (37 patients with a 1-year postoperative s-CEA>6 ng/mL) and group 2 (281 patients with a 1-year postoperative s-CEA≤6 ng/mL).
RESULTS
A postoperative recurrence was identified in 24 patients (64.9%) in group 1 and 65 patients (23.1%) in group 2 (P < 0.001). A curative resection after recurrence was performed in 22 patients (33.8%) from group 2, but no patients from group 1 (P = 0.001). The 5-year overall survival and time to recurrence were significantly lower in patients with recurrent cancer in group 1 (P < 0.001).
CONCLUSION
Patients with persistent elevated postoperative s-CEA levels are at high risk for recurrence and a low survival rate. More intensive surveillance of patients with high postoperative s-CEA levels should be mandatory.

Keyword

Serum carcinoembryonic antigens; Colorectal neoplasms; Recurrence; Survival

MeSH Terms

Colorectal Neoplasms*
Humans
Recurrence
Survival Rate

Figure

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  Fig. 1 Study algorithm used to select colorectal cancer patients with an elevated preoperative serum CEA level.

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  Fig. 2 Cumulative overall survival rates in colorectal cancer patients with an elevated preoperative serum CEA (group1, still elevated at 1-year postsurgery; group 2, normalized by 1-year postsurgery), after primary surgery (A) and recurrence (B), respectively.

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