Cancer Res Treat.  2018 Jan;50(1):283-292. 10.4143/crt.2016.537.

Clinical Significance of Discordance between Carcinoembryonic Antigen Levels and RECIST in Metastatic Colorectal Cancer

• Kim IH
• Lee JE
• Yang JH
• Jeong JW
• Ro S
• Oh ST
• Kim JG
• Choi MH
• Lee MA

• KMID: 2403497
• DOI: http://doi.org/10.4143/crt.2016.537

Abstract

PURPOSE
The purpose of this study was to investigate the prognostic implications of carcinoembryonic antigen (CEA) levels that are inconsistent with Response Evaluation Criteria in Solid Tumor (RECIST) responses in metastatic colorectal cancer patients.
MATERIALS AND METHODS
We retrospectively evaluated 360 patients with at least one measurable lesion who received first-line palliative chemotherapy. CEA-response was defined as CEA-complete response (CR; CEA normalization), CEA-partial response (PR; ≥ 50% decrease in CEA levels), CEA-progressive disease (PD; ≥ 50% increase in CEA levels), and CEA-stable disease (SD; non-CR/PR/PD). Overall survival (OS) and progression-free survival (PFS) were evaluated according to CEA-response.
RESULTS
In RECIST-PR patients, poorer CEA-response was associated with disease progression at the subsequent evaluation. In RECIST-SD patients, CEA-CR and -PR were associated with lower disease progression rates than CEA-PD at the subsequent evaluation. Correlations between survival outcome and CEA-response in same-category RECIST patients were assessed. In RECIST-PR patients, discordant CEA-response (CEA-PD/SD) was associated with poorer survival than CEA-CR/PR (median OS and PFS, 44.0 and 15.4 [CEA-CR], 28.9 and 12.5 [CEA-PR], 21.0 and 9.8 [CEA-SD], and 13.0 and 7.0 [CEA-PD] months, respectively; all p < 0.001). In RECIST-SD patients, favorable CEA-response produced better survival (median OS and PFS, 26.8 and 21.0 [CEA-CR], 21.0 and 11.0 [CEA-PR], 16.1 and 8.2 [CEA-SD], and 12.2 and 6.0 [CEA-PD] months, respectively; all p < 0.001). RECIST-PD patients with CEA-CR showed longer OS than those with CEA-PD. Multivariate analysis demonstrated that discordant CEA-response is a powerful prognostic factor for RECIST-PR and RECIST-SD patients.
CONCLUSION
Among patients of the same RECIST-response categories, CEA-response patterns are significantly prognostic and strongly predictive of subsequent evaluation outcomes.

Keyword

Carcinoembryonic antigen; Chemotherapy; Colorectal neoplasms; Prognosis; Survival

MeSH Terms

Carcinoembryonic Antigen*
Colorectal Neoplasms*
Disease Progression
Disease-Free Survival
Drug Therapy
Humans
Multivariate Analysis
Prognosis
Response Evaluation Criteria in Solid Tumors*
Retrospective Studies
Carcinoembryonic Antigen

Figure

• 

  Fig. 1. Distribution of tumor shrinkage rates according to CEA-response in RECIST-PR (A) and RECIST-SD (B) patients at the time of first response evaluation. CEA, carcinoembryonic antigen; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; RECIST, Response Evaluation Criteria in Solid Tumors.

• 

  Fig. 2. Cumulative survival rates according to CEA-response in patients with different RECIST evaluations. In patients with RECIST-PR (A and C), a discordant CEA-response (CEA-PD/SD) showed poorer survival than CEA-CR/PR (median OS and PFS: 44.0±5.9 and 15.4±1.9 months [CEA-CR], 28.9±1.8 and 12.5±1.3 [CEA-PR], 21.0±2.1 and 9.8±1.0 [CEA-SD], and 13.0±1.1 and 7.0±0.8 [CEA-PD], respectively; all p < 0.001). In patients with RECIST-SD (B and D), a more favorable CEA-response demonstrated better OS and PFS (median OS and PFS: 26.8±19.6 and 21.0±9.3 months [CEA-CR], 21.0±1.4 and 11.0±0.8 [CEA-PR], 16.1±1.4 and 8.2±0.8 [CEA-SD], and 12.2±1.1 and 6.0±0.7 [CEA-PD], respectively; all p < 0.001). In patients with RECIST-PD (E), there was no significant difference in OS according to CEA-response (median OS: 20.1±5.8 months [CEA-CR], 13.0±4.8 [CEA-PR], 9.0±1.4 [CEA-SD], and 8.7±4.6 [CEA-PD]; p=0.082). (A) OS in RECIST-PR patients, (B) OS in RECIST-SD patients, (C) PFS in RECIST-PR patients, (D) PFS in RECIST-SD patients, (E) OS in RECST-PD patients. CEA, carcinoembryonic antigen; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; RECIST, Response Evaluation Criteria in Solid Tumors; OS, overall survival; PFS, progression-free survival.

Reference

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