Cancer Res Treat.  2020 Apr;52(2):446-454. 10.4143/crt.2019.261.

Carcinoembryonic Antigen Improves the Performance of MagneticResonance Imaging in the Prediction of Pathologic Response afterNeoadjuvant Chemoradiation for Patients with Rectal Cancer

• Yoo GS
• Park HC
• Yu JI
• Choi DH
• Cho WK
• Park YS
• Park JO
• Lim HY
• Kang WK
• Lee WY
• Kim HC
• Yun SH
• Cho YB
• Park YA
• Song KD
• Kim SH
• Ha SY

• KMID: 2500330
• DOI: http://doi.org/10.4143/crt.2019.261

Abstract

Purpose
The purpose of this study was to investigate the role of carcinoembryonic antigen (CEA) levels in improving the performance of magnetic resonance imaging (MRI) for the prediction of pathologic response after the neoadjuvant chemoradiation (NCRT) for patients with rectal cancer.
Materials and Methods
We retrospectively reviewed the medical records of 524 rectal cancer patients who underwent NCRT and total mesorectal excision between January 2009 and December 2014. The performances of MRI with or without CEA parameters (initial CEA and CEA dynamics) for prediction of pathologic tumor response grade (pTRG) were compared by receiver-operating characteristic analysis with DeLong’s method. Cox regression was used to identify the independent factors associated to pTRG and disease-free survival (DFS) after NCRT.
Results
The median follow-up was 64.0 months (range, 3.0 to 113.0 months). On multivariate analysis, poor tumor regression grade on MRI (mrTRG; p < 0.001), initial CEA (p < 0.001) and the mesorectal fascia involvement on MRI before NCRT (mrMFI; p=0.054) showed association with poor pTRG. The mrTRG plus CEA parameters showed significantly improved performances in the prediction of pTRG than mrTRG alone. All of mrTRG, mrMFI, and initial CEA were also identified as independent factors associated with DFS. The initial CEA further discriminated DFS in the subgroups with good mrTRG or that without mrMFI.
Conclusion
The CEA parameters significantly improved the performance of MRI in the prediction of pTRG after NCRT for patients with rectal cancer. The DFS was further discriminated by initial CEA level in the groups with favorable MRI parameters.

Keyword

Rectal neoplasms; Neoadjuvant; Chemoradiation; Carcinoembryonic antigen; Magnetic resonance imaging; Pathology; Response; Disease-free survival

Figure

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  Fig. 1. Receiver-operating characteristic curves of tumor regression grade on magnetic resonance imaging (mrTRG) (good vs. poor) alone and the combination of mrTRG plus carcinoembryonic antigen (CEA) parameters (initial CEA [iCEA] and CEA dynamics) for the prediction of pathologic tumor regression grade (pTRG) (A) and pathologic complete response (pCR) (B). CI, confidence interval. a)p-values are for the comparison of each area under the curve (AUC) and that of mrTRG based on DeLong’s method.

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  Fig. 2. The positive predictive values (PPVs) of good tumor regression grade on magnetic resonance imaging (mrTRG) for good pathologic tumor regression grade (pTRG) (A) and pathologic complete response (pCR) (B) according to the interval of initial carcinoembryonic antigen (iCEA).

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  Fig. 3. Disease-free survival of the subgroups with good tumor regression grade on magnetic resonance imaging (mrTRG) (A), poor mrTRG (B), negative mesorectal fascia invasion on initial magnetic resonance imaging (mrMFI) (C), and positive mrMFI (D). iCEA, initial carcinoembryonic antigen.

Reference

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