title: Prognostic value of carcinoembryonic antigen level in rectal cancer treated with neoadjuvant chemoradiotherapy.
abstract: BACKGROUND
  The purpose of this study was to identify clinical and pathological parameters to improve prediction of disease-free survival (DFS) and overall survival (OS) in patients treated with neoadjuvant chemoradiotherapy for rectal cancer.
  
  
  METHODS
  Between July 1995 and May 2007, 148 patients with primary rectal adenocarcinoma received neoadjuvant chemoradiotherapy followed by mesorectal excision. Preoperative treatment included various protocols, UFT and leucovorin (28%) and oxaliplatin-based chemotherapy (72%). Clinical and pathological variables were evaluated in relation to patient outcomes.
  
  
  RESULTS
  Thirteen percent of patients achieved a complete pathologic response. No response or minimal response as defined by Dworak (Tumor Regression Grade 0/1) was observed in 30 patients (20%). At a median follow-up of 37 months, the 3-year DFS and OS were 64% and 83%, respectively. Pre-treatment serum carcinoembryonic antigen (CEA) level </= 2.5 ng/ml was associated with higher DFS (74 vs. 53%; p = 0.018), higher complete pathologic responses (21 vs. 9%; p = 0.05), and less recurrences (24 vs. 44%; p = 0.014).
  
  
  CONCLUSIONS
  The data suggest that a CEA level </= 2.5 ng/ml might be a predictor not only of tumor response, as has been suggested before, but also of DFS. This finding could be useful in the future to predict individual risk and to develop more aggressive or alternative strategies.
authors.affiliation: Service of Medical Oncology, University Hospital La Paz, Madrid, Spain. victor.mgarc@gmail.com
authors.forename: V
authors.initials: V
authors.lastname: Moreno García
authors.forename: P
authors.initials: P
authors.lastname: Cejas
authors.forename: M
authors.initials: M
authors.lastname: Blanco Codesido
authors.forename: J
authors.initials: J
authors.lastname: Feliu Batlle
authors.forename: J
authors.initials: J
authors.lastname: de Castro Carpeño
authors.forename: C
authors.initials: C
authors.lastname: Belda-Iniesta
authors.forename: J
authors.initials: J
authors.lastname: Barriuso
authors.forename: J J
authors.initials: JJ
authors.lastname: Sánchez
authors.forename: J
authors.initials: J
authors.lastname: Larrauri
authors.forename: M
authors.initials: M
authors.lastname: González-Barón
authors.forename: E
authors.initials: E
authors.lastname: Casado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D011379:Prognosis; D012004:Rectal Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen