title: Early postoperative CEA level is a better prognostic indicator than is preoperative CEA level in predicting prognosis of patients with curable colorectal cancer.
abstract: OBJECTIVE
  Carcinoembryonic antigen (CEA) measurements performed preoperatively and during the early postoperative period were examined prospectively to assess their prognostic value for colorectal cancer (CRC) patients receiving curative surgery.
  
  
  METHODS
  Between 2000 and 2004, 1,361 patients with CRC who underwent curative surgery at the Taipei Veterans General Hospital were enrolled prospectively. CEA was measured prior to surgery and during the third or fourth postoperative week. The endpoint was length of postoperative disease-free survival, and prognostic importance was determined using the log-rank test and Cox regression hazard model.
  
  
  RESULTS
  Six hundred (44.1%) CRC patients had high CEA concentrations preoperatively, and 188 (13.8%) patients retained high values postoperatively. Within the median follow-up period of 61 (6-108) months, CRC recurred in 313 patients. By univariate analysis TNM staging, tumor differentiation, lymphovascular invasion, preoperative CEA concentration, and postoperative CEA concentration affected the outcome. By multivariate analysis, the prognostic importance of postoperative CEA was retained (95% CI, 1.73-3.01; HR = 2.28) but that of preoperative CEA was lost (95% CI, 0.82-1.33; HR = 1.05). CRC recurred earlier in patients with high postoperative CEA concentrations; metastasis to the liver was common (72.3%) among patients in this group.
  
  
  CONCLUSIONS
  Early postoperative CEA concentration is an independent prognostic factor for CRC. Patients with high postoperative CEA values should receive aggressive follow-up examinations for early relapse of CRC, with special attention paid to recurrence at the liver.
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, No 201, Section 2, Shih-Pai Road Taipei, 11217, Taipei, Taiwan.
authors.forename: Jen-Kou
authors.initials: JK
authors.lastname: Lin
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Lin
authors.forename: Shung-Haur
authors.initials: SH
authors.lastname: Yang
authors.forename: Huann-Sheng
authors.initials: HS
authors.lastname: Wang
authors.forename: Jeng-Kai
authors.initials: JK
authors.lastname: Jiang
authors.forename: Yuan-Tzu
authors.initials: YT
authors.lastname: Lan
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Lin
authors.forename: Anna Fen-Yau
authors.initials: AF
authors.lastname: Li
authors.forename: Wei-Shone
authors.initials: WS
authors.lastname: Chen
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood*; D015179:Colorectal Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011184:Postoperative Period; D057234:Preoperative Period; D011379:Prognosis; D055815:Young Adult
chemical_list: D002272:Carcinoembryonic Antigen