Elevated preoperative CEA is associated with worse survival in stage I-III rectal cancer patients.
BACKGROUND
The objective of this investigation was to assess whether preoperative carcinoembryonic antigen (CEA) level is an independent predictor of overall survival in rectal cancer patients.


METHODS
All patients (n=504) undergoing a resection for stage I-III rectal cancer at the Kantonsspital St Gallen were included into a database between 1991 and 2008. The impact of preoperative CEA level on overall survival was assessed using risk-adjusted Cox proportional hazard regression models and propensity score methods.


RESULTS
In risk-adjusted Cox proportional hazard regression analyses, preoperative CEA level (hazard ratio (HR): 1.98, 95% confidence interval (CI): 1.36-2.90, P<0.001), distance from anal verge (<5 cm: HR: 1.93, 95% CI: 1.11-3.37; P=0.039), older age (HR: 1.07, 95% CI: 1.05-1.09; P<0.001), lower body mass index (HR: 0.94, 95% CI: 0.89-0.98; P=0.006), advanced tumour stage (stage II HR: 1.41, 95% CI: 0.85-2.32; stage III HR: 2.08, 95% CI: 1.31-3.31; P=0.004), R 1 resection (HR: 5.65, 95% CI: 1.59-20.1; P=0.005) and chronic kidney disease (HR: 2.28, 95% CI: 1.03-5.04; P=0.049) were all predictors for poor overall survival.


CONCLUSIONS
This is one of the first investigations based on a large cohort of exclusively rectal cancer patients demonstrating that preoperative CEA level is a strong predictor of decreased overall survival. Preoperative CEA should be used as a prognostic factor in the preoperative assessment of rectal cancer patients.
Department of Surgery, Kantonsspital St Gallen, 9007 St Gallen, Switzerland. Tarantino@kssg.ch
I
I
Tarantino
R
R
Warschkow
M
M
Worni
K
K
Merati-Kashani
D
D
Köberle
B M
BM
Schmied
S A
SA
Müller
T
T
Steffen
T
T
Cerny
U
U
Güller
D000230:Adenocarcinoma / Q000097:blood* / Q000401:mortality / Q000473:pathology; D000368:Aged; D002272:Carcinoembryonic Antigen / Q000097:blood*; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology; D012044:Regression Analysis; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology
D002272:Carcinoembryonic Antigen