title: Optimal predictive value of preoperative serum carcinoembryonic antigen for surgical outcomes in stage I non-small cell lung cancer: differences according to histology and smoking status.
abstract: BACKGROUND
  The cutoff value of preoperative serum carcinoembryonic antigen (CEA) levels has not been investigated using appropriate subgroup analyses for non-small cell lung carcinoma (NSCLC). This study was undertaken to determine whether the most predictive preoperative CEA level for risk of recurrence differs according to histological type, and how smoking status influences predictive values in Stage I NSCLC.
  
  
  METHODS
  Subjects comprised Stage I NSCLC patients [141 patients with adenocarcinoma (ADC) and 36 with squamous cell carcinoma (SCC)].
  
  
  RESULTS
  In patients with Stage I ADC, recurrence-free survival (RFS) differed most significantly at a preoperative CEA level of 2.5 ng/ml, regardless of smoking status. Cases with preoperative CEA >2.5 ng/ml correlated with male sex, high maximum standard uptake value on (18) F-fluorodeoxyglucose positron emission tomography, poorer histopathological grade, lymphatic invasion, and smoking status. Importantly, preoperative CEA >2.5 ng/ml was identified as an independent risk factor for recurrence (P = 0.0015). Conversely, in patients with SCC, a preoperative CEA level of 3.0 ng/ml was the most predictive threshold.
  
  
  CONCLUSIONS
  Thresholds of preoperative CEA should be considered when predicting risk of relapse, even if these levels are within normal limits, as optimal cutoff levels may vary according to histological type.
authors.affiliation: Department of Thoracic Surgery, Sapporo Minami-Sanjo Hospital, Sapporo, Japan. katotatu7@msn.com
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kato
authors.forename: Keidai
authors.initials: K
authors.lastname: Ishikawa
authors.forename: Masato
authors.initials: M
authors.lastname: Aragaki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Sato
authors.forename: Kenzo
authors.initials: K
authors.lastname: Okamoto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ishibashi
authors.forename: Koji
authors.initials: K
authors.lastname: Oba
authors.forename: Mitsuhito
authors.initials: M
authors.lastname: Kaji
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood*; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen