title: Evaluation of preoperative serum markers for individual patient prognosis in stage I-III rectal cancer.
abstract: Several independent serum biomarkers have been proposed as prognostic and/or predictive markers for colorectal cancer (CRC). To this date, carcinoembryonic antigen (CEA) remains the only recommended serological CRC biomarker. The present retrospective analysis investigates the prognostic value of several serum markers. A total of 256 patients with rectal cancer underwent surgery for curative intent in a university cancer center between January 1988 and June 2007. Preoperative serum was retrospectively analyzed for albumin, alkaline phosphatase (aP), beta-human chorionic gonadotropin, bilirubin, CA 125, cancer antigen 19-9, cancer antigen 72-4 (CA 72-4), CEA, CRP, CYFRA 21-1, ferritin, gamma-glutamyl transpeptidase, glutamate oxaloacetate transanunase, glutamate pyruvate transaminase, hemoglobin, haptoglobin, interleukin-6, interleukin-8, creatinine, lactate-dehydrogenase, serum amyloid A (SAA), and 25-hydroxyvitamin D. Cancer-specific survival (CSS) and disease-free survival (DFS) were estimated. Median follow-up time was 8.4 years. Overall 3- and 5-year CSS was 88.6 and 78.9 %, respectively. DFS rates were 72.8 % (3 years) and 67.5 % (5 years). Univariate analysis of CSS indicated aP, CA 72-4, CEA, and SAA as prognostic factors, while aP, CEA, and SAA were also prognostic with regard to DFS. Multivariate analysis confirmed SAA together with T and N stage as prognostic factors. According to UICC stage, CEA and SAA add prognostic value in stages II and III with regard to DFS and CSS, respectively. The combined use of CEA and SAA is able to identify patients with favorable and poor prognosis. In addition to tumor baseline parameters, routine analysis of SAA together with CEA provided markedly improved prognostic value on CSS and DFS in resected rectal cancer.
authors.affiliation: Department of Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany, clemens.giessen@med.uni-muenchen.de.
authors.forename: Clemens
authors.initials: C
authors.lastname: Giessen
authors.forename: Dorothea
authors.initials: D
authors.lastname: Nagel
authors.forename: Maria
authors.initials: M
authors.lastname: Glas
authors.forename: Fritz
authors.initials: F
authors.lastname: Spelsberg
authors.forename: Ulla
authors.initials: U
authors.lastname: Lau-Werner
authors.forename: Dominik Paul
authors.initials: DP
authors.lastname: Modest
authors.forename: Marlies
authors.initials: M
authors.lastname: Michl
authors.forename: Volker
authors.initials: V
authors.lastname: Heinemann
authors.forename: Petra
authors.initials: P
authors.lastname: Stieber
authors.forename: Christoph
authors.initials: C
authors.lastname: Schulz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007118:Immunoassay; D053208:Kaplan-Meier Estimate; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D000685:Serum Amyloid A Protein / Q000032:analysis / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D000685:Serum Amyloid A Protein