title: Elevated CA19-9 as the Most Significant Prognostic Factor in Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy.
abstract: It remains controversial regarding the prognostic significance of carbohydrate antigen 19-9 (CA19-9) for locally advanced rectal cancer (LARC) (T3-4/N+) patients with neoadjuvant chemoradiotherapy (neo-CRT). And it is unknown whether CA19-9 can identify patients who may benefit from adjuvant chemotherapy.Overall, 303 LARC patients with neo-CRT between 2004 and 2010 were recruited. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and local recurrence-free survival across pretreatment CA19-9 were estimated by Kaplan-Meier method and Cox regression model.In univariate analysis, elevated CA19-9 (>35 U/mL) was significantly correlated with poor OS (P = 0.003), DFS (P = 0.001), and DMFS (P = 0.039). Adjusting for the known covariates, CA19-9 was significantly associated with OS (HR = 1.86, 95% CI 1.03-3.34, P = 0.039) and DFS (HR = 1.74, 95% CI 1.08-2.80, P = 0.024). In the elevated CA19-9 subgroup, patients with adjuvant chemotherapy got much better OS (P < 0.001) and DFS (P = 0.016) than those without. In consideration of both CA19-9 and carcinoembryonic antigen (CEA), we found that patients with both elevated CA19-9 and CEA (>5 ng/mL) got the worst OS (P = 0.021) and DFS (P = 0.006), and significantly benefited from adjuvant chemotherapy in OS (P < 0.001) and DFS (P = 0.026).Pretreatment CA19-9 level is a significant prognostic indicator in patients with LARC following neo-CRT. The addition of CA19-9 to CEA is valuable to discriminate the appropriate patients for adjuvant chemotherapy.
authors.affiliation: From the Department of Radiation Oncology (L-NZ, P-YOY, W-WX, XY, Z-FZ, Y-HG), Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong (R-HX) and Department of Oncology, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K-YY).
authors.forename: Lu-Ning
authors.initials: LN
authors.lastname: Zhang
authors.forename: Pu-Yun
authors.initials: PY
authors.lastname: OuYang
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Xiao
authors.forename: Xin
authors.initials: X
authors.lastname: Yu
authors.forename: Kai-Yun
authors.initials: KY
authors.lastname: You
authors.forename: Zhi-Fan
authors.initials: ZF
authors.lastname: Zeng
authors.forename: Rui-Hua
authors.initials: RH
authors.lastname: Xu
authors.forename: Yuan-Hong
authors.initials: YH
authors.lastname: Gao
mesh_terms: D018395:CA-19-9 Antigen / Q000378:metabolism*; D002277:Carcinoma / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D018395:CA-19-9 Antigen