title: Evaluating the Prognostic Role of Elevated Preoperative Carcinoembryonic Antigen Levels in Colon Cancer Patients: Results from the National Cancer Database.
abstract: OBJECTIVE
  Carcinoembryonic antigen (CEA) is a reliable tumor marker for the management and surveillance of colon cancer. However, limitations in previous studies have made it difficult to elucidate whether CEA should be established as a prognostic indicator. This study examines the association between elevated preoperative CEA levels and overall survival in colon cancer patients using a national population-based registry.
  
  
  METHODS
  Stage I-III colon cancer patients were identified from the 2004-2006 National Cancer Database. A multivariable Cox proportional hazards model was used to estimate the association between elevated CEA levels and overall survival after controlling for important patient, hospital, and tumor characteristics. A Monte Carlo Markov Chain was used to impute the large degree of missing CEA data. All models controlled for the propensity score in order to account for selection bias.
  
  
  RESULTS
  A total of 137,381 patients met the inclusion criteria. Overall, 34 % of patients had an elevated CEA level and 66 % had a normal CEA level, with a median survival of 70 and 100 months, respectively. Patients with an elevated CEA level had a 62 % increase in the hazard of death (HR 1.62, 95 % CI 1.53-1.74) compared with patients with a normal CEA level.
  
  
  CONCLUSIONS
  Preoperative CEA was an independent predictor of overall survival across all stages. The results support recommendations to include CEA levels as another high-risk feature that clinicians can use to counsel patients on adjuvant chemotherapy, especially for stage II patients.
authors.affiliation: Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA. adan_becerra@urmc.rochester.edu.
authors.forename: Adan Z
authors.initials: AZ
authors.lastname: Becerra
authors.affiliation: Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Probst
authors.affiliation: Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Mohamedtaki A
authors.initials: MA
authors.lastname: Tejani
authors.affiliation: Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Aquina
authors.affiliation: Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
authors.forename: Maynor G
authors.initials: MG
authors.lastname: González
authors.affiliation: Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Hensley
authors.affiliation: Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.affiliation: Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Monson
authors.affiliation: Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D018279:Carcinoma, Signet Ring Cell / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D003110:Colonic Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen