title: Predictive Value of CEA for Survival in Stage I Rectal Cancer: a Population-Based Propensity Score-Matched Analysis.
abstract: The aim of the study was to assess whether preoperative carcinoembryonic antigen (CEA) level is an independent predictor of overall- and cancer-specific survival in stage I rectal cancer.
  
  
  
  Stage I rectal cancer patients were identified in the Surveillance, Epidemiology, and End Results database between 2004 and 2011. The impact of an elevated preoperative CEA level (C1-stage) compared with a normal CEA level (C0-stage) on overall and cancer-specific survival was assessed using risk-adjusted Cox proportional hazard regression models and propensity score methods.
  
  
  
  Overall, 1932 stage I rectal cancer patients were included, of which 328 (17 %) patients had C1-stage. The 5-year overall and cancer-specific survival for patients with C0-stage were 85.7 % (95 % CI 83.2-88.2 %) and 94.7 % (95 % CI 93.1-96.3 %), versus 76.8 % (95 % CI 70.9-83.1 %) and 88.1 % (95 % CI 83.3-93.2 %) for patients with C1-stage (P < 0.001 and P = 0.001). The negative impact of C1-stage on overall and cancer-specific survival was confirmed by risk-adjusted Cox proportional hazard regression analysis (hazard ratio [HR] = 1.57, 95 % CI = 1.15-2.16, P = 0.007 and 2.04, 95 % CI = 1.25-3.33, P = 0.006), and after propensity score matching (overall survival [OS]: HR = 1.46, 95 % CI = 1.02-2.08, P = 0.044 and cancer-specific survival [CSS]: HR = 3.28, 95 % CI = 1.78-6.03, P < 0.001).
  
  
  
  This is the first population-based investigation of a large cohort of exclusively stage I rectal cancer patients providing compelling evidence that elevated preoperative CEA level is a strong predictor of worse overall and cancer-specific survival.
authors.affiliation: Department of General, Abdominal and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
authors.affiliation: Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.|Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany.
authors.forename: Rene
authors.initials: R
authors.lastname: Warschkow
authors.affiliation: Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.affiliation: Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.|University Clinics for Visceral Surgery and Medicine, University Hospital Berne, 3010, Berne, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Güller
authors.affiliation: Department of General, Abdominal and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Mieth
authors.affiliation: Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cerny
authors.affiliation: Department of General, Abdominal and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Department of General, Abdominal and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. alexis.ulrich@med.uni-heidelberg.de.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ulrich
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057234:Preoperative Period; D011379:Prognosis; D057216:Propensity Score; D012004:Rectal Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018426:SEER Program; D016019:Survival Analysis
chemical_list: D002272:Carcinoembryonic Antigen
keywords: CEA; Carcinoembryonic antigen; Rectal cancer