title: Postoperative carcinoembryonic antigen level has a prognostic value for distant metastasis and survival in rectal cancer patients who receive preoperative chemoradiotherapy and curative surgery: a retrospective multi-institutional analysis.
abstract: The cut-off value and prognostic significance of postoperative carcinoembryonic antigen (CEA) level in rectal cancer after preoperative chemoradiotherapy (CRT) and curative surgery are still unclear. 1559 rectal cancer patients staged with cT3-4N0-2M0 received preoperative CRT and total mesorectal excision (TME). CEA levels were measured before CRT and 3-4 weeks after surgery. Clinicopathologic factors that could be associated with tumor recurrence and patient survival were analyzed. The cumulative probability of tumor recurrence showed a steep increase with a cutoff value of 2.5 ng/mL for postoperative CEA level, and the gradient decreased as the CEA levels increased above 2.5 ng/mL. After a median follow-up time of 46.7 months, patients with postoperative CEA level >2.5 ng/mL had significantly lower relapse-free survival (RFS) (65.2 vs. 75.6 %, P < 0.001) and overall survival (OS) (78.1 vs. 88.3 %, P < 0.001) at 5 years than patients with postoperative CEA level ≤2.5 ng/mL. On the multivariate analysis, postoperative CEA level was a significant prognostic factor for RFS (HR 1.561; 95 % CI 1.221-1.996; P < 0.001) and OS (HR 2.073; 95 % CI 1.498-2.869; P < 0.001). Postoperative CEA level independently affected RFS irrespective of pre-CRT CEA level. Postoperative CEA level was a significant predictor for distant recurrence (P = 0.004), but not for locoregional recurrence (P = 0.472). Postoperative CEA level >2.5 ng/ml is a predictor of distant metastasis and a negative prognostic factor for survival in rectal cancer patients who receive preoperative CRT and curative surgery.
authors.affiliation: Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors.forename: Songmi
authors.initials: S
authors.lastname: Jeong
authors.affiliation: Department of Radiation Oncology, Chonnam National University School of Medicine, Gwang-Ju, Republic of Korea.
authors.forename: Taek Keun
authors.initials: TK
authors.lastname: Nam
authors.affiliation: Department of Radiation Oncology, Chonnam National University School of Medicine, Gwang-Ju, Republic of Korea.
authors.forename: Jae Uk
authors.initials: JU
authors.lastname: Jeong
authors.affiliation: Department of Radiation Oncology, St. Vincent`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kyubo
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Seoul St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Jang
authors.affiliation: Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
authors.forename: Bae Kwon
authors.initials: BK
authors.lastname: Jeong
authors.affiliation: Department of Radiation Oncology, St. Vincent`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. koppul@catholic.ac.kr.
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002272:Carcinoembryonic Antigen / Q000097:blood*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D011300:Preoperative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*
chemical_list: D002272:Carcinoembryonic Antigen
keywords: Chemoradiotherapy; Metastasis; Postoperative CEA; Rectal cancer; Surgery