title: Preoperative Serum Carcinoembryonic Antigen Level as a Prognostic Factor for Recurrence and Survival After Curative Resection Followed by Adjuvant Chemotherapy in Stage III Colon Cancer.
abstract: BACKGROUND
  Carcinoembryonic antigen (CEA) is the most widely used tumor marker in colon cancer; however, there has been controversy regarding the significance of preoperative serum CEA level as a prognostic factor for recurrence. In this study, we evaluated the optimal cutoff value and prognostic significance of preoperative serum CEA level in stage III colon cancer.
  
  
  METHODS
  Based on a retrospective cohort of 965 patients with stage III colon cancer who underwent elective curative surgery and adjuvant chemotherapy with fluoropyrimidine and oxaliplatin (training set), we determined the optimal cutoff value of CEA for recurrence using the Contal and O'Quigley method. We assessed the prognostic value of this cutoff value in terms of disease-free survival (DFS) and overall survival (OS) in a prospective cohort of 268 patients with stage III colon cancer (validation set). A Cox proportional hazards model was used to explore the association of prognostic variables with DFS and OS.
  
  
  RESULTS
  The statistically determined best cutoff value for CEA was 3 ng/mL in the training set. A high CEA level (≥3 ng/mL) was associated with inferior DFS (hazard ratio [HR] 4.609, 95 % confidence interval [CI] 2.028-10.474) and OS (HR 3.956, 95 % CI 1.127-13.882) in the validation set, while multivariate analysis showed that a high CEA level was an independent risk factor for DFS and OS in both study subsets.
  
  
  CONCLUSIONS
  Preoperative serum CEA level is an independent prognostic factor for DFS and OS in patients with stage III colon cancer after curative resection and adjuvant chemotherapy.
authors.affiliation: Department of Medical Oncology, Yonsei Cancer Center, Seoul, Korea.|Graduate School of Medical Science and Engineering, KAIST, Daejeon, Korea.
authors.forename: Chang Gon
authors.initials: CG
authors.lastname: Kim
authors.affiliation: Department of Medical Oncology, Yonsei Cancer Center, Seoul, Korea.
authors.forename: Joong Bae
authors.initials: JB
authors.lastname: Ahn
authors.affiliation: Department of Medical Oncology, Yonsei Cancer Center, Seoul, Korea.
authors.forename: Minkyu
authors.initials: M
authors.lastname: Jung
authors.affiliation: Department of Medical Oncology, Yonsei Cancer Center, Seoul, Korea.
authors.forename: Seung Hoon
authors.initials: SH
authors.lastname: Beom
authors.affiliation: Department of Medical Oncology, Yonsei Cancer Center, Seoul, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Heo
authors.affiliation: Department of Medical Oncology, Yonsei Cancer Center, Seoul, Korea.
authors.forename: Jee Hung
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Medical Oncology, Yonsei Cancer Center, Seoul, Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei Cancer Center, Seoul, Korea.
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei Cancer Center, Seoul, Korea.
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Seoul, Korea.
authors.forename: Woong Sub
authors.initials: WS
authors.lastname: Koom
authors.affiliation: Department of Pathology, Yonsei Cancer Center, Seoul, Korea.
authors.forename: Hoguen
authors.initials: H
authors.lastname: Kim
authors.affiliation: Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yun Ho
authors.initials: YH
authors.lastname: Roh
authors.affiliation: Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Bo Gyoung
authors.initials: BG
authors.lastname: Ma
authors.affiliation: Department of Medical Oncology, Yonsei Cancer Center, Seoul, Korea. ssj338@yuhs.ac.
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Shin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood*; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011379:Prognosis; D011743:Pyrimidines / Q000008:administration & dosage; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D009944:Organoplatinum Compounds; D011743:Pyrimidines; D000077150:Oxaliplatin; D005472:Fluorouracil