title: Incorporation of CEA Improves Risk Stratification in Stage II Colon Cancer.
abstract: High-risk features are used to direct adjuvant therapy for stage II colon cancer. Currently, high-risk features are identified postoperatively, limiting preoperative risk stratification. We hypothesized carcinoembryonic antigen (CEA) can improve preoperative risk stratification for stage II colon cancer. The National Cancer Database (NCDB 2004-2009) was reviewed for stage II colon adenocarcinoma patients undergoing curative intent resection. A novel risk stratification including both traditional high-risk features (T4 lesion, <12 lymph nodes sampled, and poor differentiation) and elevated CEA was developed. Unadjusted Kaplan-Meier and adjusted Cox proportional hazards analyzed overall survival. Concordance Probability Estimates (CPE) assessed discrimination. Seventy-four thousand nine hundred forty-five patients were identified; 40,844 (54.5%) had CEA levels reported and were included. Chemotherapy administration was similar between normal and elevated CEA groups (23.8 vs. 25.1%, p = 0.003). Compared to patients with CEA elevation, 5-year overall survival in patients with normal CEA was improved (74.5 vs. 63.4%, p < 0.001). Restratification incorporating CEA resulted in reclassification of 6912 patients (16.9%) from average to high risk. CPE increased for novel risk stratification (0.634 vs. 0.612, SE = 0.005). The routinely available CEA test improved risk stratification for stage II colon cancer. CEA not only may improve staging of colon cancer but may also help guide additional therapy.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.
authors.forename: Blake A
authors.initials: BA
authors.lastname: Spindler
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Bergquist
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Cornelius A
authors.initials: CA
authors.lastname: Thiels
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Kelley
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA. Mathis.kellie@mayo.edu.
authors.forename: Kellie L
authors.initials: KL
authors.lastname: Mathis
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood*; D003110:Colonic Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen
keywords: CEA; Colon cancer; Risk stratification; Staging