Key result
Elevated preoperative CEA levels (≥5 ng/ml) were independently associated with a 98% increased risk of overall mortality (HR 1.98) compared to normal levels in patients with stage I-III rectal cancer.
Why the study?
Does elevated preoperative CEA level predict worse overall survival in patients with stage I-III rectal cancer?
Cohort (n=504)
No
Does elevated preoperative CEA level predict worse overall survival in patients with stage I-III rectal cancer?
Hazard Ratio: 1.98 (95% CI 1.36–2.9)
Absolute Event Rate: 46.7% vs 81%
p-value: p=<0.001
Elevated preoperative CEA level (≥5 ng/ml) is a strong independent predictor of decreased overall and disease-free survival in patients with stage I-III rectal cancer.
Supports preoperative CEA for prognostication in stage I-III rectal cancer; hypothesis-generating pending prospective validation.
BACKGROUND: The objective of this investigation was to assess whether preoperative carcinoembryonic antigen (CEA) level is an independent predictor of overall survival in rectal cancer patients. METHODS: All patients (n=504) undergoing a resection for stage I-III rectal cancer at the Kantonsspital St Gallen were included into a database between 1991 and 2008. The impact of preoperative CEA level on overall survival was assessed using risk-adjusted Cox proportional hazard regression models and propensity score methods. RESULTS: In risk-adjusted Cox proportional hazard regression analyses, preoperative CEA level (hazard ratio (HR): 1.98, 95% confidence interval (CI): 1.36-2.90, P<0.001), distance from anal verge (<5 cm: HR: 1.93, 95% CI: 1.11-3.37; P=0.039), older age (HR: 1.07, 95% CI: 1.05-1.09; P<0.001), lower body mass index (HR: 0.94, 95% CI: 0.89-0.98; P=0.006), advanced tumour stage (stage II HR: 1.41, 95% CI: 0.85-2.32; stage III HR: 2.08, 95% CI: 1.31-3.31; P=0.004), R 1 resection (HR: 5.65, 95% CI: 1.59-20.1; P=0.005) and chronic kidney disease (HR: 2.28, 95% CI: 1.03-5.04; P=0.049) were all predictors for poor overall survival. CONCLUSION: This is one of the first investigations based on a large cohort of exclusively rectal cancer patients demonstrating that preoperative CEA level is a strong predictor of decreased overall survival. Preoperative CEA should be used as a prognostic factor in the preoperative assessment of rectal cancer patients.
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Tarantino et al. (2012) conducted a cohort in Stage I-III rectal cancer (n=504). Elevated preoperative CEA (≥5 ng/ml) vs. Normal preoperative CEA (<5 ng/ml) was evaluated on Overall mortality (HR 1.98, 95% CI 1.36-2.90, p=<0.001). Elevated preoperative CEA levels (≥5 ng/ml) were independently associated with a 98% increased risk of overall mortality (HR 1.98) compared to normal levels in patients with stage I-III rectal cancer.
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