Preoperative Carcinoembryonic Antigen as a Poor Prognostic Factor in Stage I-III Colorectal Cancer After Curative-Intent Resection: A Propensity Score Matching Analysis
Preoperative Carcinoembryonic Antigen as a Poor Prognostic Factor in Stage I-III Colorectal Cancer After Curative-Intent Resection: A Propensity Score Matching Analysis
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DOI：
10.1245/s10434-019-07184-3
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发表时间：
2019-06-01
影响因子：
3.7
通讯作者：
Chen, Jinn-Shiun
中科院分区：
文献类型：
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作者：
Huang, Shu-Huan;Tsai, Wen-Sy;Chen, Jinn-Shiun
背景术前癌胚抗原（CEA）尚未被用作结直肠癌（CRC）的预后或辅助化疗因素。MethodsThis回顾性队列研究包括1995年至2010年期间在一个单一中心的所有I-III期CRC患者，术前血清CEA水平不同（5、5-10和> 10 ng/ml）。CEA升高组（5- 10 ng/ml和> 10 ng/ml）与未升高组（5 ng/ml）按1：2比例进行配对，卡尺为0.05。结果经排除配对后，术前CEA <5 ng/ml者3857例，<5 - 10 ng/ml者1121例，> 10 ng/ml者1121例。术前CEA升高显示总生存风险增加（5- 10 ng/ml：风险比[HR] 1.376;> 10 ng/ml：HR 1.523;均为p10 ng/ml：HR 1.712;均为p10 ng/ml：HR 1.468;均为p10 ng/ml，以及阳性LN和CEA 5 ng/ml的患者，显示出相似的总生存率（5年生存率：72% vs. 69%; P=0.542）和无复发间隔（19.9 vs.21.72个月; P=0.662）。结论术前CEA水平可作为I-III期结直肠癌根治性切除术后的独立预后因素。淋巴结阴性且术前CEA> 10 ng/ml的患者应考虑加强随访或辅助化疗。
BackgroundPreoperative carcinoembryonic antigen (CEA) has yet to be used as a prognostic or adjuvant chemotherapy factor for colorectal cancer (CRC).MethodsThis retrospective cohort study included all stage I-III CRC patients with different preoperative serum CEA levels (5, 5-10, and>10ng/ml) at a single center between 1995 and 2010. Propensity score matching was performed in a 1:1 ratio between the two elevated CEA groups (5-10ng/ml and>10ng/ml) and in a 1:2 ratio between the elevated and non-elevated groups (5ng/ml), with a caliper of 0.05.ResultsAfter exclusion and matching, 3857 patients had preoperative CEA levels5ng/ml, 1121 patients had CEA levels between 5 and 10ng/ml, and 1121 patients had CEA levels>10ng/ml. Elevated preoperative CEA showed an increased risk of overall survival (5-10ng/ml: hazard ratio [HR] 1.376;>10ng/ml:HR1.523; both p10ng/ml:HR1.712; both p10ng/ml:HR 1.468; both p10ng/ml, as well as those with positive LNs and CEA5ng/ml, showed similar overall survival (5-year survival: 72% vs. 69%; p=0.542) and recurrence free intervals (19.9 vs. 21.72months; p=0.662).ConclusionsA preoperative CEA level can be an independent prognostic factor for stage I-III CRC after curative resection. Patients with negative LNs and preoperative CEA level>10ng/ml should be considered for intensive follow-up or adjuvant chemotherapy.