Early Postoperative Serum Carcinoembryonic Antigen Is a Stronger Independent Prognostic Factor for Stage II Colorectal Cancer Patients Than T4 Stage and Preoperative CEA.
Early Postoperative Serum Carcinoembryonic Antigen Is a Stronger Independent Prognostic Factor for Stage II Colorectal Cancer Patients Than T4 Stage and Preoperative CEA.
复制标题
DOI：
10.3389/fonc.2021.758509
复制
发表时间：
2021
影响因子：
4.7
通讯作者：
Yanlong L
中科院分区：
文献类型：
--
作者：
Fenqi D;Yupeng L;Qiuju Z;Chao Y;Wenjie S;Tianyi X;Junnan G;Weinan X;Xiufeng J;Junge B;Chenyang J;Hua X;Yien L;Xuefeng B;Yanlong L
血清癌胚抗原（CEA）是结直肠癌诊断、预后、复发、转移监测及评价化疗效果的重要生物标志物。然而，很少有研究关注术后早期CEA在II期CRC预后中的作用。纳入了2007年1月至2015年12月期间诊断为II期CRC的患者。采用受试者工作特征曲线（ROC）求出术后早期CEA的截断值、CEA比值和CEA绝对值。用曲线下面积（AUC）评价CEA和T分期的预测能力。采用逐步回归方法筛选纳入考克斯回归分析的因素。采用倾向评分（PS）调整前后的考克斯回归和敏感性分析，探讨术后早期CEA与预后的关系。并进行Meta分析验证。采用Kaplan-Meier生存曲线评价CEA对预后的影响。我们纳入了1081例符合条件的患者。ROC曲线显示术后早期CEA的临界值为3.66ng/ml（P <0.001），AUC显示术后早期CEA是II期大肠癌最有意义的预后指标（P = 0.0189）。校正PS前后的考克斯回归和敏感性分析均显示术后早期CEA升高是OS、DFS和CSS的最强独立预后因素（P < 0.001）。术后早期CEA升高者的OS（53.62% VS 84.16%）、DFS（50.03% VS 86.75%）和CSS（61.77% VS 90.30%）均低于术后早期CEA正常者（P < 0.001）。当术后CEA阳性时，术前CEA水平对患者的预后无显著影响（所有P值均> 0.05）。CEA比值≤0.55或CEA绝对值≤-0.98的患者预后较差（所有P值均< 0.001）。生存分析表明，术后早期CEA升高的II期CRC患者的辅助化疗可改善CSS（P = 0.040）。与T分期和术前CEA相比，术后早期CEA是判断II期结直肠癌患者预后的更好的生物标志物，有可能成为指导II期结直肠癌患者预后和治疗的高危因素。
Serum carcinoembryonic antigen (CEA) is an important biomarker for diagnosis, prognosis, recurrence, metastasis monitoring, and the evaluation of the effect of chemotherapy in colorectal cancer (CRC). However, few studies have focused on the role of early postoperative CEA in the prognosis of stage II CRC. Patients with stage II CRC diagnosed between January 2007 and December 2015 were included. Receiver operating characteristic (ROC) curves were used to obtain the cutoff value of early postoperative CEA, CEA ratio and CEA absolute value. The areas under curves (AUCs) were used to estimate the predictive abilities of the CEA and T stage. The stepwise regression method was used to screen the factors included in the Cox regression analysis. Before and after propensity score (PS) - adjusted Cox regression and sensitivity analysis were used to identify the relationship between early postoperative CEA and prognosis. Meta-analysis was performed to verify the results. Kaplan-Meier survival curves were used to estimate the effects of CEA on prognosis. We included 1081 eligible patients. ROC curves suggested that the cutoff value of early postoperative CEA was 3.66 ng/ml (P <0.001) and the AUC showed early postoperative CEA was the most significant prognostic marker in stage II CRC (P = 0.0189). The Cox regression and sensitivity analysis before and after adjusting for PS both revealed elevated early postoperative CEA was the strongest independent prognostic factor of OS, DFS, and CSS (P < 0.001). Survival analysis revealed that patients with elevated early postoperative CEA had lower OS (53.62% VS 84.16%), DFS (50.03% VS 86.75%), and CSS (61.77% VS 90.30%) than patients with normal early postoperative CEA (P < 0.001). When the postoperative CEA was positive, the preoperative CEA level showed no significant effect on the patient’s prognosis (all P-values were > 0.05). Patients with a CEA ratio ≤0.55 or CEA absolute value ≤-0.98 had a worse prognosis (all P-values were < 0.001). Survival analysis suggested that adjuvant chemotherapy for stage II CRC patients with elevated early postoperative CEA may improve the CSS (P = 0.040). Early postoperative CEA was a better biomarker for prognosis of stage II CRC patients than T stage and preoperative CEA, and has the potential to become a high-risk factor to guide the prognosis and treatment of stage II CRC patients.
登录
查看更多内容
影响因子：
6.2
作者：
Casadaban, Leigh;Rauscher, Garth;Aklilu, Mebea;Villenes, Dana;Freels, Sally;Maker, Ajay V.
通讯作者：
Maker, Ajay V.
影响因子：
8.8
作者：
Kim CG;Ahn JB;Jung M;Beom SH;Kim C;Kim JH;Heo SJ;Park HS;Kim JH;Kim NK;Min BS;Kim H;Koom WS;Shin SJ
通讯作者：
Shin SJ
影响因子：
6.4
作者：
Duffy, M. J.;Lamerz, R.;Haglund, C.;Nicolini, A.;Kalousova, M.;Holubec, L.;Sturgeon, C.
通讯作者：
Sturgeon, C.
影响因子：
3.7
作者：
Park, In Ja;Choi, Gyu-Seog;Jun, Soo Han
通讯作者：
Jun, Soo Han
影响因子：
5.6
作者：
Mármol I;Sánchez-de-Diego C;Pradilla Dieste A;Cerrada E;Rodriguez Yoldi MJ
通讯作者：
Rodriguez Yoldi MJ