Evaluating the Prognostic Role of Elevated Preoperative Carcinoembryonic Antigen Levels in Colon Cancer Patients: Results from the National Cancer Database
Evaluating the Prognostic Role of Elevated Preoperative Carcinoembryonic Antigen Levels in Colon Cancer Patients: Results from the National Cancer Database
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DOI：
10.1245/s10434-015-5014-1
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发表时间：
2016-05-01
影响因子：
3.7
通讯作者：
Fleming, Fergal J.
中科院分区：
文献类型：
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作者：
Becerra, Adan Z.;Probst, Christian P.;Fleming, Fergal J.
癌胚抗原（CEA）是一种可靠的肿瘤标记物，用于结肠癌的管理和监测。然而，在以前的研究的局限性，很难阐明是否CEA应建立作为一个预后指标。本研究通过一项全国性的基于人群的登记研究，探讨了术前CEA水平升高与结肠癌患者总生存率之间的关系。I-III期结肠癌患者来自2004-2006年国家癌症数据库。多变量考克斯比例风险模型被用来评估在控制了重要的患者、医院和肿瘤特征后，CEA水平升高与总生存率之间的关系。使用蒙特卡罗马尔可夫链对大量缺失的CEA数据进行插补。所有模型均对倾向评分进行控制，以考虑选择偏倚。共有137，381例患者符合纳入标准。总体而言，34%的患者CEA水平升高，66%的患者CEA水平正常，中位生存期分别为70和100个月。与CEA水平正常的患者相比，CEA水平升高的患者的死亡风险增加62%（HR 1.62，95%CI 1.53-1.74）。研究结果支持将CEA水平作为另一个高风险特征的建议，临床医生可以使用它来指导患者进行辅助化疗，特别是对于II期患者。
Carcinoembryonic antigen (CEA) is a reliable tumor marker for the management and surveillance of colon cancer. However, limitations in previous studies have made it difficult to elucidate whether CEA should be established as a prognostic indicator. This study examines the association between elevated preoperative CEA levels and overall survival in colon cancer patients using a national population-based registry.Stage I-III colon cancer patients were identified from the 2004-2006 National Cancer Database. A multivariable Cox proportional hazards model was used to estimate the association between elevated CEA levels and overall survival after controlling for important patient, hospital, and tumor characteristics. A Monte Carlo Markov Chain was used to impute the large degree of missing CEA data. All models controlled for the propensity score in order to account for selection bias.A total of 137,381 patients met the inclusion criteria. Overall, 34 % of patients had an elevated CEA level and 66 % had a normal CEA level, with a median survival of 70 and 100 months, respectively. Patients with an elevated CEA level had a 62 % increase in the hazard of death (HR 1.62, 95 % CI 1.53-1.74) compared with patients with a normal CEA level.Preoperative CEA was an independent predictor of overall survival across all stages. The results support recommendations to include CEA levels as another high-risk feature that clinicians can use to counsel patients on adjuvant chemotherapy, especially for stage II patients.