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Combination of carcinoembryonic antigen with the American Joint Committee on Cancer TNM staging system in rectal cancer: a real-world and large population-based study

Authors Liu Q, Lian P, Luo D, Cai S, Li Q, Li X

Received 17 April 2018

Accepted for publication 14 July 2018

Published 13 September 2018 Volume 2018:11 Pages 5827—5834


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Leo Jen-Liang Su

Qi Liu,1,2,* Peng Lian,1,2,* Dakui Luo,1,2 Sanjun Cai,1,2 Qingguo Li,1,2 Xinxiang Li1,2

1Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

*These authors contributed equally to this work

Aim: This study assessed the combination of carcinoembryonic antigen (CEA) with the American Joint Committee on Cancer (AJCC) TNM staging system, aiming to improve the AJCC TNM staging system, in terms of prognostic accuracy and clinical management of rectal cancer.
Methods: Eligible patients (N=22,132) were selected from the Surveillance, Epidemiology, and End Results database between January 1, 2004, and December 31, 2010. Patients with elevated CEA levels were designated as “C1 stage” and those with normal CEA amounts as “C0 stage”. The outcome of interest was cancer-specific survival (CSS). Cox proportional hazards regression analyses and Kaplan–Meier curves were used to identify independent prognostic factors and analyze the odds of CSS in patients with rectal cancer in different C and TNM stages, respectively.
Results: C1 stage was associated with a 61.0% risk increase in cancer-specific mortality (HR=1.610, 95% CI=1.219–1.705, P<0.001). In addition, C0-stage patients showed improved CSS compared with C1-stage counterparts. In addition, CSS was improved in stage IIB–C0 patients (HR=2.478, 95% CI=1.660–3.699) compared with stage IIIB–C1 patients (HR=2.431, 95% CI=2.021–2.924) or IIIA–C1 patients (HR=1.060, 95% CI=0.823–1.366, P=0.650) and stage IIC–C0 patients (HR=4.263, 95% CI=3.308–5.493) compared with stage IIIB–C1 or IIIA–C1 counterparts.
Conclusion: C stage is an independent prognostic factor of rectal cancer. The improved prognostic precision of the C–TNM staging system and, thus, more individualized risk-adaptive treatments support the incorporation of C stage into the AJCC TNM staging system in rectal cancer.

Keywords: C-stage, AJCC, rectal cancer, SEER

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