Relationship Between Preoperative and Postoperative Serum Carcinoembryonic Antigen and Prognosis of Patients with Stage I–III Rectal Cancer: A Retrospective Study of a Multicentre Cohort of 1022 Rectal Cancer Patients
Received 6 December 2020
Accepted for publication 17 February 2021
Published 18 March 2021 Volume 2021:13 Pages 2643—2651
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Beicheng Sun
Hongjiang Pu,1,* Peiyi Xie,2,* Yaxue Chen,3,* Yanrong Zhao,4 Xi Ye,5 Guiyu Lu,4 Dafu Zhang,6 Zhenhui Li6
1Department of Oncology, Dazhou Central Hospital, Dazhou, Sichuan, 635000, People’s Republic of China; 2Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, People’s Republic of China; 3Department of Nursing, Dazhou Vocational and Technical College, Dazhou, Sichuan, 635000, People’s Republic of China; 4Department of Colorectal Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Centre, Kunming, 650118, People’s Republic of China; 5Department of Oncology, The First People’s Hospital of Honghe State, Mengzi, 661100, People’s Republic of China; 6Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Centre, Kunming, 650118, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Dafu Zhang; Zhenhui Li
Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Centre, Kunming, Yunnan, 650118, People’s Republic of China
Tel/ Fax +86 87168179594
; +86 87168179549
Email [email protected]; [email protected]
Purpose: Based on a multi-centered and a large sample size, this study aims to analyze the relationship between preoperative and postoperative serum CEA and recurrence of rectal cancer without preoperative therapy.
Methods: This retrospective cohort study enrolled stage I to III rectal cancer patients without preoperative therapy (N = 1,022) who received radical resection of rectal cancer from 2 hospitals in China. Based on the preoperative and postoperative serum carcinoembryonic antigen, the patients were subdivided into 3 groups ie, normal preoperative CEA (≤ 5.0 ng/mL, N = 627), elevated preoperative (> 5.0 ng/mL) but normalized postoperative CEA (normalized postoperative CEA, N = 255), as well as elevated preoperative and postoperative CEA (elevated postoperative CEA, N = 67). The generalized additive model was used to assess the relationship between carcinoembryonic antigen and the risk of recurrence. Further, the Cox regression model was used to evaluate the relationship between carcinoembryonic antigen and 3-year recurrence-free survival (RFS) after adjusting for potential confounders.
Results: The 3-year RFS of patients with elevated postoperative CEA was 45.8% (95% CI, 35.2% − 59.5%), which was significantly lower compared to the other two groups of patients (normalized postoperative CEA: 75.9%, 95% CI, 70.8%-81.4%; and normal preoperative CEA: 84.9%, 95% CI, 82.2%-87.8%) (P < 0.001). Based on multivariable Cox model analysis, the elevated postoperative CEA was a prognostic factor for 3 years RFS (hazard ratio [HR], 3.08; 95% CI, 2.05– 4.66; P< 0.001). At the same time, normalized postoperative CEA was insignificantly correlated with 3-year RFS (HR, 1.38; 95% CI, 1.00– 1.92; P = 0.05) and was not an independent risk factor.
Conclusion: We found that preoperative and postoperative serum CEA of rectal cancer patients were related to the 3-year recurrence-free survival rate. Moreover, the risk of recurrence in the normalized postoperative CEA group of patients was insignificantly different from that of the normalized preoperative CEA patients. Therefore, it is necessary to combine preoperative and postoperative CEA to predict the prognosis of patients with rectal cancer, rather than using it alone.
Keywords: preoperative and postoperative serum CEA, rectal cancer, RFS
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