Prediction of postoperative survival by preoperative serum concentrations of anti-p53 compared to CEA, CA 50, CA 242 and conventional blood tests in patients with colorectal carcinoma.

Blood samples were obtained preoperatively from 151 consecutive patients who were operated for colorectal carcinoma; of these 132 patients underwent curatively aimed operations. Patients who lived for more than five years without any evidence of relapse were classified as survivors and those who died during follow-up were classified as non-survivors. Tumors were staged according to Dukes and tumor differentiation was classified as high, intermediate or low. Serum anti-p53 was determined in all patients and compared to CEA, CA 50 and CA 242 in serum as well as to blood hemoglobin concentration (Hb), erythrocyte sedimentation rate (ESR), serum alkaline phosphatases (ALP), in the same preoperative blood samples for comparison of power to predict mortality in colorectal cancer. Tumor differentiation and Dukes classification predicted survival and the risk to die of colorectal carcinoma as expected. CA 242 and anti-p53 titers in serum were not significantly different among groups of patients with Dukes A-D tumors, while Hb, ESR, ALP, CEA and CA 50 were significantly different with increasing levels appearing in Dukes C-D, except for Hb which decreased. Survivors had lower ESR, ALP, CEA, CA 50 and CA 242, while Hb and serum anti-p53 titers were not different among survivors and non-survivors. Survivors among Dukes A-C patients had normal Hb, ESR, ALP and CA 242 before operation, while non-survivors had increased ESR, CEA and CA 50. Levels of anti-p53 were unrelated to concentrations of all other blood and serum variables, and did not predict survival in Dukes A-D patients. Serum levels of CEA and CA 50 displayed a significantly altered distribution among survivors and non-survivors (p<0.01). This altered distribution was independent of Dukes A-C tumor stage for CEA (p<0.05) but not for CA 50. Based on these results, we conclude that patients with CEA levels above 15 ng/ml should be regarded as high risk patients even when their tumors are classified as Dukes B. These patients may benefit from neoadjuvant or adjuvant chemotherapy.