Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Cancer Res Clin Oncol. 2013 Sep;139(9):1449-55. doi: 10.1007/s00432-013-1459-4. Epub 2013 Jun 14.
The aim of this study was to determine which clinicopathological factors influenced the long-term survival after potentially curative resection of colorectal cancer patients with a normal preoperative serum level of carcinoembryonic antigen (CEA).
A total of 1,732 patients who underwent curative surgery for primary nonmetastatic colorectal cancers from 1997 to 2009 were analyzed. Of these patients, 1,128 (65.1 %) had normal level of preoperative CEA (<5 ng/mL). The predicting factors for survival were analyzed.
When the serum CEA cutoff value was set at 2.4 ng/mL (median value), the high CEA groups displayed a higher percentage of older patients, males, large-diameter tumors, advanced T and N categories, and positive perineural invasion, compared to the low CEA groups. Multivariate analysis revealed that age, T category, N category, number of lymph nodes retrieved, operative method, lymphovascular invasion, perineural invasion, postoperative chemotherapy, and preoperative serum CEA level ≥ 2.4 ng/mL were independent predictors for 5-year overall survival, while tumor location, tumor size, T category, N category, lymphovascular invasion, and perineural invasion were independent predictors for 5-year disease-free survival.
Even if patients with colorectal cancer have a normal preoperative CEA before surgery, CEA may be useful for prognostic stratification using 2.4 ng/mL as the cutoff.
本研究旨在确定哪些临床病理因素会影响术前癌胚抗原（CEA）水平正常的结直肠癌患者接受根治性手术后的长期生存。
分析了 1997 年至 2009 年间接受初次非转移性结直肠癌根治性手术的 1732 例患者。其中 1128 例（65.1%）术前 CEA 水平正常（<5ng/mL）。分析了生存的预测因素。
当血清 CEA 截断值设定为 2.4ng/mL（中位数）时，高 CEA 组较低 CEA 组患者年龄更大、男性比例更高、肿瘤直径更大、T 和 N 分期更晚、神经周围侵犯阳性的比例更高。多因素分析显示，年龄、T 分期、N 分期、淋巴结检出数、手术方式、血管淋巴管侵犯、神经周围侵犯、术后化疗和术前 CEA 水平≥2.4ng/mL 是 5 年总生存的独立预测因素，而肿瘤位置、肿瘤大小、T 分期、N 分期、血管淋巴管侵犯和神经周围侵犯是 5 年无病生存的独立预测因素。
即使术前 CEA 水平正常，CEA 仍可用作 2.4ng/mL 的截断值来进行预后分层。
