Huang Chih-Sheng, Lin Jen-Kou, Wang Ling-Wei, Liang Wen-Yih, Lin Chun-Chi, Lan Yuan-Tzu, Wang Huann-Sheng, Yang Shung-Haur, Jiang Jeng-Kai, Chen Wei-Shone, Lin Tzu-Chen, Chang Shih-Ching
Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2. Shih-Pai Road, Taipei 11217, Taiwan; School of Medicine, National Yang-Ming University, Taiwan.
School of Medicine, National Yang-Ming University, Taiwan; Cancer Center, Taipei Veterans General Hospital, Taiwan.
Am J Surg. 2014 Jul;208(1):99-105. doi: 10.1016/j.amjsurg.2013.08.054. Epub 2014 Jan 16.
Carcinoembryonic antigen (CEA) is the most widely used tumor marker for colorectal cancer. This study aimed to investigate the role of CEA reduction ratio after preoperative chemoradiotherapy (CRT).
We enrolled 284 patients who underwent preoperative CRT followed by radical surgical resection. Patients were divided into 3 groups: serum CEA levels before CRT (pre-CRT CEA) less than 5 ng/mL (group 1); pre-CRT CEA of 5 ng/mL or more with CEA reduction ratio of 50% or more (group 2); and pre-CRT CEA of 5 ng/mL or more with CEA reduction ratio less than 50% (group 3).
The 5-year disease-free survival (DFS) rate was not different between groups 1 (71.8%) and 2 (69.4%) but was significantly lower in group 3 (49.5%). CEA group, lymph node status after CRT (ypN) stage, and histologic type were independent prognostic factors for DFS on multivariate analysis.
CEA reduction ratio might be an independent prognostic factor for DFS in rectal cancer patients treated with preoperative CRT and radical surgery.
癌胚抗原（CEA）是结直肠癌最常用的肿瘤标志物。本研究旨在探讨术前放化疗（CRT）后CEA降低率的作用。
我们纳入了284例行术前CRT并随后接受根治性手术切除的患者。患者分为3组：CRT前血清CEA水平（CRT前CEA）低于5 ng/mL（第1组）；CRT前CEA为5 ng/mL或更高且CEA降低率为50%或更高（第2组）；以及CRT前CEA为5 ng/mL或更高且CEA降低率低于50%（第3组）。
第1组（71.8%）和第2组（69.4%）的5年无病生存率（DFS）无差异，但第3组（49.5%）显著更低。多因素分析显示，CEA组、CRT后淋巴结状态（ypN）分期和组织学类型是DFS的独立预后因素。
CEA降低率可能是术前CRT和根治性手术治疗的直肠癌患者DFS的独立预后因素。
