Lee Soo Young, Jo Jeong Seon, Kim Hun Jin, Kim Chang Hyun, Ju Jae-Kyun, Kim Young Jin, Kim Hyeong Rok
Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun Jeonnam, 519-763, Hwasun, South Korea.
Int J Colorectal Dis. 2015 Jan;30(1):63-9. doi: 10.1007/s00384-014-2053-1. Epub 2014 Nov 1.
The aim of this study is to investigate the clinicopathologic features and oncologic outcomes of colorectal cancer patients with extremely elevated (≥50 ng/mL) preoperative serum carcinoembryonic antigen (CEA) levels.
We enrolled 756 primary colorectal cancer patients with elevated preoperative CEA levels (≥5 ng/mL) who underwent surgery between 2004 and 2010 and compared clinicopathologic features according to preoperative CEA levels of 5-50 ng/mL (n = 676) and ≥50 ng/mL (n = 80). The impact of extremely elevated CEA on overall survival (OS) and disease-free survival (DFS) was analyzed using Kaplan-Meier analysis and the Cox proportional hazards model.
The median follow-up period was 43 months (range, 0-121). Patients with preoperative CEA ≥50 ng/mL demonstrated higher rates of advanced T stage (97.3 vs. 88.6%, p = 0.016) and distant metastasis (33.8 vs. 17.9%, p = 0.002), but not lymph node metastasis (54.1 vs. 52.2%, p = 0.807). The 5-year OS rate was 69.1%, and the 3-year DFS rate of curatively resected patients (n = 641; 84.8%) was 68.9%. In multivariate analysis, preoperative CEA ≥50 ng/mL, as well as age, N stage, vascular invasion, perineural invasion, post/preoperative CEA ratio ≥0.32, and palliative resection, was an independent predictor of OS. However, for patients treated with curative resection, preoperative CEA ≥50 ng/mL was not significantly associated with DFS or OS (p = 0.053 and 0.157, respectively).
Colorectal cancer patients with extremely elevated (≥50 ng/mL) preoperative CEA had advanced disease more frequently but comparable oncologic outcomes if curative resection was performed.
本研究旨在调查术前血清癌胚抗原（CEA）水平极度升高（≥50 ng/mL）的结直肠癌患者的临床病理特征及肿瘤学转归。
我们纳入了2004年至2010年间接受手术的756例术前CEA水平升高（≥5 ng/mL）的原发性结直肠癌患者，并根据术前CEA水平5 - 50 ng/mL（n = 676）和≥50 ng/mL（n = 80）比较临床病理特征。使用Kaplan-Meier分析和Cox比例风险模型分析CEA极度升高对总生存期（OS）和无病生存期（DFS）的影响。
中位随访期为43个月（范围0 - 121个月）。术前CEA≥50 ng/mL的患者表现出更高的T分期进展率（97.3%对88.6%，p = 0.016）和远处转移率（33.8%对17.9%，p = 0.002），但淋巴结转移率无差异（54.1%对52.2%，p = 0.807）。5年总生存率为69.1%，根治性切除患者（n = 641；84.8%）的3年无病生存率为68.9%。多因素分析显示，术前CEA≥50 ng/mL以及年龄、N分期、血管侵犯、神经周围侵犯、术前/术后CEA比值≥0.32和姑息性切除是总生存期的独立预测因素。然而，对于接受根治性切除的患者，术前CEA≥50 ng/mL与无病生存期或总生存期无显著相关性（分别为p = 0.053和0.157）。
术前CEA极度升高（≥50 ng/mL）的结直肠癌患者疾病进展更频繁，但如果进行根治性切除，其肿瘤学转归相当。
