Kim Chang Gon, Ahn Joong Bae, Jung Minkyu, Beom Seung Hoon, Heo Su Jin, Kim Jee Hung, Kim Young Jin, Kim Nam Kyu, Min Byung Soh, Koom Woong Sub, Kim Hoguen, Roh Yun Ho, Ma Bo Gyoung, Shin Sang Joon
Department of Medical Oncology, Yonsei Cancer Center, Seoul, Korea.
Graduate School of Medical Science and Engineering, KAIST, Daejeon, Korea.
Ann Surg Oncol. 2017 Jan;24(1):227-235. doi: 10.1245/s10434-016-5613-5. Epub 2016 Oct 3.
Carcinoembryonic antigen (CEA) is the most widely used tumor marker in colon cancer; however, there has been controversy regarding the significance of preoperative serum CEA level as a prognostic factor for recurrence. In this study, we evaluated the optimal cutoff value and prognostic significance of preoperative serum CEA level in stage III colon cancer.
Based on a retrospective cohort of 965 patients with stage III colon cancer who underwent elective curative surgery and adjuvant chemotherapy with fluoropyrimidine and oxaliplatin (training set), we determined the optimal cutoff value of CEA for recurrence using the Contal and O'Quigley method. We assessed the prognostic value of this cutoff value in terms of disease-free survival (DFS) and overall survival (OS) in a prospective cohort of 268 patients with stage III colon cancer (validation set). A Cox proportional hazards model was used to explore the association of prognostic variables with DFS and OS.
The statistically determined best cutoff value for CEA was 3 ng/mL in the training set. A high CEA level (≥3 ng/mL) was associated with inferior DFS (hazard ratio [HR] 4.609, 95 % confidence interval [CI] 2.028-10.474) and OS (HR 3.956, 95 % CI 1.127-13.882) in the validation set, while multivariate analysis showed that a high CEA level was an independent risk factor for DFS and OS in both study subsets.
Preoperative serum CEA level is an independent prognostic factor for DFS and OS in patients with stage III colon cancer after curative resection and adjuvant chemotherapy.
癌胚抗原（CEA）是结肠癌中应用最广泛的肿瘤标志物；然而，术前血清CEA水平作为复发的预后因素的意义一直存在争议。在本研究中，我们评估了III期结肠癌术前血清CEA水平的最佳临界值及预后意义。
基于965例行择期根治性手术并接受氟嘧啶和奥沙利铂辅助化疗的III期结肠癌患者的回顾性队列（训练集），我们采用Contal和O'Quigley方法确定CEA复发的最佳临界值。我们在268例III期结肠癌患者的前瞻性队列（验证集）中评估了该临界值在无病生存期（DFS）和总生存期（OS）方面的预后价值。采用Cox比例风险模型探讨预后变量与DFS和OS的关联。
训练集中CEA的统计学最佳临界值为3 ng/mL。在验证集中，高CEA水平（≥3 ng/mL）与较差的DFS（风险比[HR] 4.609，95%置信区间[CI] 2.028 - 10.474）和OS（HR 3.956，95% CI 1.127 - 13.882）相关，而多变量分析显示高CEA水平在两个研究亚组中都是DFS和OS的独立危险因素。
术前血清CEA水平是III期结肠癌患者根治性切除及辅助化疗后DFS和OS的独立预后因素。
