Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
PLoS One. 2020 Jun 5;15(6):e0233687. doi: 10.1371/journal.pone.0233687. eCollection 2020.
Serum carcinoembryonic antigen (CEA) levels can help predict the prognosis of colorectal cancer patients. Accordingly, high preoperative CEA levels that is not restored after surgery are indicative of a worse outcome. On the other hand, smoking can increase serum CEA levels independently of the disease status. Thus, we aimed to evaluate the impact of smoking on the prognostic value of serum CEA levels. This retrospective cohort study included 273 patients who underwent curative resection for stage I-III colorectal adenocarcinoma at a single institution, between January 2010 and December 2017. Patients were grouped as follows: group A, normal preoperative and postoperative CEA levels (n = 152); group B, elevated preoperative CEA levels that returned to reference values after surgery (n = 69); and group C, elevated postoperative serum CEA levels (n = 52). Patients were also grouped according to their smoking history: group S (current smokers, n = 79) and group NS (never and former smokers, n = 194). Group A showed a higher 3-year disease-free survival (DFS) rate (84.9%) than groups B (75.4%) and C (62.0%) (p < 0.001). Postoperative serum CEA levels were significantly higher in the S group than in the NS group (2.6 vs. 3.1 ng/mL, p = 0.009), whereas preoperative levels were similar (3.8 vs. 4.1, p = 0.182). Further, smokers showed higher 3 year-DFS rates than nonsmokers in group C (83.3% vs. 43.9%, p = 0.029). This suggests that while elevated postoperative CEA levels are associated with lower DFS rates in never and former smokers, they are not associated with lower DFS rates in current smokers. We conclude that persistent smoking alters the prognostic value of postoperative serum CEA levels in colorectal cancer patients and that, consequently, alternative surveillance strategies need to be developed for colon cancer patients with smoking habits.
血清癌胚抗原（CEA）水平有助于预测结直肠癌患者的预后。因此，术前 CEA 水平升高且术后未恢复正常提示预后不良。另一方面，吸烟可独立于疾病状态增加血清 CEA 水平。因此，我们旨在评估吸烟对血清 CEA 水平预后价值的影响。本回顾性队列研究纳入了 2010 年 1 月至 2017 年 12 月期间在一家机构接受 I-III 期结直肠腺癌根治性切除术的 273 例患者。患者分为以下三组：A 组，术前和术后 CEA 水平正常（n = 152）；B 组，术前 CEA 水平升高，但术后恢复至参考值（n = 69）；C 组，术后血清 CEA 水平升高（n = 52）。根据吸烟史将患者分为 S 组（现吸烟者，n = 79）和 NS 组（从不吸烟者和既往吸烟者，n = 194）。A 组患者的 3 年无病生存率（DFS）为 84.9%，高于 B 组（75.4%）和 C 组（62.0%）（p < 0.001）。S 组术后血清 CEA 水平明显高于 NS 组（2.6 与 3.1 ng/mL，p = 0.009），而术前水平相似（3.8 与 4.1，p = 0.182）。此外，在 C 组中，吸烟者的 3 年 DFS 率高于非吸烟者（83.3%与 43.9%，p = 0.029）。这表明，在从不吸烟者和既往吸烟者中，术后 CEA 水平升高与 DFS 率降低相关，但在现吸烟者中则不相关。我们得出结论，持续吸烟改变了结直肠癌患者术后血清 CEA 水平的预后价值，因此，需要为有吸烟习惯的结直肠癌患者制定替代监测策略。
