Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Department of Hematology and Oncology, Cleveland Clinic Florida, Weston, FL, USA.
Colorectal Dis. 2021 Jun;23(6):1346-1356. doi: 10.1111/codi.15583. Epub 2021 Feb 25.
The aim of this work was to evaluate whether normalized carcinoembryonic antigen (CEA) following neoadjuvant chemoradiation predicts the prognosis following curative resection in locally advanced rectal cancer.
Patients who underwent neoadjuvant chemoradiation and curative resection for locally advanced rectal cancer between 2010 and 2015 were divided into three groups: Group A (n = 119, normal-to-normal): normal CEA before and after neoadjuvant chemoradiation; Group B (n = 37, high-to-normal): elevated CEA before and normal CEA after neoadjuvant chemoradiation; Group C (n = 36, high-to-high): elevated CEA before and after neoadjuvant chemoradiation. Overall and disease-free survival were compared. Univariate and multivariate analyses identified potential predictors for recurrence.
One hundred and ninety two patients [median age 59 years (range 31-87), 65.1% male] were identified: 54.7% had low rectal cancer: 12.5% were clinical stage T4 and 70.3% were clinically node positive; 21.9% achieved complete pathological response; 24.5% had abdominoperineal resection (APR); and 70.3% underwent adjuvant chemotherapy following curative resection. Significantly more patients in Group C underwent APR (p = 0.0209), had advanced pathological T stage (P = 0.0065) and a higher prevalence of perineural invasion (p = 0.0042). Overall and disease-free survival were significantly higher for Group A than for Group C [hazard ratio (HR) = 4.32, 95% CI = 1.66-11.21, p = 0.0026 and HR=2.68, 95% CI = 1.33-5.40, p = 0.0057, respectively]. No significant difference was noted between Groups A and B for overall (p = 0.0591) or disease-free (p = 0.2834) survival. Another risk factor associated with recurrence and death was clinical T4 stage; nodal positivity was a risk factor only for recurrence.
Elevated CEA after neoadjuvant chemoradiation and clinical stage T4 disease were unfavourable predictors for overall and disease-free survival. Normalized CEA during neoadjuvant chemoradiation may serve as a prognosticator, although pretreatment CEA may significantly affect survival.
本研究旨在评估新辅助放化疗后正常化的癌胚抗原（CEA）能否预测局部晚期直肠癌根治性切除术后的预后。
2010 年至 2015 年间，接受新辅助放化疗和局部晚期直肠癌根治性切除术的患者分为三组：A 组（n=119，正常-正常）：新辅助放化疗前后 CEA 正常；B 组（n=37，高-正常）：新辅助放化疗前 CEA 升高，新辅助放化疗后 CEA 正常；C 组（n=36，高-高）：新辅助放化疗前后 CEA 升高。比较总生存期和无病生存期。单因素和多因素分析确定了复发的潜在预测因素。
共纳入 192 例患者[中位年龄 59 岁（范围 31-87），65.1%为男性]：54.7%为低位直肠癌；12.5%为临床 T4 期，70.3%为临床淋巴结阳性；21.9%达到完全病理缓解；24.5%接受腹会阴联合切除术（APR）；70.3%在根治性切除术后接受辅助化疗。C 组患者中接受 APR 的比例明显更高（p=0.0209），且病理 T 分期更晚（P=0.0065）和神经周围侵犯的发生率更高（p=0.0042）。A 组患者的总生存期和无病生存期明显高于 C 组[风险比（HR）=4.32，95%置信区间（CI）=1.66-11.21，p=0.0026 和 HR=2.68，95% CI=1.33-5.40，p=0.0057]。A 组和 B 组患者的总生存期（p=0.0591）或无病生存期（p=0.2834）无显著差异。另一个与复发和死亡相关的危险因素是临床 T4 期；淋巴结阳性仅与复发相关。
新辅助放化疗后 CEA 升高和临床 T4 期疾病是总生存期和无病生存期的不利预测因素。新辅助放化疗期间 CEA 正常化可能是一种预后指标，尽管术前 CEA 可能显著影响生存。
