Pu Hongjiang, Xie Peiyi, Chen Yaxue, Zhao Yanrong, Ye Xi, Lu Guiyu, Zhang Dafu, Li Zhenhui
Department of Oncology, Dazhou Central Hospital, Dazhou, Sichuan, 635000, People's Republic of China.
Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, People's Republic of China.
Cancer Manag Res. 2021 Mar 18;13:2643-2651. doi: 10.2147/CMAR.S290416. eCollection 2021.
Based on a multi-centered and a large sample size, this study aims to analyze the relationship between preoperative and postoperative serum CEA and recurrence of rectal cancer without preoperative therapy.
This retrospective cohort study enrolled stage I to III rectal cancer patients without preoperative therapy (N = 1,022) who received radical resection of rectal cancer from 2 hospitals in China. Based on the preoperative and postoperative serum carcinoembryonic antigen, the patients were subdivided into 3 groups ie, normal preoperative CEA (≤5.0 ng/mL, N = 627), elevated preoperative (>5.0 ng/mL) but normalized postoperative CEA (normalized postoperative CEA, N = 255), as well as elevated preoperative and postoperative CEA (elevated postoperative CEA, N = 67). The generalized additive model was used to assess the relationship between carcinoembryonic antigen and the risk of recurrence. Further, the Cox regression model was used to evaluate the relationship between carcinoembryonic antigen and 3-year recurrence-free survival (RFS) after adjusting for potential confounders.
The 3-year RFS of patients with elevated postoperative CEA was 45.8% (95% CI, 35.2% -59.5%), which was significantly lower compared to the other two groups of patients (normalized postoperative CEA: 75.9%, 95% CI, 70.8%-81.4%; and normal preoperative CEA: 84.9%, 95% CI, 82.2%-87.8%) (P <0.001). Based on multivariable Cox model analysis, the elevated postoperative CEA was a prognostic factor for 3 years RFS (hazard ratio [HR], 3.08; 95% CI, 2.05-4.66; P<0.001). At the same time, normalized postoperative CEA was insignificantly correlated with 3-year RFS (HR, 1.38; 95% CI, 1.00-1.92; P = 0.05) and was not an independent risk factor.
We found that preoperative and postoperative serum CEA of rectal cancer patients were related to the 3-year recurrence-free survival rate. Moreover, the risk of recurrence in the normalized postoperative CEA group of patients was insignificantly different from that of the normalized preoperative CEA patients. Therefore, it is necessary to combine preoperative and postoperative CEA to predict the prognosis of patients with rectal cancer, rather than using it alone.
基于多中心、大样本量，本研究旨在分析术前和术后血清癌胚抗原（CEA）与未经术前治疗的直肠癌复发之间的关系。
本回顾性队列研究纳入了中国两家医院的1022例未经术前治疗的Ⅰ至Ⅲ期直肠癌患者，这些患者均接受了直肠癌根治性切除术。根据术前和术后血清癌胚抗原，将患者分为3组，即术前CEA正常（≤5.0 ng/mL，n = 627）、术前升高（>5.0 ng/mL）但术后CEA恢复正常（术后CEA恢复正常，n = 255）以及术前和术后CEA均升高（术后CEA升高，n = 67）。采用广义相加模型评估癌胚抗原与复发风险之间的关系。此外，在调整潜在混杂因素后，使用Cox回归模型评估癌胚抗原与3年无复发生存率（RFS）之间的关系。
术后CEA升高患者的3年RFS为45.8%（95%CI，35.2% - 59.5%），与其他两组患者相比显著更低（术后CEA恢复正常组：75.9%，95%CI，70.8% - 81.4%；术前CEA正常组：84.9%，95%CI，82.2% - 87.8%）（P <0.001）。基于多变量Cox模型分析，术后CEA升高是3年RFS的一个预后因素（风险比[HR]，3.08；95%CI，2.05 - 4.66；P <0.001）。同时，术后CEA恢复正常与3年RFS无显著相关性（HR，1.38；95%CI，1.00 - 1.92；P = 0.05），且不是独立危险因素。
我们发现直肠癌患者术前和术后血清CEA与3年无复发生存率相关。此外，术后CEA恢复正常组患者的复发风险与术前CEA正常患者的复发风险无显著差异。因此，有必要结合术前和术后CEA来预测直肠癌患者的预后，而不是单独使用它。
