Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
Department of Laboratory Medicine, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
Langenbecks Arch Surg. 2021 Sep;406(6):1987-1997. doi: 10.1007/s00423-021-02236-3. Epub 2021 Jun 19.
This unicentric, retrospective cohort study aimed to identify the optimal cutoff values of preoperative serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) for the prognosis in patients with stage II/III colon cancer.
After excluding 43 patients with CA19-9 levels < 0.2 U/mL, 588 were included. Receiver operating characteristic curves were constructed to determine the optimal cutoff values of CEA and CA 19-9 for disease relapse.
The median CEA and CA19-9 values were 3.6 (interquartile range: 2.1-7.2 ng/mL) and 14.3 (interquartile range: 8.1-30.0) U/mL, respectively. The optimal cutoff values of CEA and CA19-9 were 5.4 ng/mL and 22.4 U/mL, respectively. A multivariate analysis of relapse-free survival (RFS) showed that cancer stage, CEA, and CA19-9 were significant independent factors. The RFS of patients with stages II and III colon cancer was significantly stratified by CEA (< 5.4/ ≥ 5.4 ng/mL) and CA19-9 (< 22.4/ ≥ 22.4 U/mL). Prognostication based on the reference values (< 5.0 ng/mL for CEA and < 37.0 U/mL for CA19-9) was less significant than that based on the optimal cutoff values. Both elevated CEA and CA19-9 had no value dependency on RFS: RFS curves were similar between extremely elevated CEA (≥ 54.0 ng/ml) and intermediate CEA (5.4-54.0 ng/ml) and between extremely elevated CA19-9 (≥ 224.0 U/ml) and intermediate CA19-9 (22.4-224.0 U/ml).
The optimal cutoff values of preoperative CEA and CA19-9 for RFS were 5.4 ng/ml and 22.4 U/mL, respectively, in patients with stages II and III colon cancer. Further relapse risk stratification is possible using these values.
本单中心回顾性队列研究旨在确定术前血清癌胚抗原（CEA）和糖类抗原 19-9（CA19-9）对 II/III 期结肠癌患者预后的最佳截断值。
排除 CA19-9 水平<0.2 U/mL 的 43 例患者后，共纳入 588 例患者。构建受试者工作特征曲线以确定 CEA 和 CA19-9 用于疾病复发的最佳截断值。
中位 CEA 和 CA19-9 值分别为 3.6（四分位距：2.1-7.2 ng/mL）和 14.3（四分位距：8.1-30.0 U/mL）。CEA 和 CA19-9 的最佳截断值分别为 5.4 ng/mL 和 22.4 U/mL。无复发生存（RFS）的多变量分析显示，癌症分期、CEA 和 CA19-9 是显著的独立因素。CEA（<5.4/≥5.4 ng/mL）和 CA19-9（<22.4/≥22.4 U/mL）可显著分层 II 期和 III 期结肠癌患者的 RFS。基于参考值（CEA<5.0 ng/mL 和 CA19-9<37.0 U/mL）的预后预测意义小于基于最佳截断值的预后预测意义。CEA 和 CA19-9 升高均与 RFS 无明显的依赖性：CEA 极高值（≥54.0 ng/ml）和中间值（5.4-54.0 ng/ml）以及 CA19-9 极高值（≥224.0 U/ml）和中间值（22.4-224.0 U/ml）的 RFS 曲线相似。
在 II/III 期结肠癌患者中，术前 CEA 和 CA19-9 用于 RFS 的最佳截断值分别为 5.4 ng/ml 和 22.4 U/ml。使用这些值可进一步进行复发风险分层。
