Ogata Suguru, Fujita Fumihiko, Fujiyoshi Kenji, Sudou Tomoya, Yoshida Takefumi, Koushi Kenichi, Murotani Kenta, Yamauchi Shinichi, Sugihara Kenichi, Akagi Yoshito
Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
Biostatistics Center, Kurume University, Fukuoka, Japan.
J Anus Rectum Colon. 2022 Oct 27;6(4):249-258. doi: 10.23922/jarc.2022-020. eCollection 2022.
Adjuvant chemotherapy for stage II colorectal cancer patients with high-risk factors for recurrence can be useful; however, its advantage in prognosis remains to be controversial. Thus, in this study, we aimed to assess whether a combination of preoperative serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels can predict the prognosis and advantage of adjuvant chemotherapy.
Using a Japanese nationwide database, in total, 3,688 patients with curative resected stage II colorectal cancer were registered retrospectively between 2008 and 2012 in 24 referral institutions. Patients were classified into three groups as follows: Group A (both non-high levels of CEA and CA19-9), Group B (either high levels of CEA or CA19-9), and Group C (both high levels of CEA and CA19-9).
Multivariable Cox regression analysis, adjusting the depth of tumor invasion, number of dissected lymph nodes, tumor differentiation, lymphatic and venous invasion, and other covariates, showed that the 5-year disease-free survival and overall survival were shorter in Group C than in Groups A and B. Furthermore, in Group C, the 5-year disease-free survival rate was improved in the surgery-plus-AC group compared to the surgery-alone group.
As with existing high-risk factors for recurrence, the combination assessment of preoperative serum CEA and CA19-9 can predict the prognosis for colorectal cancer. Adjuvant chemotherapy may provide a prolonged disease-free survival advantage in stage II colorectal cancer patients with high levels of both tumor markers.
对具有复发高危因素的II期结直肠癌患者进行辅助化疗可能是有益的；然而，其在预后方面的优势仍存在争议。因此，在本研究中，我们旨在评估术前血清癌胚抗原（CEA）和糖类抗原19-9（CA19-9）水平的联合检测能否预测辅助化疗的预后及优势。
利用日本全国性数据库，2008年至2012年间，共有3688例接受根治性切除的II期结直肠癌患者在24家转诊机构进行了回顾性登记。患者被分为以下三组：A组（CEA和CA19-9水平均不高）、B组（CEA或CA19-9水平高）和C组（CEA和CA19-9水平均高）。
多变量Cox回归分析对肿瘤浸润深度、清扫淋巴结数量、肿瘤分化程度、淋巴管和血管侵犯以及其他协变量进行了校正，结果显示C组的5年无病生存率和总生存率均短于A组和B组。此外，在C组中，与单纯手术组相比，手术加辅助化疗组的5年无病生存率有所提高。
与现有的复发高危因素一样，术前血清CEA和CA19-9的联合评估可以预测结直肠癌的预后。辅助化疗可能为两种肿瘤标志物水平均高的II期结直肠癌患者提供延长无病生存期的优势。
