Xie Hailun, Wei Lishuang, Liu Mingxiang, Liang Yanren, Wang Qiwen, Tang Shuangyi, Gan Jialiang
Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China.
Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, China.
Front Oncol. 2023 Oct 5;13:1268783. doi: 10.3389/fonc.2023.1268783. eCollection 2023.
Combining the carcinoembryonic antigen (CEA) level (C stage) with TNM staging can provide a more comprehensive prognostic assessment of colorectal cancer (CRC). However, the clinical value of incorporating CEA status into the TNM staging system needs to be evaluated.
We used the SEER database (N = 49,350) and a retrospective cohort from China (N = 1,440). A normal CEA level was staged as C0 and an elevated CEA level was staged as C1. Restricted cubic spline analysis was used to examine the dose-response relationship between the CEA level and survival. The Kaplan-Meier method with the log-rank test was used to plot survival curves. Multivariable Cox proportional hazards regression models with forward stepwise variable selection were used to estimate the hazard ratios and 95% confidence intervals.
Patients with C1 were more likely to have advanced disease than those with C0. CEA on a continuous scale was positively associated with mortality risk. Compared with patients with C0 stage, those with C1 stage had significantly lower survival rates. In the SEER dataset, C1 was independently associated with poor prognosis in patients with CRC, with an approximately 70% increased risk of mortality. Patients with C1 stage had significantly lower survival than those with C0 stage at all clinical stages. Incorporating the C stage into the TNM staging refined the prediction of prognosis of patients with CRC, with a gradual decline in prognosis from stage I C0 to stage IV C1. A similar pattern was observed in the present retrospective cohort study. At each lymph node stage, patients with C1 had significantly lower 5-year survival rates than patients with C0. Compared with lymph node positivity, CEA positivity may have a stronger correlation with a worse prognosis.
Our findings not only validated the independent prognostic significance of CEA in CRC but also demonstrated its enhanced prognostic value when combined with TNM staging. Our study provides evidence supporting the inclusion of C stage in the TNM staging system.
将癌胚抗原（CEA）水平（C期）与TNM分期相结合，可以为结直肠癌（CRC）提供更全面的预后评估。然而，将CEA状态纳入TNM分期系统的临床价值需要评估。
我们使用了监测、流行病学和最终结果（SEER）数据库（N = 49350）以及来自中国的一项回顾性队列研究（N = 1440）。CEA水平正常者分期为C0，CEA水平升高者分期为C1。采用限制性立方样条分析来检验CEA水平与生存之间的剂量反应关系。使用带有对数秩检验的Kaplan-Meier方法绘制生存曲线。采用向前逐步变量选择的多变量Cox比例风险回归模型来估计风险比和95%置信区间。
与C0期患者相比，C1期患者更有可能患有晚期疾病。CEA连续变量与死亡风险呈正相关。与C0期患者相比，C1期患者的生存率显著更低。在SEER数据集中，C1与CRC患者的不良预后独立相关，死亡风险增加约70%。在所有临床分期中，C1期患者的生存率均显著低于C0期患者。将C期纳入TNM分期可优化CRC患者预后的预测，从I期C0到IV期C1，预后逐渐下降。在本回顾性队列研究中观察到类似模式。在每个淋巴结分期，C1期患者的5年生存率均显著低于C0期患者。与淋巴结阳性相比，CEA阳性可能与更差的预后具有更强的相关性。
我们的研究结果不仅验证了CEA在CRC中的独立预后意义，还证明了其与TNM分期相结合时增强的预后价值。我们的研究提供了支持将C期纳入TNM分期系统的证据。
