Individualized Cutoff Value of the Preoperative Carcinoembryonic Antigen Level is Necessary for Optimal Use as a Prognostic Marker
Open Access
- 1 January 2013
- journal article
- Published by Korean Society of Coloproctology in Annals of Coloproctology
- Vol. 29 (3), 106-114
- https://doi.org/10.3393/ac.2013.29.3.106
Abstract
Carcinoembryonic antigen (CEA) is an important prognostic marker in colorectal cancer (CRC). However, in some stages, it does not work. We performed this study to find a way in which preoperative CEA could be used as a constant prognostic marker in harmony with the TNM staging system. Preoperative CEA levels and recurrences in CRC were surveyed. The distribution of CEA levels and the recurrences in each TNM stage of CRC were analyzed. An optimal cutoff value for each TNM stage was calculated and tested for validity as a prognostic marker within the TNM staging system. The conventional cutoff value of CEA (5 ng/mL) was an independent prognostic factor on the whole. However, when evaluated in subgroups, it was not a prognostic factor in stage I or stage III of N2. A subgroup analysis according to TNM stage revealed different CEA distributions and recurrence rates corresponding to different CEA ranges. The mean CEA levels were higher in advanced stages. In addition, the recurrence rates of corresponding CEA ranges were higher in advanced stages. Optimal cutoff values from the receiver operating characteristic curves were 7.4, 5.5, and 4.5 ng/mL for TNM stage I, II, and III, respectively. Those for N0, N1, and N2 stages were 5.5, 4.8, and 3.5 ng/mL, respectively. The 5-year disease-free survivals were significantly different according to these cutoff values for each TNM and N stage. The multivariate analysis confirmed the new cutoff values to be more efficient in discriminating the prognosis in the subgroups of the TNM stages. Individualized cutoff values of the preoperative CEA level are a more practical prognostic marker following and in harmony with the TNM staging system.Keywords
This publication has 18 references indexed in Scilit:
- Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancerJournal of Surgical Oncology, 2010
- Preoperative serum carcinoembryonic antigen, albumin and age are supplementary to UICC staging systems in predicting survival for colorectal cancer patients undergoing surgical treatmentBMC Cancer, 2009
- Serum Carcinoembryonic Antigen Monitoring After Curative Resection for Colorectal Cancer: Clinical Significance of the Preoperative LevelAnnals of Surgical Oncology, 2009
- Prognostic Significance of Pre- and Postoperative Serum Carcinoembryonic Antigen Levels in Patients with Colorectal CancerEuropean Surgical Research, 2007
- Cutoff Values of Preoperative s-CEA Levels for Predicting Survivals after Curative Resection of Colorectal CancerJournal of Korean Medical Science, 2005
- High preoperative serum carcinoembryonic antigen predicts metastatic recurrence in potentially curative colonic cancerDiseases of the Colon & Rectum, 2001
- Preoperative Carcinoembryonic Antigen Level as an Independent Prognostic Factor in Colorectal Cancer: Taiwan ExperienceJapanese Journal of Clinical Oncology, 2000
- Preoperative Carcinoembryonic Antigen Predicts Outcomes in Node-Negative Colon Cancer Patients: A Multivariate Analysis of 572 PatientsJournal of the American College of Surgeons, 1997
- The Use of Preoperative Plasma CEA Levels for the Stratification of Patients After Curative Resection of Colorectal CancersAnnals of Surgery, 1980
- SPECIFIC CARCINOEMBRYONIC ANTIGENS OF THE HUMAN DIGESTIVE SYSTEMThe Journal of Experimental Medicine, 1965