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Incorporation of serum carcinoembryonic antigen levels into the prognostic grouping system of colon cancer

  • Original Article
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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to clarify the significance of preoperative serum carcinoembryonic antigen (CEA) on disease-free survival (DFS) in colon cancer and propose a new prognostic grouping system.

Methods

A multiinstitutional retrospective cohort of 7296 colon cancer patients who underwent R0 surgery between 1997 and 2006 was analyzed. We stratified preoperative serum CEA values into three categories (C-stages): C0 (normal CEA), C1A (up to double the cutoff value), and C1B (more than double the cutoff value) and stratified each TNM stage by C-stage. Multivariate analyses using Cox regression models were used to analyze the significance of C-stage on 5-year DFS.

Results

CEA level was an independent factor affecting DFS; the 5-year DFS of patients with C0 and C1, as well as those with C1A and C1B, differed significantly (C0 84.6%, C1 69.8%, C1A 72.7%, and C1B 66.4%, P < 0.0001). Additionally, the DFS of pStages IIC and C1B was significantly lower than of pStages IIIA and C0 (65.8 vs. 87.7%, respectively; hazard ratio 3.44, 95% confidence interval 1.97–5.88, P < 0.0001). Moreover, the 5-year DFS of pStages IIIA and C0 or C1A did not differ significantly from pStages I and C1A (87.7 vs. 87.7%, P = 0.90 and 86.4 vs. 87.7%, P = 0.78, respectively).

Conclusions

pStage IIC and C1B disease should be considered candidates for intensive adjuvant chemotherapy. Conversely, pStages IIIA and C0 or C1A could be exempted from adjuvant chemotherapy. Incorporating C-stage into the current TNM staging system may facilitate decision making regarding the use of adjuvant chemotherapy in colon cancer patients.

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Acknowledgements

The authors completed this study in collaboration with the following: M. Watanabe (Kitasato University School of Medicine), I. Takemasa (Sapporo Medical University), K. Hakamada (Hirosaki University), H. Kameyama (Niigata University), Y. Takii (Niigata Cancer Center Hospital), K. Hase (National Defense Medical College), T. Watanabe (Tokyo University), K. Takahashi (Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital), Y. Kanemitsu (National Cancer Center Hospital), M. Itabashi (Tokyo Women’s Medical University), H. Yano (National Center for Global Health and Medicine), M. Yasuno (Tokyo Medical and Dental University), H. Hasegawa (Keio University), Y. Hashiguchi (Teikyo University), T. Masaki (Kyorin University), K. Maeda (Fujita Health University), K. Komori (Aichi Cancer Center Hospital), Y. Sakai (Kyoto University), M. Ohue (Osaka Medical Center for Cancer and Cardiovascular Diseases), N. Tomita (Hyogo College of Medicine), and Y. Akagi (Kurume University).

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Authors and Affiliations

  1. Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan

    Heita Ozawa, Kenjiro Kotake, Miki Hosaka, Akira Hirata, Yusuke Nakagawa & Shin Fujita

  2. Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Kenichi Sugihara

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  1. Heita Ozawa
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  2. Kenjiro Kotake
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  5. Yusuke Nakagawa
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Correspondence to Heita Ozawa.

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Ethical statement

Ethics approval was obtained from the Tochigi Cancer Center’s institutional review board, and for this type of study, formal consent is not required.

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The authors declare that they have no conflict of interest.

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Ozawa, H., Kotake, K., Hosaka, M. et al. Incorporation of serum carcinoembryonic antigen levels into the prognostic grouping system of colon cancer. Int J Colorectal Dis 32, 821–829 (2017). https://doi.org/10.1007/s00384-017-2772-1

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  • DOI: https://doi.org/10.1007/s00384-017-2772-1

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