Medicine
®
OBSERVATIONAL STUDY
Prognostic Effect of Pretreatment Serum Carcinoembryonic Antigen Level A Useful Tool for Prediction of Distant Metastasis in Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy and Total Mesorectal Excision Chang Hyun Kim, MD, Soo Young Lee, MD, Hyeong Rok Kim, MD, PhD, and Young Jin Kim, MD, PhD
Abstract: Many studies have reported the prognostic value of pretreatment serum carcinoembryonic antigen (pre-CEA) levels on colorectal cancer outcomes. However, controversy remains concerning the significance of pre-CEA levels in patients with rectal cancer treated with neoadjuvant chemoradiotherapy (CRT). Our aim in this study was to investigate the prognostic role of the pre-CEA level in patients with locally advanced rectal cancer undergoing neoadjuvant CRT followed by total mesorectal excision (TME). A total of 419 patients with stages II and III rectal cancer treated with neoadjuvant CRT followed by TME with available pre-CEA data were included. The outcomes studied were 5-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and diseasefree survival (DFS). Optimal pre-CEA cutoff values to predict DMFS were determined based on current smoking history. The median pre-CEA level of smokers was 3.8 ng/mL, and that of nonsmokers was 2.8 ng/mL (P < 0.01). Pre-CEA levels of 6.6 ng/mL for nonsmokers and 11.4 ng/mL for smokers were determined to best separate patients on the basis of time to distant metastasis by using log-rank statistics. The pre-CEA level was associated with DMFS (hazard ratio ¼ 1.743, 95% confidence interval ¼ 1.129–2.690, P ¼ 0.01). The pre-CEA level was not associated with LRFS or DFS.The pre-CEA level appears to be a significant preoperative prognostic factor. Moreover, it is as valuable as any known pathologic factor. Future studies evaluating oncologic outcomes should take into consideration the pre-CEA level. (Medicine 94(31):e1291) Abbreviations: CEA = carcinoembryonic antigen, CRM = circumferential resection margin, CRT = chemoradiotherapy, CT = computed tomography, DFS = disease-free survival, DMFS = distant metastasis-free survival, LRFS = local recurrence-free survival, MRI = magnetic resonance image, pCR = pathologic
Editor: Sergio Huerta. Received: April 28, 2015; revised: June 16, 2015; accepted: July 8, 2015. Form the Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea. Correspondence: Hyeong Rok Kim, Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea (e-mail: [email protected]). The authors have no funding and conflicts of interest to disclose. Copyright # 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. ISSN: 0025-7974 DOI: 10.1097/MD.0000000000001291
Medicine
Volume 94, Number 31, August 2015
complete response, TME = total mesorectal excision, TRG = tumor regression grade.
INTRODUCTION reoperative chemoradiotherapy (CRT)1– 3 and total mesorectal excision (TME)4,5 are widely accepted as the treatment of choice for locally advanced distal rectal cancer, and this multidisciplinary approach has dramatically improved local control from an unacceptable local recurrence rate of 25% to 40% to
®
OBSERVATIONAL STUDY
Prognostic Effect of Pretreatment Serum Carcinoembryonic Antigen Level A Useful Tool for Prediction of Distant Metastasis in Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy and Total Mesorectal Excision Chang Hyun Kim, MD, Soo Young Lee, MD, Hyeong Rok Kim, MD, PhD, and Young Jin Kim, MD, PhD
Abstract: Many studies have reported the prognostic value of pretreatment serum carcinoembryonic antigen (pre-CEA) levels on colorectal cancer outcomes. However, controversy remains concerning the significance of pre-CEA levels in patients with rectal cancer treated with neoadjuvant chemoradiotherapy (CRT). Our aim in this study was to investigate the prognostic role of the pre-CEA level in patients with locally advanced rectal cancer undergoing neoadjuvant CRT followed by total mesorectal excision (TME). A total of 419 patients with stages II and III rectal cancer treated with neoadjuvant CRT followed by TME with available pre-CEA data were included. The outcomes studied were 5-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and diseasefree survival (DFS). Optimal pre-CEA cutoff values to predict DMFS were determined based on current smoking history. The median pre-CEA level of smokers was 3.8 ng/mL, and that of nonsmokers was 2.8 ng/mL (P < 0.01). Pre-CEA levels of 6.6 ng/mL for nonsmokers and 11.4 ng/mL for smokers were determined to best separate patients on the basis of time to distant metastasis by using log-rank statistics. The pre-CEA level was associated with DMFS (hazard ratio ¼ 1.743, 95% confidence interval ¼ 1.129–2.690, P ¼ 0.01). The pre-CEA level was not associated with LRFS or DFS.The pre-CEA level appears to be a significant preoperative prognostic factor. Moreover, it is as valuable as any known pathologic factor. Future studies evaluating oncologic outcomes should take into consideration the pre-CEA level. (Medicine 94(31):e1291) Abbreviations: CEA = carcinoembryonic antigen, CRM = circumferential resection margin, CRT = chemoradiotherapy, CT = computed tomography, DFS = disease-free survival, DMFS = distant metastasis-free survival, LRFS = local recurrence-free survival, MRI = magnetic resonance image, pCR = pathologic
Editor: Sergio Huerta. Received: April 28, 2015; revised: June 16, 2015; accepted: July 8, 2015. Form the Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea. Correspondence: Hyeong Rok Kim, Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea (e-mail: [email protected]). The authors have no funding and conflicts of interest to disclose. Copyright # 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. ISSN: 0025-7974 DOI: 10.1097/MD.0000000000001291
Medicine
Volume 94, Number 31, August 2015
complete response, TME = total mesorectal excision, TRG = tumor regression grade.
INTRODUCTION reoperative chemoradiotherapy (CRT)1– 3 and total mesorectal excision (TME)4,5 are widely accepted as the treatment of choice for locally advanced distal rectal cancer, and this multidisciplinary approach has dramatically improved local control from an unacceptable local recurrence rate of 25% to 40% to
