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Open Access Research

Carcinoembryonic antigen (CEA) level, CEA ratio, and treatment outcome of rectal cancer patients receiving pre-operative chemoradiation and surgery

Kai-Lin Yang1, Shung-Haur Yang25, Wen-Yih Liang35, Ying-Ju Kuo3, Jen-Kou Lin25, Tzu-Chen Lin2, Wei-Shone Chen25, Jeng-Kae Jiang25, Huann-Sheng Wang25, Shih-Ching Chang25, Lee-Shing Chu45 and Ling-Wei Wang15*

Author Affiliations

1 Cancer Center, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan

2 Division of Colon and Rectal Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

3 Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan

4 Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

5 School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan

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Radiation Oncology 2013, 8:43  doi:10.1186/1748-717X-8-43

Published: 1 March 2013

Abstract

Background

To investigate serum carcinoembryonic antigen (CEA) as a prognostic factor for rectal cancer patients receiving pre-operative chemoradiotherapy (CRT).

Methods

Between 2000 and 2009, 138 patients with advanced rectal cancer receiving CRT before surgery at our hospital were retrospectively classified into 3 groups: pre-CRT CEA <6 ng/ml (group L; n = 87); pre-CRT CEA ≥ 6 ng/ml and post-CRT CEA <6 ng/ml (group H-L; n = 32); and both pre- and post-CRT CEA ≥ 6 ng/ml (group H-H; n = 19). CEA ratio (defined as post-CRT CEA divided by pre-CRT CEA), post-CRT CEA level and other factors were reviewed for prediction of pathologic complete response (pCR).

Results

Five-year disease-free survival (DFS) was better in groups L (69.0%) and H-L (74.5%) than in group H-H (44.9%) (p = 0.024). Pathologic complete response was observed in 19.5%, 21.9% and 5.3% of groups L, H-L and H-H respectively (p = 0.281). Multivariate analysis showed that ypN stage and pCR were independent prognostic factors for DFS and that post-CRT CEA level was independently predictive of pCR. As a whole, post-CRT CEA <2.61 ng/ml predicted pCR (sensitivity 76.0%; specificity 58.4%). For those with pre-CRT CEA ≥6 ng/ml, post-CRT CEA and CEA ratio both predicted pCR (sensitivity 87.5%, specificity 76.7%).

Conclusions

In patients with pre-CRT serum CEA ≥6 ng/ml, those with “normalized” CEA levels after CRT may have similar DFS to those with “normal” (<6 ng/ml) pre-CRT values. Post-CRT CEA level is a predictor for pCR, especially in those with pre-CRT CEA ≥6 ng/ml.

Keywords:
Rectal cancer; Pre-operative chemoradiation; Carcinoembryonic antigen; CEA ratio; Tumor response