Preoperative elevation of carcinoembryonic antigen predicts poor tumor response and frequent distant recurrence for pati
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ORIGINAL ARTICLE
Preoperative elevation of carcinoembryonic antigen predicts poor tumor response and frequent distant recurrence for patients with rectal cancer who receive preoperative chemoradiotherapy and total mesorectal excision: a multi-institutional analysis in an Asian population Jong Hoon Lee & Sung Hwan Kim & Hong Seok Jang & Hyuk Jun Chung & Seong Taek Oh & Doo Seok Lee & Jun-Gi Kim Accepted: 16 September 2012 / Published online: 4 December 2012 # Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose This study was conducted to evaluate the significance of carcinoembryonic antigen (CEA) level as a predictor for tumor response to chemoradiotherapy (CRT) and a prognosticator for survival in Asian patients with advanced rectal cancer. Materials and methods We enrolled 345 patients with primary rectal cancer who had undergone preoperative CRT and total mesorectal excision. We analyzed clinicopathological factors that could be associated with pathologically complete response (ypCR) and disease-free survival (DFS). Results A cutoff level of 5 ng/mL (p00.002) for CEA was found to be significant for prediction of ypCR. Increased CEA level (p00.025) was a significant negative predictor of ypCR after CRT in patients with rectal cancer. The 5-year DFS rate was significantly higher in the CEA ≤5-ng/mL group than in J. H. Lee : S. H. Kim Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea H. S. Jang Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea H. J. Chung : S. T. Oh : J.-G. Kim (*) Department of Colorectal Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Banpo-dong 505, Seocho-gu, 137-040 Seoul, South Korea e-mail: [email protected] D. S. Lee Department of Colorectal Surgery, Daehang Hospital, Seoul, South Korea
the CEA >5-ng/mL group (73.2 vs. 60.9 %, p00.002). This is mainly due to the higher chance of distant recurrence (p00.013), not locoregional recurrence (p00.732), in the CEA >5-ng/mL group. Conclusions Elevated CEA (>5 ng/mL) is a negative predictor of ypCR and has a negative impact on DFS in Asian rectal cancer patients who underwent preoperative CRT and surgery due to an increased chance of distant recurrences. Keywords Rectal cancer . Preoperative chemoradiotherapy . Predictor . Prognosticator . Tumor response
Introduction In the last few decades, the incidence of colorectal cancer has shown a rapid increase in Asian countries, and the colon and rectum are the fourth most common sites of cancer in South Korea, with an estimated 11,000 new cases per year [1]. The current treatment guideline for locally advanced rectal cancer has stepped into multimodality therapy, consisting of chemoradiotherapy (CRT) and total mesorectal excision (TME). Preoperative CRT is a standard treatment that has been widely used for the cure of locally advanced cancer of the rectum, based on the conclusions of prospec
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