Carcinoembryonic antigen has prognostic value for tumor downstaging and recurrence in rectal cancer after preoperative chemoradiotherapy and curative surgery: a multi-institutional and case-matched control study of KROG 14-12
- Affiliated Author(s)
- 김진희
- Alternative Author(s)
- Kim, Jin Hee
- Journal Title
- Radiotherapy and Oncology
- ISSN
- 0167-8140
- Issued Date
- 2015
- Keyword
- CEA Chemoradiotherapy Rectal cancer; Response; Recurrence
- Abstract
- Background and purpose: The Korean Radiation Oncology Group evaluated the significance of carcinoembryonic
antigen (CEA) levels both as a predictor of tumor response after CRT and as a prognosticator for
recurrence-free survival.
Methods and materials: 1804 rectal cancer patients, staged cT3–4N0–2M0, participated in a multicenter
study. The patients were administered preoperative radiation of 50.4 Gy in 28 fractions with 5-FU or
capecitabine, followed by total mesorectal excision. Patients with elevated CEA levels (>5 ng/mL) were
matched at a 1 (n = 595):1 (n = 595) ratio with patients with normal CEA (65 ng/mL). The tumor response
after CRT and the recurrence-free survival (RFS) rates were evaluated and compared between two arms.
Results: An elevated CEA level (p < 0.001) was determined to be a significant negative predictor of downstaging
after CRT. The downstaging rate was 42.9% for normal CEA and 23.4% for elevated CEA. A multivariate
analysis also revealed that cT (p = 0.021) and cN classification (p = 0.001), tumor size (p = 0.002),
and tumor location from the anal verge (p = 0.006) were significant predictors for tumor downstaging.
The 5-year RFS rates were significantly higher for the normal CEA arm than for the elevated CEA arm
(74.2 vs. 63.5%, p < 0.001).
Conclusions: Elevated CEA (>5 ng/mL) is a negative predictor of tumor downstaging after CRT and also has
a negative impact on RFS in rectal cancer.
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