Elevated preoperative CEA is associated with worse survival in stage I-III rectal cancer patients.

ABSTRACT

BACKGROUND: The objective of this investigation was to assess whether preoperative carcinoembryonic antigen (CEA) level is an independent predictor of overall survival in rectal cancer patients. METHODS: All patients (n=504) undergoing a resection for stage I-III rectal cancer at the Kantonsspital St Gallen were included into a database between 1991 and 2008. The impact of preoperative CEA level on overall survival was assessed using risk-adjusted Cox proportional hazard regression models and propensity score methods. RESULTS: In risk-adjusted Cox proportional hazard regression analyses, preoperative CEA level (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.36-2.90, P<0.001), distance from anal verge (<5 cm HR 1.93, 95% CI 1.11-3.37; P=0.039), older age (HR 1.07, 95% CI 1.05-1.09; P<0.001), lower body mass index (HR 0.94, 95% CI 0.89-0.98; P=0.006), advanced tumour stage (stage II HR 1.41, 95% CI 0.85-2.32; stage III HR 2.08, 95% CI 1.31-3.31; P=0.004), R 1 resection (HR 5.65, 95% CI 1.59-20.1; P=0.005) and chronic kidney disease (HR 2.28, 95% CI 1.03-5.04; P=0.049) were all predictors for poor overall survival. CONCLUSION: This is one of the first investigations based on a large cohort of exclusively rectal cancer patients demonstrating that preoperative CEA level is a strong predictor of decreased overall survival. Preoperative CEA should be used as a prognostic factor in the preoperative assessment of rectal cancer patients.