Antígeno carcinoembrionario preoperatorio como factor pronóstico independiente en cáncer de colon y recto / Carcinoembryonic antigen (CEA) as an independent prognostic factor in colorectal carcinoma

RESUMO

Background: CEA is widely used in the follow up of patients with colorectal carcinoma. Aim: To study the value of preoperative CEA as an independent prognostic factor in colorectal carcinoma. Patients and methods: Analysis of 373 operated patients (204 females, age range 21-92 years) with colorectal carcinoma and a mean follow up of 53 months. The cutoff value for CEA was 5 ng/ml. Ninety four percent of patients had an excisable tumor, 79 percent had involvement of perirectal/pericolonic adipose tissue and 46 percent had lymph node involvement. Staging was done using Dukes-Turnbull and TNM classifications. Results: CEA was normal in 61 percent of cases, over 5 ng/ml in 39 percent and over 15 ng/ml in 22 percent. There was a strong correlation between mean preoperative CEA and tumor stage, depth and lymph node involvement. During the follow up, 140 patients died, 57 with normal and 83 with elevated CEA. Cancer mortality in patients subjected to a curative excision of the tumor (Dukes A-C2/TNM I-III) was 9 percent for colonic tumors and 36 percent for rectal tumors (p <0.001). There were no survival differences in patients with Dukes B/TNM II tumors according to preoperative CEA. Among Dukes C/TNM III tumors, survival difference was only significant for rectal tumors. A Cox model disclosed tumor stage, location and preoperative CEA as independent prognostic factors for survival. Conclusions: CEA is an independent prognostic factor for survival in colorectal carcinoma and high levels suggest an advanced disease (Rev Méd Chile 2004; 132 691-700).