Annals of Coloproctology

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Malignant disease,Rectal cancer,Prognosis and adjuvant therapy,Colorectal cancer

Prognostic Impact of Carcinoembryonic Antigen Levels in Rectal Cancer Patients Who Had Received Neoadjuvant Chemoradiotherapy: Jung Il Joo, Sang Woo Lim, Bo Young Oh; Ann Coloproctol. 2021;37(3):179-185. Published online May 11, 2021; DOI: https://doi.org/10.3393/ac.2020.11.27

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Purpose
Carcinoembryonic antigen (CEA) is a useful marker for rectal cancer. The aim of this study was to investigate the prognostic impact of CEA level according to neoadjuvant chemoradiotherapy (nCRT) in rectal cancer patients who underwent radical surgery.
Methods
A total of 245 patients with rectal cancer who underwent radical surgery were retrospectively evaluated. Serum CEA level was measured preoperatively and postoperatively. We compared survival outcomes based on CEA level before and after surgery according to nCRT.
Results
Of the 245 patients, elevation of CEA level was observed preoperatively in 79 and postoperatively in 30, respectively. Eighty-seven (35.5%) patients received nCRT, and elevated CEA level was a significant prognostic factor both before and after surgery. In patients who had not received nCRT, an elevated CEA level was a significant prognostic factor before surgery but was not significant after surgery. In a multivariate analysis for prognostic factors, elevation of preoperative CEA level was an independent prognostic factor of disease-free survival (DFS) regardless of nCRT. Postoperative CEA level was an independent prognostic factor of DFS in patients who had received nCRT but was not a factor in patients who had not received nCRT.
Conclusion
Serum CEA level was an independent prognostic factor both preoperatively and postoperatively in rectal cancer patients who had received nCRT.

Citations

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Progress of MRI‑based radiomics and deep learning for predicting the prognosis of locally advanced rectal cancer (Review)
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Prognostic Value of Dynamic Changes in Immune-Inflammatory and Tumor Biomarkers Following Chemoradiotherapy in Locally Advanced Rectal Cancer
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Prognostic Impact of An Integrative Landscape of Clinical, Immune, and Molecular Features in Non-Metastatic Rectal Cancer
Soledad Iseas, Juan M. Sendoya, Juan Robbio, Mariana Coraglio, Mirta Kujaruk, Vanesa Mikolaitis, Mariana Rizzolo, Ana Cabanne, Gonzalo Ruiz, Rubén Salanova, Ubaldo Gualdrini, Guillermo Méndez, Marina Antelo, Marcela Carballido, Cecilia Rotondaro, Julieta
Frontiers in Oncology.2022;[Epub] CrossRef
Carcinoembryonic Antigen, the Most Accessible Test for Predicting Colorectal Cancer Prognosis: Exploring Alternative Roles
Sanghee Kang
Annals of Coloproctology.2021; 37(3): 129. CrossRef

Clinical Significance of Serial Serum Carcinoembryonic Antigen Values for Treating Rectal Cancer with Preoperative Chemoradiotherapy: Young Jae Ryu, Chang Hyun Kim, Hun Jin Kim, Hyo Kang, Sang Woo Lim, Jung Wook Huh, Jae Kyun Ju, Young Jin Kim, Hyeong Rok Kim; J Korean Soc Coloproctol. 2012;28(4):205-212. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.205

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6 Citations

Abstract PDF

Purpose

Preoperative chemoradiotherapy is now widely accepted to treat rectal cancer; however, the prognosis for rectal cancer patients during and after chemoradiotherapy must be determined. The aim of this study was to evaluate the serial serum carcinoembryonic antigen (s-CEA) samples in patients with rectal cancer who underwent radical surgery after concurrent chemoradiotherapy (CRT).

Methods

This study evaluated 236 patients with rectal cancer who received preoperative CRT followed by curative surgery between June 2005 and June 2010. We measured the patient's s-CEA levels pre-CRT, post-CRT and post-surgery. Patients were classified into four groups according to their s-CEA concentrations (group 1, high, high, high; group 2, high, high, normal; group 3, high, normal, normal; group 4, normal, normal, normal). We analyzed the clinicopathologic factors and the outcomes among these groups.

Results

Of the 236 patients, 12 were in group 1, 31 were in group 2, 67 were in group 3, and 126 were in group 4. The 3-year disease-free survival rate in group 1 was poorer than those in group 3 (P = 0.007) and group 4 (P < 0.001). In a univariate analysis, type of surgery, clinical N stage, pathologic T or N stage, lymphovascular invasion, perineural invasion, and CEA group were prognostic factors. A multivariate analysis revealed that type of surgery, pathologic T stage, and lymphovascular invasion were independent prognostic factors; however, no statistical significance was associated with the CEA group.

Conclusion

High pre-CRT, post-CRT, and post-surgery s-CEA levels in patients with rectal cancer were associated with high rates of systemic recurrence and poor survival. Therefore, patients with sustained high s-CEA levels during CRT require careful monitoring after surgery.

Citations

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Accessing new prognostic significance of preoperative carcinoembryonic antigen in colorectal cancer receiving tumor resection: More than positive and negative
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Prognosis Can Be Predicted More Accurately Using Pre- and Postchemoradiotherapy Carcinoembryonic Antigen Levels Compared to Only Prechemoradiotherapy Carcinoembryonic Antigen Level in Locally Advanced Rectal Cancer Patients Who Received Neoadjuvant Chemor
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Biomarkers and Molecular Imaging as Predictors of Response to Neoadjuvant Chemoradiotherapy in Patients With Locally Advanced Rectal Cancer
Chiara Molinari, Federica Matteucci, Paola Caroli, Alessandro Passardi
Clinical Colorectal Cancer.2015; 14(4): 227. CrossRef
Prognostic factors associated with locally recurrent rectal cancer following primary surgery (Review)
YANTAO CAI, ZHENYANG LI, XIAODONG GU, YANTIAN FANG, JIANBIN XIANG, ZONGYOU CHEN
Oncology Letters.2014; 7(1): 10. CrossRef
Factors predicting long-term survival in colorectal cancer patients with a normal preoperative serum level of carcinoembryonic antigen
Jung Wook Huh, Chang Hyun Kim, Sang Woo Lim, Hyeong Rok Kim, Young Jin Kim
Journal of Cancer Research and Clinical Oncology.2013; 139(9): 1449. CrossRef

Clinical Significance of Tumor Regression Grade in Rectal Cancer with Preoperative Chemoradiotherapy: Young Joo Park, Byung Ryul Oh, Sang Woo Lim, Jung Wook Huh, Jae Kyun Joo, Young Jin Kim, Hyeong Rok Kim; J Korean Soc Coloproctol. 2010;26(4):279-286. Published online August 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.4.279

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18 Citations

Abstract PDF

Purpose

Neoadjuvant chemoradiotherapy applied to the locally advanced rectal cancer reduces local recurrence and improves survival. We assessed tumor regression grade (TRG) and its influence on survival in rectal cancer patients treated with chemoradiotherapy followed by surgical resection.

Methods

We studied 108 patients that were seen at our hospital between August 2004 and December 2008. Patients received preoperative chemoradiotherapy consisting of 5-fluorouracil and leucovorin by continous infusion during the first and fifth week, delivered with concurrent pelvic radiation of 50.4 Gy, followed by radical surgery at 6-8 weeks. The TRG was determined by the amount of fibrosis in the tumor embedding area and was divided into 5 grades based on the relative amount of fibrosis. We analyzed all preoperative clinicopathologic factors, postoperative pathologic stages, TRG and prognosis, retrospectively.

Results

Downstaging of rectal cancer through neoadjuvant chemoradiotherapy occurred in 64 (59%) patients. The numbers of total regressions (TRG4), good regressions (TRG3), moderate regressions (TRG2), minor regressions (TRG1), and no regression (TRG0) were 19 (18%), 65 (60%), 17 (16%), 6 (5%), and 1 (1%) respectively. The TRG was inversely correlated with perineural invasion and lymphovascular invasion (P = 0.008, P = 0.032). The local recurrence rate declined as the tumor regression grade increased (P = 0.032). The 19 patients with TRG4 had a better three-year disease free survival than the 89 patients with TRG0-3 (P = 0.034). The 16 patients with pathologic complete remission (pCR) had a better three-year disease free survival than the 92 patients with non-pCR (P = 0.025).

Conclusion

Higher TRG after preoperative chemoradiotherapy for rectal cancer closely correlates with better survival and low local recurrence. The TRG is considered to be a significant prognostic factor.

Citations

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