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. Issue 2 (August 2015)

• Record Type: Journal Article
• Authors: Lee, Jong Hoon; Kim, Dae Yong; Kim, Sung Hwan; Cho, Hyeon Min; Shim, Byoung Yong; Kim, Tae Hyun; Kim, Sun Young; Baek, Ji Yeon; Oh, Jae Hwan; Nam, Taek Keun; Yoon, Mee Sun; Jeong, Jae Uk; Kim, Kyubo; Chie, Eui Kyu; Jang, Hong Seok; Kim, Jae-Sung; Kim, Jin Hee; Jeong, Bae Kwon
• Is Part Of: Radiotherapy and oncology. Volume 116:Issue 2(2015:Aug.)
• Page Start: 202
• Page End: 208
• Publication Date: 2015-08
• Subjects: CEA -- Chemoradiotherapy -- Rectal cancer -- Response -- Recurrence; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2015.07.049
• Languages: English
• ISSNs: 0167-8140

Abstract

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 (⩽5 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.