Jong Hoon Lee1, Dae Yong Kim2, Sung Hwan Kim3, Hyeon Min Cho4, Byoung Yong Shim5, Tae Hyun Kim2, Sun Young Kim2, Ji Yeon Baek2, Jae Hwan Oh2, Taek Keun Nam6, Mee Sun Yoon6, Jae Uk Jeong6, Kyubo Kim7, Eui Kyu Chie7, Hong Seok Jang8, Jae-Sung Kim9, Jin Hee Kim10, Bae Kwon Jeong11. 1. Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea. Electronic address: koppul@catholic.ac.kr. 2. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea. 3. Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea. 4. Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea. 5. Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea. 6. Department of Radiation Oncology, Chonnam National University Hospital, Republic of Korea. 7. Department of Radiation Oncology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea. 8. Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 9. Department of Radiation Oncology, Seoul National University Bundang Hospital, College of Medicine, Republic of Korea. 10. Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea. 11. Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
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.
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 cancerpatients, 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.
Authors: Won Kyung Cho; Doo Ho Choi; Hee Chul Park; Won Park; Jeong Il Yu; Young Suk Park; Joon Oh Park; Ho Yeong Lim; Won Ki Kang; Hee Cheol Kim; Yong Beom Cho; Seong Hyeon Yun; Woo Yong Lee Journal: Oncotarget Date: 2017-11-18