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Prognostic value of postoperative CEA clearance in rectal cancer patients with high preoperative CEA levels

 Jeong Yeon Kim  ;  Nam Kyu Kim  ;  Seung Kook Sohn  ;  Yong Wan Kim  ;  Kim Jin Soo Kim  ;  Hyuk Hur  ;  Byung Soh Min  ;  Chang Hwan Cho 
 ANNALS OF SURGICAL ONCOLOGY, Vol.16(10) : 2771-2778, 2009 
Journal Title
Issue Date
Biomarkers, Tumor/blood* ; Carcinoembryonic Antigen/blood* ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local/blood* ; Neoplasm Recurrence, Local/surgery ; Neoplasm Staging ; Postoperative Period ; Preoperative Care ; Prognosis ; Prospective Studies ; Rectal Neoplasms/blood* ; Rectal Neoplasms/surgery* ; Retrospective Studies ; Survival Rate ; Treatment Outcome
Overall Survival ; Rectal Cancer ; Exponential Kinetic ; Exponential Trend Line ; Good Overall Survival Rate
PURPOSE: We determined the prognostic value of carcinoembryonic antigen (CEA) clearance after tumor resection with serial evaluation of postoperative CEA levels in rectal cancer.

METHODS: Between 1994 and 2004, we retrospectively reviewed 122 patients with rectal cancer whose serum CEA levels were measured on the preoperative day and postoperative days 7 and 30. Patients with preoperative CEA levels <5.0 ng/ml were excluded. An exponential trend line was drawn using the three CEA values. Patients were categorized into three groups based on R(2) values calculated through trend line, which indicates the correlation coefficient between exponential graph and measured CEA values: exponential decrease group (group 1: 0.9 < R(2) < or = 1.0), nearly exponential decrease group (group 2: 0.5 < R(2) < or = 0.9), and randomized clearance group (group 3: 0.5 < or = R(2)). We then analyzed the CEA clearance pattern as a prognostic indicator.

RESULTS: With a median follow-up of 57 months, the 5-year overall survival was 62.3% vs. 48.1% vs. 25% and the 5-year disease-free survival was 58.6% vs. 52.7% vs. 25% among groups 1, 2, and 3 (P = 0.014, P = 0.027, respectively) in patients with stage III rectal cancer. For those with stage II rectal cancer, the 5-year overall survival rate of group 1 was significantly better than groups 2 and 3 (88.8% vs. 74.1%, respectively, P = 0.021).

CONCLUSIONS: the postoperative pattern of CEA clearance is a useful prognostic determinant in patients with rectal cancer. Patients with a randomized pattern of CEA clearance after tumor resection should be regarded as having the possibility of a persistent CEA source and may require consideration of intensive follow-up or adjuvant therapy.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Young Wan(김영완)
Kim, Jeong Yeon(김정연)
Kim, Jin Soo(김진수)
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Sohn, Seung Kook(손승국)
Cho, Chang Hwan(조장환)
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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