Purpose: The aim of this study was to investigate the prognosis of resected lung cancer patients with extremely high carcinoembryonic antigen (CEA) levels. Several reports have indicated that increased preoperative serum CEA levels are associated with a dismal outcome after surgery, whereas others have reported long-term survival among patients with extremely high preoperative CEA levels. We investigated whether preoperative serum CEA levels, especially extremely high levels, were related to the prognosis of non-small-cell lung cancer (NSCLC) after surgery.
Methods: From September 1996 to January 2008, a total of 649 patients underwent surgical treatment for NSCLC at Juntendo University Hospital. We conducted a retrospective review to investigate the prognostic significance of the preoperative CEA level in these patients. We also investigated the prognosis of patients with an extremely high preoperative CEA level (>30 ng/ml).
Results: The 5-year survival rates were 78.4% and 63.0% for patients with normal and abnormal preoperative CEA levels, respectively. The survival rate was significantly worse for patients with abnormal preoperative CEA levels (P = 0.0002). In all, 28 patients had preoperative CEA levels >30 ng/ml. Although most of these patients showed a poor prognosis, 7 (25.0%) were longterm survivors (>4 years).
Conclusion: An abnormal preoperative CEA level suggests a poor prognosis for patients with NSCLC after surgery. Nevertheless, a few patients with an extremely high preoperative CEA level had long-term survival. Even if the preoperative CEA is extremely high, we perform a careful survey for distant or intrathoracic metastases and should not overlook operable cases.