CEA Decline Predicts Tumor Regression and Prognosis in Locally Advanced Rectal Cancer Patients with Elevated Baseline CEA

Zerong Cai; Lingyu Huang; Yufeng Chen; Xiaoyu Xie; Yifeng Zou; Ping Lan; Xiaojian Wu

doi:10.7150/jca.49252

CEA Decline Predicts Tumor Regression and Prognosis in Locally Advanced Rectal Cancer Patients with Elevated Baseline CEA

J Cancer. 2020 Sep 23;11(22):6565-6570. doi: 10.7150/jca.49252. eCollection 2020.

Authors

Zerong Cai¹, Lingyu Huang¹, Yufeng Chen¹, Xiaoyu Xie², Yifeng Zou¹, Ping Lan^{1

3

4}, Xiaojian Wu^{1

3

4}

Affiliations

¹ Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
² Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
³ Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, China.
⁴ Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong, China.

Abstract

Purpose: To investigate the value of carcinoembryonic antigen (CEA) decline in predicting pathological tumor regression and outcome for locally advanced rectal cancer (LARC) patients who received neoadjuvant therapy with elevated baseline CEA. Methods: LARC patients with elevated pre-treatment CEA who received neoadjuvant therapy and radical tumor resection were retrospectively collected. Serum CEA level during treatment were recorded and the predictive value of pre-treatment CEA, post-treatment CEA and CEA ratio (CEA^{post-treatment} /CEA^{pre-treatment}) for tumor regression grade (TRG), overall survival and diseases free survival were estimated by logistic regression or cox proportional hazard regression. Results: Two hundred and eighty-four LARC patients with elevated pre-treatment CEA were enrolled and the baseline, post-treatment CEA level and CEA ratio were 11.87 (5.02-731.31) ng/ml, 4.23 (0.50-173.80) ng/ml and 0.31(0.01-2.55) respectively. CEA level in 59.2% of the patients declined to normal after neoadjuvant therapy. Multivariate analysis showed that CEA ratio was an independent predictor for TRG (OR=3.463, 95% CI: 1.269-9.446, P=0.015) and tumor downstage (OR=0.393, 95% CI: 0.187-0.829, P=0.014). Patients with normalized post-treatment CEA level had better overall survival (P=0.010) and disease free survival (P=0.003) than those with elevated CEA level. Higher post-treatment CEA was an independent unfavored predictor for overall survival in LARC patients with elevated pre-treatment CEA (OR=1.042, 95% CI: 1.017-1.067, P=0.001). Conclusion: Post/pre-treatment CEA ratio predicted tumor regression in term of TRG and tumor downstage for LARC patients with elevated pre-treatment CEA and higher post-treatment CEA predicted poor overall survival.