Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study
Zhenhui Li,
Haibin Zhu,
Xiaolin Pang,
Yun Mao,
Xiaoping Yi,
Chunxia Li,
Ming Lei,
Xianshuo Cheng,
Lei Liang,
Jiamei Wu,
Yingying Ding,
Jun Yang,
Yingshi Sun,
Tao Zhang,
Dingyun You,
Zaiyi Liu
Affiliations
Zhenhui Li
Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
Haibin Zhu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute
Xiaolin Pang
Department of Radiotherapy, Sixth Affiliated Hospital of Sun Yat-Sen University
Yun Mao
Department of Radiology, the First Affiliated Hospital of Chongqing Medical University
Xiaoping Yi
Department of Radiology, Xiangya Hospital, Central South University
Chunxia Li
Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
Ming Lei
Department of Clinical Laboratory Medicine, Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center
Xianshuo Cheng
Department of Colorectal Surgery, Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center
Lei Liang
Department of Oncology, the First Affiliated Hospital of Kunming Medical University
Jiamei Wu
Department of Radiology, the First Affiliated Hospital of Chongqing Medical University
Yingying Ding
Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center
Jun Yang
Department of Oncology, the First Affiliated Hospital of Kunming Medical University
Yingshi Sun
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute
Tao Zhang
Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
Dingyun You
School of Public Health, Kunming Medical University
Zaiyi Liu
Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
Abstract Objective Whether preoperative serum carbohydrate antigen 19–9 (CA19-9) is an independent prognostic factor and there are interactions of serum CA19-9 with carcinoembryonic antigen (CEA) on the risk of recurrence in colorectal cancer (CRC) patients are still not clarified. Methods Consecutive patients with CRC who underwent curative resection for stage II-III colorectal adenocarcinoma at five hospitals were collected. Based on Cox models, associations of preoperative CA19-9 with recurrence-free survival (RFS) and overall survival (OS) were evaluated in patients with or without elevated CEA, and interactions between CEA and CA19-9 were also calculated. Restricted cubic spline (RCS) curves were used to evaluate the associations between preoperative CA19-9 and CRC outcomes on a continuous scale. Results A total of 5048 patients (3029 [60.0%] men; median [interquartile range, IQR] age, 61.0 [51.0, 68.0] years; median [IQR] follow-up duration 46.8 [36.5–62.4] months) were included. The risk of recurrence increased with the elevated level of preoperative CA19-9, with the slope steeper in patients with normal CEA than those with elevated CEA. Worse RFS was observed for elevated preoperative CA19-9 (> 37 U/mL) (n = 738) versus normal preoperative CA19-9 (≤ 37 U/mL) (n = 4310) (3-year RFS rate: 59.4% versus 78.0%; unadjusted hazard ratio [HR]: 2.02; 95% confidence interval [CI]:1.79 to 2.28), and significant interaction was found between CA19-9 and CEA (P for interaction = 0.001). Increased risk and interaction with CEA were also observed for OS. In the Cox multivariable analysis, elevated CA19-9 was associated with shorter RFS and OS regardless of preoperative CEA level, even after adjustment for other prognostic factors (HR: 2.08, 95% CI:1.75 to 2.47; HR: 2.25, 95% CI:1.80 to 2.81). Subgroup analyses and sensitivity analyses yielded largely similar results. These associations were maintained in patients with stage II disease (n = 2724). Conclusions Preoperative CA19-9 is an independent prognostic factor in CRC patients. Preoperative CA19-9 can be clinically used as a routine biomarker for CRC patients, especially with preoperative normal serum CEA.
