Cancer Management and Research (Sep 2022)
Combination of Changes in CEA and CA199 Concentration After Neoadjuvant Chemoradiotherapy Could Predict the Prognosis of Stage II/III Rectal Cancer Patients Receiving Neoadjuvant Chemoradiotherapy Followed by Total Mesorectal Excision
Abstract
Jieyi Zhao,1,2 Huamin Zhao,2 Tingting Jia,2 Shiru Yang,2 Xiaoyu Wang1,2 1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2West China Medical School, Sichuan University, Chengdu, People’s Republic of ChinaCorrespondence: Xiaoyu Wang, Tel +86 18980605160, Email [email protected]: Previous studies have shown that the levels of serum tumor markers CEA and CA19-9 were related to chemoradiotherapy. Therefore, it has been assumed that dynamic monitoring of these markers could predict the prognosis of stage II/III rectal cancer (RC). Therefore, this study proposed to evaluate the prognostic value of changes in serum tumor biomarkers for stage II/III RC patients undergoing neoadjuvant chemoradiotherapy (NCRT) followed by total mesorectal excision (TME).Methods: A total of 217 patients with stage II/III RC receiving NCRT followed by TME were retrospectively analyzed. Serum CEA and CA199 levels were measured within one week before NCRT and one week before TME. The optimal cut-off points of ∆CEA% and ∆CA199% for prognosis prediction were calculated by receiver operating characteristics (ROC) analysis. Independent prognostic predictors were identified by univariate and multivariate Cox regression analyses. To avoid the efficiency of ∆CEA% and ∆CA199% on serum tumor biomarker change (STBC) score, two models including and excluding ∆CEA% and ∆CA199% were established separately in multivariate analysis.Results: The optimal cut-off point for ∆CEA% and ∆CA199% were − 30.29% and 20.30%, respectively. Univariate analysis showed that ∆CEA%, ∆CA199%, STBC score, ypT staging and yN staging could predict OS. ypT staging and STBC score could predict DFS. In multivariate analysis, only ∆CA199% (HR = 0.468, 95% CI: 0.220– 0.994, p = 0.048), ypT staging (HR = 0.420, 95% CI: 0.182– 0.970, p = 0.042), and STBC score (HR = 0.204, 95% CI: 0.078– 0.532, p = 0.001) were independently related to OS; and STBC score (HR = 0.412, 95% CI: 0.216– 0.785, p=0.007) and ypT staging (HR = 0.421, 95% CI: 0.224– 0.792, p = 0.007) were independently related to DFS.Conclusion: We established a combined STBC score to predict the prognosis of stage II/III RC patients receiving NCRT followed by TME. The predictive value of the combined score was stronger than a single marker alone and even stronger than several pathological indicators.Graphical Abstract: Keywords: neoadjuvant chemoradiotherapy, stage II/III rectal cancer, total mesorectal excision, prognosis, STBC score