Year 2021 / Volume 113 / Number 6
Original
Can we optimize CEA as a response marker in rectal cancer?

423-428

DOI: 10.17235/reed.2020.7321/2020

Tânia Gago, Paulo Caldeira, Ana Catarina Cunha, Pedro Campelo, Horácio Guerreiro,

Abstract
Background and aim: carcinoembryonic antigen (CEA) is a biomarker commonly used in colorectal cancer. However, its prognostic value is still controversial. Recent studies demonstrate that CEA produced locally by tumor cells has a higher prognostic value compared to serum CEA. This study aimed to determine whether there was an association between the CEA/tumor size ratio (CEA/ExT) and the pathological tumor response in patients with rectal adenocarcinoma (ADC), who underwent neoadjuvant chemoradiotherapy (N-CRT), followed by surgical tumor resection. Methods: a retrospective study was performed of rectal ADC patients who underwent N-CRT followed by curative surgery between March/2012 and October/2017. CEA and tumor extension for pre-treatment CEA/ExT calculation and the pathological response in the surgical specimen after treatment were analyzed. Results: eighty-nine patients were included, 60.7 % were male and the mean age was 63.8 ± 10.42. There was a good response to N-CRT in 41.6 % of the patients, tumor downstaging occurred in 83.1 % and a complete pathological response in 23.6 % of cases. The average CEA/ExT was 2.01 ng/ml/cm. In the univariate analysis, higher CEA/ExT values were related to a lower frequency of pathological response (p = 0.04) and to a lower frequency of tumor downstaging (p = 0.02). In the multivariate analysis, CEA/ExT was independently related to tumor downstaging (OR: 0.72; 95 % IC: 0.53-0.98, p-0.036). Conclusions: lower pre-treatment CEA/ExT values seem to be associated with tumor downstaging and this parameter may be a promising predictor of a more favorable response in patients with rectal ADC undergoing treatment with N-CRT.
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References
Ferlay, J, Soerjomataram, Dikshit R et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer. 2014, 136:359-386.
Glynne-Jones R, Wyrwicz L, Tiret E et al. Rectal Cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2017: 22–40.
Ponti A, Anttila A, Ronco G et al. Cancer Screening in the European Union (2017). European Comission. 2017: 7–8. DOI:10.1002/ijc.31043
Instituto Nacional de Estatística IP. Estatísticas da Saúde 2015. https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_publicacoes&PUBLICACOEStipo=ea&PUBLICACOEScoleccao=107773&selTab=tab0&xlang=pt.
Lu-Ning Zhang, Pu-Yun OuYang, Wei-Wei Xiao, et al. Elevated CA19-9 as the most significant prognostic factor in locally advanced rectal cancer following neoadjuvant chemoradiotherapy. Medicine. 2015; 94: 1-7. DOI:10.1097/MD.0000000000001793
Letaief, F; Nasri MAM et al. Potential predictive factors for pathologic complete response after the neoadjuvant treatment of rectal adenocarcinoma: a single center experience. Cancer Biology & Medicine. 2017; 14: 327–34.
Steele MVI. Pre-treatment platelet counts as a prognostic and predictive factor in stage II and III rectal adenocarcinoma. World Journal of Gastrointestinal Oncology. 2017; 9: 42–9.
Santos, M; Silva, C; Rocha A et al. Tumor Regression Grades: Can They Influence Rectal Cancer Therapy Decision Tree?. International Journal of Surgical Oncology. 2013: 1–8.
Letaief, F; Nasri MAM et al. Potential predictive factors for pathologic complete response after the neoadjuvant treatment of rectal adenocarcinoma: a single center experience. Cancer Biology & Medicine. 2017; 14: 327–34.
Choi, E; Kim, J; Kim O et al. Predictors of pathologic complete response after after preoperative concurrent chemoradiotherapy of rectal cancer: a single center experience. Radiation Oncology Journal. 2016: 106–12.
Santos, M.; Silva, C.; Rocha A. et al. Predictive Response Value of Pre- and Postchemoradiotherapy Variables in Rectal Cancer: An Analysis of Histological Data. Hindawi Publishing Corporation. 2016: 1–9.
Das, P; Skibber, J; Bigas-Rodriguez M et al. Predictors of Tumor Response and Downstaging in Patients Who Receive Preoperative Chemoradiation for Rectal Cancer. Cancer. 2007; 109: 1750–5.
Du Cai, Zeng-Hong Huang, Hui-Chuan Yu, et al. Prognostic value of preoperative carcinoembryonic antigen/tumor size in rectal cancer. World Journal of Gastroenterology. 2019; 25:4945-4958.
Duffy MJ, Lamerz R, Haglund C, Nicolini A, Kalousová M, Holubec L, Sturgeon C. Tumor markers in colorectal cancer, gastric cancer and gastrointestinal stromal cancers: European group on tumor markers 2014 guidelines update. Int J Cancer 2014; 134: 2513-2522.
Nicholson BD, Shinkins B, Pathiraja I, Roberts NW, James TJ, Mallett S, Perera R, Primrose JN, Mant D. Blood CEA levels for detecting recurrent colorectal cancer. Cochrane Database Syst Rev 2015.
Kozman MA, Fisher OM, Rebolledo BJ, Parikh R, Valle SJ, Arrowaili A, Alzahrani N, Liauw W, Morris DL. CEA to peritoneal carcinomatosis index (PCI) ratio is prognostic in patients with colorectal cancer peritoneal carcinomatosis undergoing cytoreduction surgery and intraperitoneal chemotherapy: A retrospective cohort study. J Surg Oncol 2018; 117: 725-736.
Tong G, Xu W, Zhang G, Liu J, Zheng Z, Chen Y, Niu P, Xu X. The role of tissue and serum carcinoembryonic antigen in stages I to III of colorectal cancer-A retrospective cohort study. Cancer Med 2018; 7: 5327-5338.
Huh JW, Oh BR, Kim HR, Kim YJ. Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer. J Surg Oncol 2010; 101: 396-400.
Walter CJ, Bell LTO, Parsons SR et al. Prevalence and significance of anaemia in patients receiving long- course neoadjuvant chemoradiotherapy for rectal carcinoma. Colorectal Disease. 2013; 15: 52–6.
Jun KH, Jung H, Baek JM, Chin HM, Park WB. Does tumor size have an impact on gastric cancer? A single institute experience. Langenbecks Arch Surg 2009; 394: 631-635.
Tayyab M, Razack A, Sharma A, Gunn J, Hartley JE. Correlation of rectal tumor volumes with oncological outcomes for low rectal cancers: does tumor size matter? Surg Today 2015; 45: 826-833.
Aminsharifi A, Howard L, Wu Y, De Hoedt A, Bailey C, Freedland SJ, Polascik TJ. Prostate Specific Antigen Density as a Predictor of Clinically Significant Prostate Cancer When the Prostate Specific Antigen is in the Diagnostic Gray Zone: Defining the Optimum Cutoff Point Stratified by Race and Body Mass Index. J Urol 2018; 200: 758-766.
Shimizu S, Hiratsuka H, Koike K, Tsuchihashi K, Sonoda T, Ogi K, Miyakawa A, Kobayashi J, Kaneko T, Igarashi T, Hasegawa T, Miyazaki A. Tumor-infiltrating CD8sup>+/sup> T-cell density is an independent prognostic marker for oral squamous cell carcinoma. Cancer Med 2019; 8: 80-93.
Eichelberger LE, Koch MO, Eble JN, Ulbright TM, Juliar BE, Cheng L. Maximum tumor diameter is an independent predictor of prostate-specific antigen recurrence in prostate cancer. Mod Pathol 2005; 18: 886-890.
Huo YR, Glenn D, Liauw W, Power M, Zhao J, Morris DL. Evaluation of carcinoembryonic antigen (CEA) density as a prognostic factor for percutaneous ablation of pulmonary colorectal metastases. Eur Radiol 2017.
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Gago T, Caldeira P, Cunha A, Campelo P, Guerreiro H. Can we optimize CEA as a response marker in rectal cancer?. 7321/2020


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Publication history

Received: 07/06/2020

Accepted: 09/07/2020

Online First: 24/11/2020

Published: 04/06/2021

Article revision time: 27 days

Article Online First time: 170 days

Article editing time: 362 days


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