THE PROGNOSTIC VALUE OF CEA AND CA 19-9 IN DETERMINING SURVIVAL OUTCOMES FOR PATIENT WITH LOW RECTAL CANCER

Authors

  • C.C. VOLOVAT “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • D.V. SCRIPCARIU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Diana BOBOC “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Simona-Ruxandra VOLOVAT “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ingrid-Andrada VASILACHE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Corina LUPASCU-URSULESCU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Liliana GHEORGHE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Luiza-Maria BAEAN “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • C. VOLOVAT “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • V. SCRIPCARIU “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

The prognostic value of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) is a topic of interest for surgeons. The aim of this retrospective study was to evaluate the prognostic value of CEA and CA 19-9 in patients with locally advanced low rectal cancer who underwent neoadjuvant chemoradiotherapy, underlining their potential as indicators for survival outcomes. Materials and methods: Between November 2019 and February 2023, we evaluated the medical records of 104 patients admitted to the first Oncologic Surgical Clinic from the Regional Institute of Oncology, Iasi, Romania. Clinical and paraclinical data was recorded, and patients were segregated intro three groups: one marker elevated during follow-up (group 1), 2 markers elevated during follow-up (group 2), and no marker elevated during follow-up (group 3). The overall survival and recurrence-free survival were the evaluated outcomes, and the prognostic values of serum markers were evaluated using Cox regression model and Kaplan-Meyer survival analysis. (3) Results: The presence of one (hazard ratio, HR: 2.78, 95% confidence interval, CI: 1.11- 6.92, p= 0.02) or both (HR: 4.23, 95%CI: 1.44- 9.32, p=0.03) elevated markers statistically decreased the recurrence-free survival time. A combination of elevated markers has a significantly higher impact on the recurrence-free survival time compared to a single elevated marker (p=0.001). Only the combination of biomarkers significantly decreased the overall survival rates (HR: 3.74, 95% CI: 0.57- 7.62, p= 0.04). (4) Conclusions: The combination of elevated CEA and CA 19-9 had the highest prognostic significance for the evaluated survival outcomes.

Author Biographies

  • C.C. VOLOVAT, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Surgery (II) / Radiology

  • D.V. SCRIPCARIU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Surgery (I)

  • Diana BOBOC, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Medical Specialties (III) / Oncology / Radiotherapy

  • Simona-Ruxandra VOLOVAT, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Medical Specialties (III) / Oncology / Radiotherapy

  • Ingrid-Andrada VASILACHE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Mother and Child Medicine

  • Corina LUPASCU-URSULESCU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Surgery (II) / Radiology

  • Liliana GHEORGHE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Surgery (II) / Radiology

  • Luiza-Maria BAEAN, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Surgery (II) / Radiology

  • C. VOLOVAT, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Medical Specialties (III) / Oncology / Radiotherapy

  • V. SCRIPCARIU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Surgery (I)

References

1. Damin DC, Lazzaron AR. Evolving treatment strategies for colorectal cancer: a critical review of current therapeutic options. World Journal of Gastroenterology WJG 2014; 20(4): 877.
2. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin 2023; 73(1): 17-48.
3. Tamas K, Walenkamp AM, de Vries EG, van Vugt MA, Beets-Tan RG, van Etten B, et al. Rectal and colon cancer: Not just a different anatomic site. Cancer Treat Rev 2015; 41(8): 671-679.
4. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010; 127(12): 2893-2917.
5. Duzova M, Basaran H, Inan G, Gul OV, Eren OO, Korez MK. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: Outcomes of survival, toxicity, sphincter pre-serving and prognostic factors. Transpl Immunol 2021; 69: 101489.
6. Åsli LM, Johannesen TB, Myklebust T, Møller B, Eriksen MT, Guren MG. Preoperative chemoradio-therapy for rectal cancer and impact on outcomes - A population-based study. Radiother Oncol 2017; 123(3): 446-453.
7. Fujii S, Nougaret S, Escal L, et al. MR imaging of locally advanced low rectal cancer: Relationships between imaging findings and the pathological tumor regression grade. J Magn Reson Imaging 2015; 42(2): 421-426.
8. Tripathi P, Rao SX, Zeng MS. Clinical value of MRI-detected extramural venous invasion in rectal cancer. J Dig Dis. 2017; 18(1): 2-12.
9. Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, Petkovska I, Gollub MJ. MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management. Radiographics 2019; 39(2): 367-387.
10. Fernandes MC, Gollub MJ, Brown G. The importance of MRI for rectal cancer evaluation. Surg Oncol 2022; 43: 101739.
11. Niu S, Chen Y, Peng F, Wen J, Xiong J, Yang Z, et al. The role of MRI after neochemoradiotherapy in predicting pathological tumor regression grade and clinical outcome in patients with locally advanced rectal adenocarcinoma. Front Oncol 2023; 13: 1118518.
12. Pikūnienė I, Strakšytė V, Basevičius A, et al. Prognostic Value of Tumor Volume, Tumor Volume Reduction Rate and Magnetic Resonance Tumor Regression Grade in Rectal Cancer. Medicina (Kau-nas) 2023; 59(12).
13. Rengo M, Picchia S, Marzi S, et al. Magnetic resonance tumor regression grade (MR-TRG) to assess pathological complete response following neoadjuvant radio chemotherapy in locally advanced rectal cancer. Oncotarget. 2017; 8(70): 114746-114755.
14. Hall WA, Li J, You YN, et al. Prospective Correlation of Magnetic Resonance Tumor Regression Grade with Pathologic Outcomes in Total Neoadjuvant Therapy for Rectal Adenocarcinoma. J Clin Oncol 2023; 41(29): 4643-4651.
15. Choi MS, Huh JW, Shin JK, et al. Prognostic Factors and Treatment of Recurrence after Local Excision of Rectal Cancer. Yonsei Med J 2021; 62(12): 1107-1116.
16. Khalfallah M, Dougaz W, Jerraya H, Nouira R, Bouasker I, Dziri C. Prognostic factors in rectal cancer: where is the evidence? Tunis Med 2017; 95(2): 79-86.
17. Chatila WK, Kim JK, Walch H, et al. Genomic and transcriptomic determinants of response to neoad-juvant therapy in rectal cancer. Nat Med 2022; 28(8): 1646-1655.
18. Colloca G, Venturino A, Vitucci P. Pre-treatment carcinoembryonic antigen and outcome of patients with rectal cancer receiving neo-adjuvant chemo-radiation and surgical resection: a systematic review and meta-analysis. Med Oncol 2017; 34(10): 177.
19. Zheng Z, Wang X, Lu X, Huang Y, Chi P. Prognostic significance of carcinoembryonic antigen combined with carbohydrate antigen 19-9 following neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Colorectal Dis. 2021; 23(9): 2320-2330.
20. Cai D, Huang ZH, Yu HC, Wang XL, Bai LL, Tang GN, et al. Prognostic value of preoperative car-cinoembryonic antigen/tumor size in rectal cancer. World J Gastroenterol. 2019; 25(33): 4945-4958.
21. Caglar M, Yener C, Karabulut E. Value of CT, FDG PET-CT and serum tumor markers in staging recurrent colorectal cancer. Int J Comput Assist Radiol Surg 2015; 10(7): 993-1002.
22. Shan J, Gu B, Shi L, et al. Prognostic value of CEA and CA19-9 in patients with local advanced rectal cancer receiving neoadjuvant chemoradiotherapy, radical surgery and postoperative chemotherapy. Transl Cancer Res 2021; 10(1): 88-98.
23. Song S, Hong JC, McDonnell SE, et al. Combined modality therapy for rectal cancer: the relative value of posttreatment versus pretreatment CEA as a prognostic marker for disease recurrence. Ann Surg Oncol 2012; 19(8): 2471-2476.
24. Kim JY, Kim NK, Sohn SK, et al. Prognostic value of postoperative CEA clearance in rectal cancer patients with high preoperative CEA levels. Ann Surg Oncol 2009; 16(10): 2771-2778.
25. Harabor V, Mogos R, Nechita A, et al. Machine Learning Approaches for the Prediction of Hepatitis B and C Seropositivity. International Journal of Environmental Research and Public Health 2023; 20(3): 2380.
26. Melinte-Popescu AS, Vasilache IA, Socolov D, Melinte-Popescu M. Predictive Performance of Ma-chine Learning-Based Methods for the Prediction of Preeclampsia-A Prospective Study. Journal of Clinical Medicine 2023; 12(2): 418.
27. Vicoveanu P, Vasilache IA, Scripcariu IS, et al. Use of a Feed-Forward Back Propagation Network for the Prediction of Small for Gestational Age Newborns in a Cohort of Pregnant Patients with Thrombophilia. Diagnostics (Basel) 2022; 12(4).
28. Adam AM, Popa RF, Vaduva C, et al. Pregnancy Outcomes, Immunophenotyping and Immunohisto-chemical Findings in a Cohort of Pregnant Patients with COVID-19-A Prospective Study. Diagnostics (Basel) 2023; 13(7).
29. Zonda GI, Mogos R, Melinte-Popescu AS, et al. Hematologic Risk Factors for the Development of Retinopathy of Prematurity-A Retrospective Study. Children (Basel) 2023; 10(3).
30. Melinte-Popescu AS, Popa RF, et al. Managing Fetal Ovarian Cysts: Clinical Experience with a Rare Disorder. Medicina (Kaunas) 2023; 59(4).
31. Galesanu C, Buzduga C, Florescu A, Moisii L, Ciubotaru V. Diabetes mellitus, chronic complication in patients with acromegaly: case report and review of the literature. The Medical-Surgical Journal. 2015; 119(1): 92-96.

Additional Files

Published

2024-03-29

Issue

Vol. 128 No. 1 (2024): The Medical-Surgical Journal

Section

SURGERY

License

COPYRIGHT 
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.

COPYRIGHT TRANSFER FORM FOR 

REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /

THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI

We, the undersigned authors of the manuscript entitled

_____________________________________________________________________________________

_____________________________________________________________________________________

warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.

  1. we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
  2. the manuscript does not break the intellectual property rights of any other person.
  3. we have read the submitted version of the manuscript and we are fully responsible for the content.

Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):

  1. ______________________________/_________________________
  2. ______________________________/_________________________
  3. ______________________________/_________________________

N.B.  All the authors must sign this form