Table 1.
CEA and prognosis: selected studies
| Author | Year | Origin | Study type | Study summary | Endpoint | No. of patients | Age (yr)a | Sex ratio (%male) | Outcome summary |
|---|---|---|---|---|---|---|---|---|---|
| Stelzner [68] | 2005 | Germany | Cohort (retrospective database) | Database review for predictors of survival in colorectal cancer | Overall survival in stage IV colorectal cancer | 186 | 68.6 (range, 30–92) | 54.3 | Preop CEA ≥ 5 ng/mL associated with decreased overall survival in stage IV disease. |
| Katoh [6] | 2008 | Japan | Cohort (retrospective database) | Review of preop CEA levels in Dukes C patients | Survival | Retrospective: 237; prospective: 197 | 54.4% ≥ 60 in retrospective; 63.5% ≥ 60 in prospective | Retrospective: 59.1; prospective: 57.4 | CEA ≤ 2.5 ng/mL was a predictor of disease-free survival in Dukes C in earlier cohort. Association lost in later cohort, possibly due to improved chemotherapy. |
| Kim [7] | 2009 | Korea | Cohort (retrospective data base) | Postoperative analysis of CEA preop and day 7 and 30-day post op | Survival | 122 | 57.56 ± 12.24 | 62.3 | Significant decrease in survival if CEA levels remain elevated in postop period. |
| Sun [69] | 2009 | Taiwan | Cohort (retrospective data base) | Retrospective review of potential prognostic markers | Disease-free and overall survival | 1,367 | 66 (IQR, 19-25) | 55.4 | Preop CEA ≥ 5 ng/mL 2.38x more likely to die of cancer than those with CEA ≤5 ng/mL (P ≤ 0.001) |
| Thirunavukarasu [70] | 2015 | USA | Cohort (retrospective SEER database) | Review of preop CEA levels | 5-Year overall and disease-specific mortality | 16,619 | 67.4 ± 13.8 | 49.7 | Elevated CEA was associated with worse overall and disease-specific mortality |
| Becerra [3] | 2016 | USA | Cohort (retrospective data base) | Review of preop CEA levels in Stage I-III CRC | Overall survival | 69,512 | Normal CEA: 69.1 ± 13.0; elevated CEA: 70.3 ± 12.9 | Normal CEA: 49.0; elevated CEA: 43.7 | Preop CEA level is associated with overall survival |
| Ozawa [4] | 2017 | Japan | Cohort (retrospective National Cancer Database) | Review of preop CEA levels | 5-Year disease-free survival | 7,296 | 65.3 ± 11.2 | 54.4 | Preop CEA level is independently associated with 5-year disease-free survival |
| Spindler [5] | 2017 | USA | Cohort (retrospective National Cancer Database) | Review of preop CEA levels in Stage II CRC | 5-Year overall survival | 74,945 | Normal CEA: 70 (IQR, 59-79); elevated CEA 72 (IQR, 6081) | Normal CEA: 49.3 Elevated CEA: 43.4 | Preop elevated CEA is associated with reduced 5-year overall survival |
| Kim [71] | 2017 | Korea | Retrospective and prospective cohort | To determine cutoff values for preop CEA in Stage III CRC | 5-Year overall and disease-free survival | Retrospective cohort: 965; prospective cohort: 268 | Retrospective: 60 (range, 14-84); prospective: 60 (range, 27-80) | Retrospective: 53.9 Prospective: 48.9 | A cutoff value of 3 ng/mL is optimal. Preoperative CEA above this level is associated with inferior overall and disease-free survival. |
CEA, carcinoembryonic antigen; IQR, interquartile range; preop, preoperative; postop, postoperative; CRC, colorectal cancer.
a
Age: meanstandard deviation, mean ± standard deviation, or median (range), or median (IQR).