Carcinoembryonic antigen is a definite predictor of tumor downstaging and recurrence in rectal cancer after preoperative chemoradiotherapy and curative surgery: a multi-institutional and case-matched control study of KROG 14-12

Aim/Background

Korean Radiation Oncology Group evaluated the significance of carcinoembryonic antigen (CEA) levels both as a predictor of tumor response after CRT and as a prognosticator for recurrence-free survival.

Methods

1804 rectal cancer patients, staged cT3-4N0-2M0, participated in a multicenter study. The patients were administered preoperative radiation of 50.4 Gy in 28 fractions with 5-FU or capecitabine, followed by total mesorectal excision. Patients with elevated CEA levels (>5 ng/mL) were matched at a 1 (n = 595): 1 (n = 595) ratio with patients with normal CEA (≤5 ng/mL). The tumor response after CRT and the recurrence-free survival (RFS) rates were evaluated and compared between two arms.

Results

An elevated CEA level (p < 0.001) was determined to be a significant negative predictor of downstaging after CRT. The downstaging rate was 42.9% for normal CEA and 23.4% for elevated CEA. A multivariate analysis also revealed that cT (p = 0.021) and cN classification (p = 0.001), tumor size (p = 0.002), and tumor location from the anal verge (p = 0.006) were significant predictors for tumor downstaging. The 5-year RFS rates were significantly higher for the normal CEA arm than for the elevated CEA arm (74.2 vs. 63.5 %, p < 0.001).

Conclusions

Elevated CEA (>5 ng/mL) is a negative predictor of tumor downstaging after CRT and also has a negative impact on RFS in rectal cancer.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.