Abstract 17P
Background
Colorectal cancer remains a global health concern, with carcinoembryonic antigen (CEA) serving as a pivotal biomarker. Our study aims to determine the prognostic significance of elevated CEA levels in US colorectal cancer patients using a population-based approach.
Methods
We accessed records from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database covering patients diagnosed between 2010 and 2019, representing around 34.6% of the US population.
Results
We identified 190,500 colorectal cancer patients between 2010-2019 with confirmed CEA status. Among them, 97,212 (51%) had elevated CEA levels at diagnosis, and 92,288 (49%) had non-elevated CEA levels. Most cases were adenocarcinoma (97.3%), with 53.4% male and 46.6% female. On multivariate regression, Females had slightly higher odds of CEA positivity (OR 1.16, CI: 1.14, 1.18), and advanced age was associated with higher odds of CEA elevation (OR 1.8). High-grade tumors were more prevalent in patients with non-elevated CEA levels (72.7% vs. 60.3%, P < 0.001). The odds of CEA elevation were over 4 times higher in distant versus local disease (OR 4.56, CI: 4.37, 4.76). Ascending colon tumors exhibited lower odds of CEA elevation compared to descending colon tumors. In survival analysis, the crude risk of colon cancer-specific mortality for CEA elevation was 3.2 times higher than for non-elevated CEA, attenuated to 1.58 after adjusting for confounders. Interstingly, The impact of CEA elevation was more pronounced in early-stage (local) disease, with an HR of 1.95(CI 1.82, 2.09) compared to an adjusted HR of 1.38 for late-stage (distant) disease.
Conclusions
Elevated CEA levels at colorectal cancer diagnosis serve as a significant prognostic indicator independently associated with an increased risk of colon cancer-specific mortality, particularly impactful in early-stage disease. These insights highlight CEA's potential utility for risk stratification and treatment decision-making in colorectal cancer patients. Further investigation is needed to identify the underlying mechanisms driving CEA's prognostic significance, promising for unveiling novel biological pathways and refining tailored therapeutic approaches in this patient population.
Legal entity responsible for the study
The authors.
Funding
RP210130 from Cancer Prevention & Research Institute of Texas.
Disclosure
All authors have declared no conflicts of interest.