medwireNews: Researchers question the use of preoperative carcinoembryonic antigen (CEA) as a prognostic marker of post-surgery recurrence in patients with colon cancer and suggest that postoperative values may be more informative.
As reported in JAMA Oncology, the chart review included 1027 patients with stage I–III disease who underwent resection at a US cancer centre between 2007 and 2014, of whom 715 had normal preoperative CEA levels (defined as ≤5.0 ng/mL). The remaining 312 participants had elevated CEA (>5.0 ng/mL) before surgery, with levels normalising in the postoperative setting for 142, remaining elevated for 57, and unavailable for 113.
Although elevated preoperative CEA levels were associated with significantly lower 3-year recurrence-free survival (RFS) rates than normal preoperative levels, at 82.3% versus 89.7%, normalisation of CEA levels postoperatively seemed to ameliorate the adverse prognostic effect, with a 3-year RFS rate of 87.9%, which was comparable to the rate for those with normal preoperative levels.
By contrast, a significantly lower proportion of individuals with elevated postoperative CEA remained recurrence-free at 3 years, at 74.5%, than either individuals with normal preoperative or normalised postoperative CEA levels.
In multivariate analysis, elevated postoperative CEA was significantly and independently associated with shorter RFS, with a hazard ratio of 2.0, while no such association was observed for normalised postoperative CEA levels.
Of note, hazard function curve analysis showed that the recurrence risk was not only higher for patients with elevated postoperative CEA than those with normal preoperative or normalised postoperative CEA, but also peaked earlier, such that the risk of recurrence or death was highest at 3.8 months versus 16.4 and 13.1 months, respectively.
In summary, Martin Weiser, from the Memorial Sloan Kettering Cancer Center in New York, USA, and co-workers say that “[e]levated preoperative CEA is not informative when postoperative CEA is normal.”
And they conclude: “Routine measurement of postoperative, rather than preoperative, CEA is warranted.”
Describing the findings as “provocative”, the authors of an accompanying commentary say that “[although] not the primary objective of the study, the potential value of CEA as a biomarker is perhaps greatest as an early indicator of tumor recurrence.”
Rebecca Anne Miksad and Neal Meropol, both from Flatiron Health in New York, write: “The observation […] that the timing of recurrence is earlier among patients with elevated postoperative CEA introduces the concept of risk-stratified surveillance that varies based on overall risk and the timing of that risk.
“While the term precision medicine is quite familiar in the setting of cancer treatment selection, its application to surveillance after definitive primary treatment also holds great promise if early subclinical metastasis can be identified and effectively treated with curative potential”, they conclude.
Konishi T, Shimada Y, Hsu M, et al. Association of preoperative and postoperative serum carcinoembryonic antigen and colon cancer outcome. JAMA Oncol; Advance online publication 21 December 2017. doi: 10.1001/jamaoncol.2017.4420
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group