5-YEAR SURVIVAL VERSUS INITIAL CONCENTRATIONS AND LONGITUDINAL SERUM CEA PATTERNS IN PATIENTS WITH COLORECTAL-CARCINOMA

Patients (n = 464) with colorectal carcinoma in stages A to D2 were st udied; 230 had CEA determined preoperatively and 433 serially. Actuari al life table analysis and the Mantel-Cox test showed that overall 5-y r survival was 59.2% and that the differences among the stages were hi ghly significant, Survival rates for patients with CEA over the cutpoi nts at 3.2, 5, 10, and 20 ng/ml decreased from 53.8% to 21.9%. When an alyzed in Cox multivariate regression, stage, initial CEA, age, and lo cation of cancer affected survival. Postoperatively, three CEA pattern s were found: 1) CEA was always normal; 2) initially elevated CEA was decreasing to the normal range to remain so thereafter; or 3) CEA star ted to increase from any nadir some time after surgery. The 5-yr survi val rate was 73.3% for patients with the normal, 44.5% with the decrea sing, and 30.1% with the increasing CEA pattern. When the postoperativ e CEA, pattern was added to the preoperative covariates in 196 patient s for whom both the initial CEA, and postoperative patterns were avail able, only the stage, postoperative CEA pattern, and location of cance r affected survival. After elimination of initial CEA 433 patients wit h postoperative serum were analyzed, and again, only stage, postoperat ive CEA pattern, and location of cancer appeared to affect survival. S tage of disease, initially elevated serum CEA, age over 60 yr, locatio n of cancer in the rectum, and CEA increasing after surgery appear to be independent ominous prognostic indicators.