CAN PREOPERATIVE AND POSTOPERATIVE CEA PREDICT SURVIVAL AFTER COLON-CANCER RESECTION

Although elevated preoperative carcinoembryonic antigen (CEA) levels a re associated with a poor prognosis, little has been written regarding the correlation of CEA response following curative resection of color ectal cancer and its relationship to survival. The purpose of this stu dy, therefore, was to retrospectively evaluate survival in three group s of patients undergoing curative resection (Dukes B and C) for colore ctal carcinoma: 1) elevated preoperative CEA/elevated postoperative CE A (EL/EL); 2) elevated preoperative CEA/normal postoperative CEA (EL/N L); and 3) normal preoperative CEA/normal postoperative CEA (NL/NL). A normal CEA was defined as a value <5.0 ng/mL. Levels were drawn the d ay before surgery and between 2 and 4 weeks postoperatively. Patients were evaluated for age, sex, histologic grade, CEA levels (pre and pos toperative), nerve and venous invasion, tumor site, and survival. Ther e were no significant differences with respect to age, sex, Dukes stag e, tumor site, histologic grade, or incidence of nerve or vascular inv asion among the three groups. Five-year survival was significantly wor se for patients with elevated preoperative CEA levels compared to thos e with normal preoperative CEA (53% versus 64% P < 0.05), and for the EL/EL group compared with either of the other two groups (EL/EL: 66.6 +/- 11.8; EL/NL: 87.7 +/- 10.2; Group 3:93.4 +/- 9.5, P < 0.05 ANOVA). The results indicate that a preoperative elevated CEA, particularly o ne that fails to decrease to normal postoperatively following a curati ve resection for colorectal carcinoma, represents a poor prognostic fa ctor. Use of the CEA response may be useful for identifying a subgroup of colorectal cancer patients who are candidates for adjuvant chemoth erapy.