PREOPERATIVE CARCINOEMBRYONIC ANTIGEN LEVEL AS A PROGNOSTIC INDICATORIN RESECTED PRIMARY LUNG-CANCER

The aim of this study was to evaluate the prognostic significance of e levated preoperative carcinoembryonic antigen (CEA) levels in cases of resected primary lung cancer. Between 1985 and 1989, 152 patients wit h tumors and CEA levels above 10 ng/mL underwent operation. One hundre d twenty-five of them underwent resection of their tumors and the othe r 27 underwent exploratory thoracotomy only. Fifty-two percent of canc ers were adenocarcinomas and 33% were epidermoid. Forty-two resected t umors were classified as stage I, 29 as stage II, 45 as stage IIIa, 7 as stage IIIb, and 2 as stage IV. The 3-year actuarial survival rate w as 54% for patients with stage I tumors, 28% for those with stage II, 18% for those with stage IIIa, 44% for those with stage IIIb, and 0% f or those with stage IV tumors. The 5 year actuarial survival was 40% f or those with stage I tumors, 28% for those with stage II, 7% for thos e with stage IIIa, and 0% for those with stage IIIb tumors. Preoperati ve CEA levels increased from stage I to stage IIIa (p < 0.05). However , based on preoperative CEA levels we were not able to predict resecta bility, because levels were not significantly different between stage IIIa and exploratory thoracotomy-only groups. Adenocarcinoma was not s ignificantly associated with higher CEA levels than was epidermoid, ex cept in stage IIIa disease (p < 0.05). We found a critical unfavorable level of prognostic significance at 30 ng/mL. Within patients who und erwent resection of stage I or II tumors, those with preoperative CEA levels under 30 ng/mL demonstrated significantly prolonged survival ov er those with CEA above 30 ng/mL (p < 0.05). Virtually all patients wi th marked elevations of CEA levels (> 50 ng/mL) died within 2 years. T herefore, these patients must be highly suspected of having metastases even if operative staging may appear limited. Determining preoperativ e CEA levels provides prognosis information which may supplement that available by staging.