PREOPERATIVE CARCINOEMBRYONIC ANTIGEN PREDICTS OUTCOMES IN NODE-NEGATIVE COLON-CANCER PATIENTS - A MULTIVARIATE-ANALYSIS OF 572 PATIENTS

Background: Although prospective trials have demonstrated that postope rative chemotherapy for nodepositive colon cancer patients provides su rvival benefit, no improvement in survival has been documented for nod e-negative colon cancer patients. There are, however, a subset of node -negative patients that go on to die of their disease. We hypothesize that this subset of node-negative patients may benefit from postoperat ive chemotherapy. We analyzed a large cohort of nodenegative colon can cer patients from a single institution to determine prognostic factors that predict which patients with node-negative colon cancer might exp erience recurrence and can benefit from postoperative chemotherapy. St udy Design: A review of the prospective database for colorectal cancer at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1985 and 19 93 identified 572 patients who underwent curative resection for nodene gative colon cancer (T1,2,3,4N0M0). Demographic, serum, and pathologic factors were analyzed for prognostic significance. Survival was calcu lated by the method of Kaplan-Meier and compared by log rank test. Mul tivariate analysis was calculated by the Cox proportional hazard model . Results: Median follow-up was 35 months. Factors predictive of survi val by univariate analysis include tumor stage, overall stage, and pre operative serum carcinoembryonic antigen (CEA) elevation. By multivari ate analysis, overall stage and preoperative serum CEA level predicted survival. Conclusions: Routine histologic and demographic factors do not predict outcome in node-negative colon cancer patients. Preoperati ve CEA and overall stage predict survival by multivariate analysis. Pr eoperative CEA elevation in node-negative patients identifies a group of patients that has a poor prognosis and defines a subset of patients who may benefit from postoperative chemotherapy. (C) 1997 by the Amer ican College of Surgeons.