The value of carcinoembryonic antigen stage in staging, prognosis, and management of colorectal cancer: results from two cohort studies
BackgroundCombining the carcinoembryonic antigen (CEA) level (C stage) with TNM staging can provide a more comprehensive prognostic assessment of colorectal cancer (CRC). However, the clinical value of incorporating CEA status into the TNM staging system needs to be evaluated.MethodsWe used the SEER...
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| Format: | Article |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1268783/full |
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| author | Hailun Xie Hailun Xie Lishuang Wei Mingxiang Liu Mingxiang Liu Yanren Liang Yanren Liang Qiwen Wang Qiwen Wang Shuangyi Tang Jialiang Gan Jialiang Gan |
| author_facet | Hailun Xie Hailun Xie Lishuang Wei Mingxiang Liu Mingxiang Liu Yanren Liang Yanren Liang Qiwen Wang Qiwen Wang Shuangyi Tang Jialiang Gan Jialiang Gan |
| author_sort | Hailun Xie |
| collection | DOAJ |
| description | BackgroundCombining the carcinoembryonic antigen (CEA) level (C stage) with TNM staging can provide a more comprehensive prognostic assessment of colorectal cancer (CRC). However, the clinical value of incorporating CEA status into the TNM staging system needs to be evaluated.MethodsWe used the SEER database (N = 49,350) and a retrospective cohort from China (N = 1,440). A normal CEA level was staged as C0 and an elevated CEA level was staged as C1. Restricted cubic spline analysis was used to examine the dose-response relationship between the CEA level and survival. The Kaplan-Meier method with the log-rank test was used to plot survival curves. Multivariable Cox proportional hazards regression models with forward stepwise variable selection were used to estimate the hazard ratios and 95% confidence intervals.ResultsPatients with C1 were more likely to have advanced disease than those with C0. CEA on a continuous scale was positively associated with mortality risk. Compared with patients with C0 stage, those with C1 stage had significantly lower survival rates. In the SEER dataset, C1 was independently associated with poor prognosis in patients with CRC, with an approximately 70% increased risk of mortality. Patients with C1 stage had significantly lower survival than those with C0 stage at all clinical stages. Incorporating the C stage into the TNM staging refined the prediction of prognosis of patients with CRC, with a gradual decline in prognosis from stage I C0 to stage IV C1. A similar pattern was observed in the present retrospective cohort study. At each lymph node stage, patients with C1 had significantly lower 5-year survival rates than patients with C0. Compared with lymph node positivity, CEA positivity may have a stronger correlation with a worse prognosis.ConclusionOur findings not only validated the independent prognostic significance of CEA in CRC but also demonstrated its enhanced prognostic value when combined with TNM staging. Our study provides evidence supporting the inclusion of C stage in the TNM staging system. |
| first_indexed | 2024-03-11T19:48:19Z |
| format | Article |
| id | doaj.art-42bd31af087e41be8822616a722fdf26 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-11T19:48:19Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-42bd31af087e41be8822616a722fdf262023-10-05T15:24:36ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-10-011310.3389/fonc.2023.12687831268783The value of carcinoembryonic antigen stage in staging, prognosis, and management of colorectal cancer: results from two cohort studiesHailun Xie0Hailun Xie1Lishuang Wei2Mingxiang Liu3Mingxiang Liu4Yanren Liang5Yanren Liang6Qiwen Wang7Qiwen Wang8Shuangyi Tang9Jialiang Gan10Jialiang Gan11Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, ChinaGuangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, ChinaDepartment of Geriatric Respiratory Disease Ward, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, ChinaDepartment of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, ChinaGuangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, ChinaDepartment of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, ChinaGuangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, ChinaDepartment of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, ChinaGuangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, ChinaDepartment of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, ChinaDepartment of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, ChinaGuangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, ChinaBackgroundCombining the carcinoembryonic antigen (CEA) level (C stage) with TNM staging can provide a more comprehensive prognostic assessment of colorectal cancer (CRC). However, the clinical value of incorporating CEA status into the TNM staging system needs to be evaluated.MethodsWe used the SEER database (N = 49,350) and a retrospective cohort from China (N = 1,440). A normal CEA level was staged as C0 and an elevated CEA level was staged as C1. Restricted cubic spline analysis was used to examine the dose-response relationship between the CEA level and survival. The Kaplan-Meier method with the log-rank test was used to plot survival curves. Multivariable Cox proportional hazards regression models with forward stepwise variable selection were used to estimate the hazard ratios and 95% confidence intervals.ResultsPatients with C1 were more likely to have advanced disease than those with C0. CEA on a continuous scale was positively associated with mortality risk. Compared with patients with C0 stage, those with C1 stage had significantly lower survival rates. In the SEER dataset, C1 was independently associated with poor prognosis in patients with CRC, with an approximately 70% increased risk of mortality. Patients with C1 stage had significantly lower survival than those with C0 stage at all clinical stages. Incorporating the C stage into the TNM staging refined the prediction of prognosis of patients with CRC, with a gradual decline in prognosis from stage I C0 to stage IV C1. A similar pattern was observed in the present retrospective cohort study. At each lymph node stage, patients with C1 had significantly lower 5-year survival rates than patients with C0. Compared with lymph node positivity, CEA positivity may have a stronger correlation with a worse prognosis.ConclusionOur findings not only validated the independent prognostic significance of CEA in CRC but also demonstrated its enhanced prognostic value when combined with TNM staging. Our study provides evidence supporting the inclusion of C stage in the TNM staging system.https://www.frontiersin.org/articles/10.3389/fonc.2023.1268783/fullcolorectal cancercarcinoembryonic antigenstagingSEERretrospective cohort studyprognosis |
| spellingShingle | Hailun Xie Hailun Xie Lishuang Wei Mingxiang Liu Mingxiang Liu Yanren Liang Yanren Liang Qiwen Wang Qiwen Wang Shuangyi Tang Jialiang Gan Jialiang Gan The value of carcinoembryonic antigen stage in staging, prognosis, and management of colorectal cancer: results from two cohort studies Frontiers in Oncology colorectal cancer carcinoembryonic antigen staging SEER retrospective cohort study prognosis |
| title | The value of carcinoembryonic antigen stage in staging, prognosis, and management of colorectal cancer: results from two cohort studies |
| title_full | The value of carcinoembryonic antigen stage in staging, prognosis, and management of colorectal cancer: results from two cohort studies |
| title_fullStr | The value of carcinoembryonic antigen stage in staging, prognosis, and management of colorectal cancer: results from two cohort studies |
| title_full_unstemmed | The value of carcinoembryonic antigen stage in staging, prognosis, and management of colorectal cancer: results from two cohort studies |
| title_short | The value of carcinoembryonic antigen stage in staging, prognosis, and management of colorectal cancer: results from two cohort studies |
| title_sort | value of carcinoembryonic antigen stage in staging prognosis and management of colorectal cancer results from two cohort studies |
| topic | colorectal cancer carcinoembryonic antigen staging SEER retrospective cohort study prognosis |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1268783/full |
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