Open AccessElevated CA19-9 as the Most Significant Prognostic Factor in Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy
Author(s) -
Lu Ning Zhang,
Pu Ou-Yang,
Weiwei Xiao,
Xinping Yu,
Kai You,
Zhi Fan Zeng,
RuiHua Xu,
Yuan Gao
Publication year - 2015
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000001793
Subject(s) - medicine , carcinoembryonic antigen , colorectal cancer , oncology , chemoradiotherapy , ca19 9 , univariate analysis , chemotherapy , gastroenterology , proportional hazards model , fluorouracil , adjuvant chemotherapy , pancreatic cancer , cancer , multivariate analysis , breast cancer
It remains controversial regarding the prognostic significance of carbohydrate antigen 19-9 (CA19-9) for locally advanced rectal cancer (LARC) (T3–4/N+) patients with neoadjuvant chemoradiotherapy (neo-CRT). And it is unknown whether CA19-9 can identify patients who may benefit from adjuvant chemotherapy. Overall, 303 LARC patients with neo-CRT between 2004 and 2010 were recruited. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and local recurrence-free survival across pretreatment CA19-9 were estimated by Kaplan–Meier method and Cox regression model. In univariate analysis, elevated CA19-9 (>35 U/mL) was significantly correlated with poor OS ( P = 0.003), DFS ( P = 0.001), and DMFS ( P = 0.039). Adjusting for the known covariates, CA19-9 was significantly associated with OS (HR = 1.86, 95% CI 1.03–3.34, P = 0.039) and DFS (HR = 1.74, 95% CI 1.08–2.80, P = 0.024). In the elevated CA19-9 subgroup, patients with adjuvant chemotherapy got much better OS ( P < 0.001) and DFS ( P = 0.016) than those without. In consideration of both CA19-9 and carcinoembryonic antigen (CEA), we found that patients with both elevated CA19-9 and CEA (>5 ng/mL) got the worst OS ( P = 0.021) and DFS ( P = 0.006), and significantly benefited from adjuvant chemotherapy in OS ( P < 0.001) and DFS ( P = 0.026). Pretreatment CA19-9 level is a significant prognostic indicator in patients with LARC following neo-CRT. The addition of CA19-9 to CEA is valuable to discriminate the appropriate patients for adjuvant chemotherapy.