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Prognostic value of pretreatment level of carcinoembryonic antigen on tumour downstaging and early occurring metastasis in locally advanced rectal cancer following neoadjuvant radiotherapy (30 Gy in 10 fractions)
Author(s) -
Wang L.,
Zhong X.G.,
Peng Y.F.,
Li Z.W.,
Gu J.
Publication year - 2014
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12354
Subject(s) - medicine , carcinoembryonic antigen , colorectal cancer , total mesorectal excision , incidence (geometry) , metastasis , neoadjuvant therapy , gastroenterology , radiation therapy , rectum , distant metastasis , retrospective cohort study , urology , cancer , physics , breast cancer , optics
Aim To evaluate the role of carcinoembryonic antigen ( CEA ) in predicting the response to and prognosis for locally advanced rectal cancer treated with 30 Gy neoadjuvant radiotherapy (n RT ) in 10 fractions (30 Gy/10 f). Method This retrospective study involved 240 patients with locally advanced rectal cancer who underwent 30 Gy/10 f n RT (biologically equivalent dose 36 Gy) followed by total mesorectal excision between August 2003 and 2009. Serum CEA level was determined before administration of n RT . The prognostic value of serum CEA level on tumour downstaging and 3‐year disease‐free survival was analysed. Results Ninety out of 240 (37.5%) patients had elevated CEA levels before n RT . The incidence of T downstaging in patients decreased significantly as the pretreatment CEA levels became more elevated (< 5 ng/ml, 50.7%; 5–10 ng/ml, 39.5%; > 10 ng/ml, 17.3%; P = 0.00014). Downstaging to yp CR or yp S tage I occurred in 46.7% (66/150) of patients with a CEA level of < 5 ng/ml and 34.2% (13/38) of patients with a CEA level of 5–10 ng/ml. In contrast, just 13.5% (7/52) of those with a CEA level > 10 ng/ml downstaged to yp S tage I and none of them achieved yp CR , with statistical difference ( P = 0.001). A significantly higher incidence of early metastasis (within 6 postoperative months) was observed with increasing CEA level: 2.0% (3/150), 5.4% (2/38) and 11.5% (6/52) in patients with CEA level < 5 ng/ml, 5–10 ng/ml or > 10 ng/ml, respectively ( P = 0.018). Conclusion Pretreatment CEA level cannot only predict tumour downstaging and yp TNM stage for rectal cancer following 30 Gy/10 f n RT , but also promisingly suggests a high incidence of early occurring distant metastasis. These findings may be used to select patients with n RT resistance and occult metastasis and make alternative treatment strategies.