The Influence Of Preoperative To Postoperative Serum Carcinoembryonic Antigen Ratio On The Prognosis Of Colorectal Cancer

BackgroundCarcino-embryonic antigen(CEA)is a type of acidic glycoprotein that is present on the surface of tumor cells and participates in cell-cell adhesion.Overexpression of CEA can inhibit the differentiation of cells and destroy the structure of the tissue.Not only can CEA expression be elevated in malignancies,but CEA expression can also be observed in non-neoplastic diseases such as smoking,inflammation,pregnancy,gynecological diseases,and hepatitis.Therefore,CEA is a broad spectrum.Tumor markers.In the diagnosis of colorectal malignancies,the tissue specificity of CEA is not high,but in existing tumor markers,CEA is the only colorectal cancer-related tumor marker recommended by the NCCN guidelines.A large number of studies have reported that preoperative CEA levels have a certain value for the prognosis of colorectal cancer;postoperative CEA levels have an important indication of tumor recurrence and metastasis.However,the preoperative and postoperative CEA levels are not ideal for the specificity and sensitivity of the prognosis.Exploring more effective prognostic and therapeutic effect markers is an urgent problem in clinical practice.Only a small amount of reports suggest that the trend of CEA before and after surgery may be of greater value to the prognosis of patients with colorectal cancer.Objective This study explored the value ofpreoperative and postoperative CEA ratio in the prognosis of patients with colorectal cancer.Methods The clinical data of 2035 patients with colorectal cancer,including gender(male 1138 cases,females)897 cases),age(1091 cases ≥ 60 years,944 cases <60 years old,mean age 59.84 +/-13.44 years old),family history(173 cases with family history,no 1862 cases),smoking(426 cases smoking,1609 cases without smoking)),Tumor size(≥5 cm1288 cases,<5 cm817 cases),lymph node metastasis(964 cases with lymph node metastasis,no lymph node metastasis 1071 cases),distant metastasis(615 distant metastases,1420 no distant metastases),TNM staging(I/II 641 cases,III/IV 1394 cases),histological type(adenocarcinoma 1551,non-adenocarcinoma 484),gross type(ulcer type 1174,non-ulcer type 861),degree of differentiation(high/ There were 1291 moderately differentiated cases,744 cases with low/ undifferentiated),and tumor sites(rectal 1163 cases,colon 872 cases).who underwent pathological diagnosis and underwent radical surgery from January 2001 to January 2011 were retrospectively analyzed.Serum CEA expression levels were detected by ELISA.Univariate analysis was performed by χ2 test to analyze pre-CEA levels and pre-post-CEA ratios and clinicopathological parameters.Kaplan Meier survival curves and log-rank test were used to compare the low and high level groups of pre-CEA levels and pre-post-CEA ratios.Multivariate survival analysis was performed by the Cox regression model to determine relative risk(RR)and95% confidence intervals(CI).Results1.In the correlation analysis,the single factor analysis showed that the preoperative and postoperative CEA ratio were related to distant metastasis and tumor differentiation(all P < 0.05);Meanwhile,pre-post-CEA ratios were not associated with gender,age,family history,smoking,tumor size,lymphatic metastasis,TNM stage,tissue type and tumor location(all P > 0.05).Multivariate analysis showed that pre-post-CEA ratios were associated with lymphatic and distant metastases,TNM stage and degree of tumor differentiation(all P < 0.01).But,they were not associated with family history,smoking,other cancer in combination,tumor size,tissue type,general tumor type and tumor location(all P > 0.05).2.In the survival analysis,univariate analysis showed that pre-CEA levels,pre-post-CEA ratios,tumor size,TNM stage,lymphatic metastasis,distant metastasis and degree of tumor differentiation were associated with 5-year overall survival(OS,all P < 0.05).Factors like age,gender,family history,smoking,tissue type and tumor location were not related with 5-year OS(all P > 0.05).Multivariate analysis showed that pre-operative CEA,pre-to post-operative CEA ratio,distant metastasis,TNM stage and degree of tumor differentiation were associated with 5-year OS(all P < 0.05).Meanwhile,gender,age,family history,smoking,tumor size,lymphatic metastasis,tissue type,general tumor type and tumor location were not associated with 5-year OS(all P > 0.05).Conciusion The preoperative and postoperative CEA ratio was closely related to distant metastases,TNM stage and degree of tumor differentiation.The preoperative and postoperative CEA ratio is an independent risk factors for 5-year OS of CRC patients,and it is expected to be an important indicator to determine the prognosis of colorectal cancer.