Preoperative And Postoperative Changes Of Serum Carcinoembryonic Antigen And Prognosis Of Three-year Recurrence-free Survival In Patients With Rectal Cancer

Objective:This study explored the relationship between the changes in serum carcinoembryonic antigen before and after surgery and the three-year recurrence free survival(RFS)prognosis of rectal cancer patients,and clarified the predictive value of the risk of recurrence and metastasis of rectal cancer after CEA It provides a new theoretical basis for the risk of recurrence and metastasis of patient with rectal cancer after surgery and adjuvant treatment for patients with stage ? rectal cancer.Methods:A retrospective and continuous collection of 1487 patients with stage?-? rectal cancer who underwent radical resection at the two research centers of Yunnan Cancer Hospital and the Sixth Affiliated Hospital of Sun Yat-Sen University from January 2010 to July 2016.After inclusion of exclusion criteria,1022 rectal cancer patients were finally entered into this study.The clinicopathological data of Yunnan Cancer Hospital(n=820 cases)and the sixth affiliated hospital of Sun Yat-sen University(n=202 cases)were collected and all patients had no new assistance Treatment and complete follow-up information for more than 3 years,the follow-up deadline is July 10,2019The clinical data collected in this study included gender,age,body mass index(BMI),preoperative and postoperative CEA values,tumor location,surgical route,surgical procedure,tumor differentiation,histological type,primary tumor(T stage),Regional lymph nodes(N staging),tumor pathological staging,lymphatic invasion,peripheral nerve invasion,tumor deposition,and adjuvant treatment after surgery total 17 related factors that may affect the prognosis of rectal cancer.According to the serum CEA levels before and after the operation,5.0 ng/mL CEA cutoff was used to determine whether the CEA was normal or elevated.All patients were divided into 3 groups;Group A:Preoperative CEA normal group(n=627);:Preoperative CEA increased and normal postoperative group(n=255);Group C:CEA increased preoperative and postoperative group(n=67).Statistical analysis was performed using SPSS23.0 software,continuous variables were compared using the Mann Whitney U test,and categorical variables were compared using the x2 test.Kaplan-Meier method was used for survival analysis to analyze patients' three-year relapse-free survival(RFS)over time.Differences in RFS were assessed by log-rank test single factor analysis.Cox proportional hazard regression model was used to estimate the hazard ratio(HR)and 95%confidence interval(CI)of different CEA groups.In the univariate analysis,variables with P values less than 0.05 were included in the final COX multivariate model.And passed the Wald testResults:1.After strict inclusion and exclusion criteria,1022 patients with rectal cancer finally entered the study,of which 206(21.71%)were in stage T2 and 608(56.38%)were in stage T3.There was no significant difference in the data between Yunnan Cancer Hospital and Zhongshan Sixth Hospital.Recurrence and metastasis occurred in 224 of the 1022 patients who completed the follow-up for more than 3 years,and the recurrence rate was 21.92%.2.Univariate analysis showed T stage,N stage,lymphatic invasion,peripheral nerve invasion,tumor deposition,preoperative CEA elevation,normal postoperative,and postoperative CEA elevation were related to 3-year RFS(P value<0.05).Multivariate analysis showed T stage,N stage,lymphatic invasion,perineural invasion,tumor deposition,and CEA elevation before and after surgery were associated with 3-year RFS(P value<0.05),which is an independent risk prognosis for 3-year RFS factor.The preoperative CEA was elevated and the normal group was not associated with 3-year RFS(HR,1.38;95%CI,1.00-1.92;P=0.05).3.Comparing the KM survival curves of groups A,B,and C shows that the 3-year RFS of patients in group A is 84.9%(95%CI,82.2%-87.8%),and the 3-year RFS of patients in group B is 75.9%(95%CI,70.8%-81.4%),the 3-year RFS of group C patients was 45.8%(95%CI,35.2%-59.5%),(Group C Vs Group A:HR,1.68;95%CI,1.22-2.33 P=0.0016 and group B vs group A:HR,5.04;95%CI,3.43-7.42;P<0.0001)The three groups were compared with statistical differences.P<0.001.Regrouping with a CEA cutoff of 10.0 ng/mL yielded similar results.Group C patients had the highest risk of recurrence,followed by group B patients,and group A patients had the lowest risk of recurrence.4.Comparison of the three groups of survival curves in patients with stage N1 found that the 3-year RFS of 126 patients with normal CEA before surgery was 80.7%(95%CI,74.1%-88.0%),and CEA was elevated before surgery in 78 patients.3.The 3-year RFS of patients in the normal group after surgery was 75.5%(95%CI,66.5%-85.7%),and the 3-year RFS of 28 patients with elevated CEA before and after surgery was 56.9%(95%CI,41.2).%-78.7%),the three groups of patients were compared with statistical differences.P=0.002.Conclusion:1.The increase in postoperative CEA is an important indicator for predicting recurrence,and can be used as a predictor of stratification and individualized monitoring strategies for rectal cancer recurrence and metastasis.2.There is no obvious predictive relationship between preoperative CEA elevation and recurrence and metastasis.