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Medline ® Abstract for Reference 45

of 'Adjuvant chemotherapy for resected stage II colon cancer'

45
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Incorporation of CEA Improves Risk Stratification in Stage II Colon Cancer.
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Spindler BA, Bergquist JR, Thiels CA, Habermann EB, Kelley SR, Larson DW, Mathis KL
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J Gastrointest Surg. 2017;21(5):770. Epub 2017 Mar 13.
 
High-risk features are used to direct adjuvant therapy for stage II colon cancer. Currently, high-risk features are identified postoperatively, limiting preoperative risk stratification. We hypothesized carcinoembryonic antigen (CEA) can improve preoperative risk stratification for stage II colon cancer. The National Cancer Database (NCDB 2004-2009) was reviewed for stage II colon adenocarcinoma patients undergoing curative intent resection. A novel risk stratification including both traditional high-risk features (T4 lesion,<12 lymph nodes sampled, and poor differentiation) and elevated CEA was developed. Unadjusted Kaplan-Meier and adjusted Cox proportional hazards analyzed overall survival. Concordance Probability Estimates (CPE) assessed discrimination. Seventy-four thousand nine hundred forty-five patients were identified; 40,844 (54.5%) had CEA levels reported and were included. Chemotherapy administration was similar between normal and elevated CEA groups (23.8 vs. 25.1%, p = 0.003). Compared to patients with CEA elevation, 5-year overall survival in patients with normal CEA was improved (74.5 vs. 63.4%, p < 0.001). Restratification incorporating CEA resulted in reclassification of 6912 patients (16.9%) from average to high risk. CPE increased for novel risk stratification (0.634 vs. 0.612, SE = 0.005). The routinely available CEA test improved risk stratification for stage II colon cancer. CEA not only may improve staging of colon cancer but may also help guide additional therapy.
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Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.
PMID