Combined Modality Therapy for Rectal Cancer: The Relative Value of Posttreatment Versus Pretreatment CEA as a Prognostic Marker for Disease Recurrence
| Autor: | Siobhan E. McDonnell, S. Song, Albert C. Koong, Daniel T. Chang, Stanley L. Liauw, Bruce D. Minsky, Julian C. Hong |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Colorectal cancer medicine.medical_treatment Leucovorin Urology Young Adult Carcinoembryonic antigen Internal medicine Antineoplastic Combined Chemotherapy Protocols Biomarkers Tumor medicine Humans Combined Modality Therapy Survival rate Neoadjuvant therapy Aged Neoplasm Staging Aged 80 and over Univariate analysis biology Rectal Neoplasms business.industry Radiotherapy Dosage Middle Aged Prognosis medicine.disease Total mesorectal excision Neoadjuvant Therapy Carcinoembryonic Antigen Survival Rate Radiation therapy Chemotherapy Adjuvant biology.protein Female Radiotherapy Adjuvant Surgery Fluorouracil Neoplasm Recurrence Local business Follow-Up Studies |
| Zdroj: | Annals of Surgical Oncology. 19:2471-2476 |
| ISSN: | 1534-4681 1068-9265 |
| Popis: | To evaluate the prognostic significance of the first postsurgery carcinoembryonic antigen (CEA) level in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation (nCRT) and total mesorectal excision.A total of 100 patients underwent nCRT and had baseline and posttreatment CEA levels recorded within 6 months of surgery. The median radiotherapy dose was 50.4 Gy. Eighty-six patients received adjuvant 5-fluorouracil-based chemotherapy. Prognostic factors were analyzed for possible associations with freedom from failure (FFF) by univariate and multivariate analyses. Median follow-up was 30 months.The median CEA (ng/ml) levels at baseline before nCRT, after nCRT, and after total mesorectal excision were 3.6, 1.7, and 1.3, respectively. Pathologic complete response was observed in 22%. FFF at 36 months was 78%. Local failure and distant failure occurred in 4 and 20% of the patients, respectively. On univariate analysis, pathologic complete response, margin status, and both pretreatment and postsurgery CEA levels were associated with recurrence (all P0.05). On multivariate analysis, pathologic complete response (P0.007), margin status (P0.001), and postsurgery CEA level (P = 0.003), but not baseline CEA level (P = 0.2), were found to be associated with recurrence.After nCRT for rectal cancer, postsurgery CEA level may have more prognostic value than pretreatment level. Patients with a postsurgery CEA level of2.5 ng/ml have higher rates of recurrence and may warrant closer surveillance. |
| Databáze: | OpenAIRE |
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