Grading carcinoembryonic antigen levels can enhance prognostic stratification in colorectal cancer

1. Higher CEA levels in patients with colorectal cancer are indicative of aggressive tumour phenotypes and survival 

Evidence Rating Level: 2 (Good) 

Despite progress in early screening and treatment for colorectal cancer (CRC), prognosis has not improved with a 5-year survival rate around 60%. Identifying reliable prognostic factors is crucial for guiding clinical decisions and can improve the prognosis of patients. Prognosis of CRC is influenced by TNM staging and various pathological factors including microsatellite instability, histological type, and differentiation amongst others. To bypass the invasive nature of these tests, serum biomarkers such as carcinoembryonic antigen (CEA) are being investigated as a prognostic factor as it is significantly elevated in cancer patients. This study aimed to create a CEA grading system for CRC patients. Patients with pathologically confirmed CRC with complete pre and postoperative data and serological testing were included. CEA levels were normal in 57.3% of patients, mildly elevated in 25.6%, moderately elevated in 9.1% and severely elevated in 8.0%. The median CEA in these patients was 3.95. Patients with CRC recurrence had an elevated CEA of 6.62 with the non-recurrence group having a CEA of 3.48. Similarly, CEA was higher in patients that died (5.98) relative to those who did not (3.18). A Kaplan-Meier survival analysis showed CEA levels could be used to stratify patients with CRC. The prognosis showed a stepwise decline as CEA increased in both progression-free survival (67.8% vs 55.1% vs 46.5% vs 32.1%, p<0.001) and overall survival (70.1% vs 56.6% vs 46.5% vs 34.0%, p<0.001). CEA grading could also stratify patients into the same stages as TNM staging. Higher CEA levels were also associated with more aggressive tumour phenotypes. 

Click to read the study in BMJ Open

Image: PD

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