Effect of elevated CEA levels on the outcome of colorectal cancer patients with different histopathologic types:A SEER population-based study

Siqi Sheng; Xiaoming Bai; Yiting Wang; Haimei Feng; Jie Chen; Yitian Chen; Mengxi  Huang; Zengjie Lei; Xiaoyuan Chu

doi:10.17305/bb.2024.11265

Authors

Siqi Sheng Department of Medical Oncology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, China
Xiaoming Bai Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
Yiting Wang Department of Oncology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China https://orcid.org/0009-0001-4765-0460
Haimei Feng Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
Jie Chen Department of Medical Oncology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, China
Yitian Chen Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
Mengxi Huang Department of Medical Oncology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, China https://orcid.org/0000-0002-9274-6023
Zengjie Lei Department of Medical Oncology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, China; Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China; Department of Medical Oncology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China and Department of Medical Oncology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu Province, China
Xiaoyuan Chu Department of Medical Oncology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, China

DOI:

https://doi.org/10.17305/bb.2024.11265

Keywords:

Colorectal cancer, carcinoembryonic antigen, histopathological type, prognosis, metastasis

Abstract

Limited and contradictory evidence has been reported regarding the prognostic effects of carcinoembryonic antigen (CEA) on the prognosis and metastasis of classical adenocarcinoma (CA), mucinous adenocarcinoma (MA), and signet-ring cell carcinoma (SRCC) in colorectal cancer (CRC) patients. We investigated the associations between histological subtypes and preoperative serum CEA levels in determining the oncologic outcomes of CRC patients. A total of 47,692 patients with clearly diagnosed CRC were selected from the Surveillance, Epidemiology, and End Results (SEER) database and divided into two cohorts based on serum CEA levels: CEA-normal (C0) and CEA-elevated (C1). Chi-square analysis revealed a correlation between CEA levels and histological classification. We then included a newly defined interaction variable (H&CEA) in the Cox regression analysis, which demonstrated that this variable could serve as an independent prognostic factor (P < 0.001). CA, in the context of elevated serum CEA levels, differed from the other two histopathological types, showing unexpectedly higher risks for both overall survival (OS) (HR = 1.70, 95% CI = 1.65–1.75, P < 0.001) and cancer-specific survival (CSS) (HR = 1.78, 95% CI = 1.72–1.85, P < 0.001). Furthermore, elevated CEA levels significantly increased the proportion of liver metastases in the CA group (25.43% vs 3.95%, P < 0.001). The interaction variable H&CEA can be used as an independent prognostic factor for CRC and should be considered in the diagnosis of CRC and the development of personalized treatment plans. Additionally, in the context of elevated CEA levels, CA is associated with poor prognosis and increased liver metastases. This CRC subgroup warrants special clinical attention from oncologists.