Elevated CA19-9 as the Most Significant Prognostic Factor in Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy.

Abstract

It remains controversial regarding the prognostic significance of carbohydrate antigen 19-9 (CA19-9) for locally advanced rectal cancer (LARC) (T3-4/N+) patients with neoadjuvant chemoradiotherapy (neo-CRT). And it is unknown whether CA19-9 can identify patients who may benefit from adjuvant chemotherapy.Overall, 303 LARC patients with neo-CRT between 2004 and 2010 were recruited. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and local recurrence-free survival across pretreatment CA19-9 were estimated by Kaplan-Meier method and Cox regression model.In univariate analysis, elevated CA19-9 (>35 U/mL) was significantly correlated with poor OS (P = 0.003), DFS (P = 0.001), and DMFS (P = 0.039). Adjusting for the known covariates, CA19-9 was significantly associated with OS (HR = 1.86, 95% CI 1.03-3.34, P = 0.039) and DFS (HR = 1.74, 95% CI 1.08-2.80, P = 0.024). In the elevated CA19-9 subgroup, patients with adjuvant chemotherapy got much better OS (P < 0.001) and DFS (P = 0.016) than those without. In consideration of both CA19-9 and carcinoembryonic antigen (CEA), we found that patients with both elevated CA19-9 and CEA (>5 ng/mL) got the worst OS (P = 0.021) and DFS (P = 0.006), and significantly benefited from adjuvant chemotherapy in OS (P < 0.001) and DFS (P = 0.026).Pretreatment CA19-9 level is a significant prognostic indicator in patients with LARC following neo-CRT. The addition of CA19-9 to CEA is valuable to discriminate the appropriate patients for adjuvant chemotherapy.

• Authors: Lu-Ning Zhang, Pu-Yun OuYang, Wei-Wei Xiao, Xin Yu, Kai-Yun You, Zhi-Fan Zeng, Rui-Hua Xu, Yuan-Hong Gao
• Journal: Medicine (Medicine (Baltimore)) Vol. 94 Issue 45 Pg. e1793 (Nov 2015) ISSN: 1536-5964 [Electronic] United States
• PMID: 26559251 (Publication Type: Journal Article, Observational Study)

Chemical References

• CA-19-9 Antigen

Topics

• CA-19-9 Antigen (metabolism)
• Carcinoma (blood, mortality, therapy)
• Chemoradiotherapy, Adjuvant
• Disease-Free Survival
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local (blood, epidemiology)
• Prognosis
• Rectal Neoplasms (blood, mortality, therapy)
• Retrospective Studies
• Survival Rate