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Dominik Hofmann, Dorothea Nagel, Ulla Lau-Werner, Matthias W. Wichmann, Hans-Martin Hornung, Ulf H. Stenman, Andreas Schalhorn, Petra Stieber
Prognosis in non-metastatic colorectal cancer: multivariate evaluation of preoperative levels of six tumor markers in addition to clinical parameters / Multivariate Analyse der prognostischen Aussagekraft von sechs properativen Tumormarkern zustzlich zu k
Keywords: CA 19-9, CA 72-4, CA 242, CEA, colorectal cancer, hCG, kolorektales Karzinom
Background: In addition to carcino-embryonic antigen (CEA), several oncological biomarkers have been described to be of prognostic relevance in colorectal cancer. Currently, it is still unclear which of these markers are able to provide additive information to established prognostic factors in non-metastatic colorectal cancer. Methods: We investigated whether tumor markers have additive prognostic value to tumor stage in 458 patients with non-metastatic colorectal cancer. Preoperative serum levels of CEA, cancer antigen (CA) 19-9, CA 242, CA 72-4, CYFRA 21-1 and human chorionic gonadotropin (hCG) were analyzed. Results: For evaluating disease-free survival (DFS) and overall tumor-related survival (OTS), based on recommendations for adjuvant treatment, patients were divided into the good prognosis group (GPG: colon cancer stage I-II or rectal cancer stage I) and the bad prognosis group (BPG) consisting of the remaining patients with indication for adjuvant treatment. Evaluating tumor markers, linearity was tested. In case of non-linearity a cut-off value was determined. Log (CEA) showed linearity in the GPG and BPG. In the GPG, CEA was the only significant tumor marker, whereas in the BPG, CEA, CA 19-9, CA 242 and CA 72-4 were significant predictors. In multivariate Cox regression analysis, T stage (T3 or T4) and CEA proved independent relevance in the GPG, whereas T4, N2, site, CEA and CA 19-9 were independent predictors in the BPG. Conclusions: CEA and possibly CA 19-9 have additional prognostic value besides tumor stage and, therefore, should be included in the decision for adjuvant treatment.
LaboratoriumsMedizin, Walter de Gruyter
Print ISSN: 0025-8466
Volume: 31, 04/2007
Pages: 76 - 85