Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study
机构：[1]Department of Radiology, Guangdong Provincial People’s Hospital, GuangdongAcademy of Medical Sciences, Guangzhou 510080, China[2]GuangdongCardiovascular Institute, Guangzhou 510080, China[3]Guangdong ProvincialKey Laboratory of Artificial Intelligence in Medical Image Analysis and Application,Guangdong Provincial People’s Hospital, Guangdong Academyof Medical Sciences, Guangzhou 510080, China[4]Department of Radiology,Third Affiliated Hospital of Kunming Medical University, Yunnan CancerHospital, Yunnan Cancer Center, Kunming 650118, China[5]Key Laboratoryof Carcinogenesis and Translational Research (Ministry of Education/Beijing),Department of Radiology, Peking University Cancer Hospital & Institute,Beijing 100142, China[6]Department of Radiotherapy, Sixth Affiliated Hospitalof Sun Yat-Sen University, Guangzhou 510655, China中山大学附属第六医院[7]Department of Radiology,the First Affiliated Hospital of Chongqing Medical University, Chongqing400016, China重庆医科大学附属第一医院[8]Department of Radiology, Xiangya Hospital, CentralSouth University, Changsha 410008, China[9]Department of Biostatistics,School of Public Health, Cheeloo College of Medicine, Shandong University,Jinan 250012, Shandong, China[10]Department of Clinical Laboratory Medicine,Third Affiliated Hospital of Kunming Medical University, Yunnan CancerHospital, Yunnan Cancer Center, Kunming 650118, China[11]Departmentof Colorectal Surgery, Third Affiliated Hospital of Kunming Medical University,Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming 650118, China[12]Department of Oncology, the First Affiliated Hospital of Kunming MedicalUniversity, Kunming 650032, China昆明医科大学附属第一医院[13]School of Public Health, Kunming MedicalUniversity, Kunming 650500, Yunnan, China
Objective Whether preoperative serum carbohydrate antigen 19-9 (CA19-9) is an independent prognostic factor and there are interactions of serum CA19-9 with carcinoembryonic antigen (CEA) on the risk of recurrence in colorectal cancer (CRC) patients are still not clarified. Methods Consecutive patients with CRC who underwent curative resection for stage II-III colorectal adenocarcinoma at five hospitals were collected. Based on Cox models, associations of preoperative CA19-9 with recurrence-free survival (RFS) and overall survival (OS) were evaluated in patients with or without elevated CEA, and interactions between CEA and CA19-9 were also calculated. Restricted cubic spline (RCS) curves were used to evaluate the associations between preoperative CA19-9 and CRC outcomes on a continuous scale. Results A total of 5048 patients (3029 [60.0%] men; median [interquartile range, IQR] age, 61.0 [51.0, 68.0] years; median [IQR] follow-up duration 46.8 [36.5-62.4] months) were included. The risk of recurrence increased with the elevated level of preoperative CA19-9, with the slope steeper in patients with normal CEA than those with elevated CEA. Worse RFS was observed for elevated preoperative CA19-9 (> 37 U/mL) (n = 738) versus normal preoperative CA19-9 (<= 37 U/mL) (n = 4310) (3-year RFS rate: 59.4% versus 78.0%; unadjusted hazard ratio [HR]: 2.02; 95% confidence interval [CI]:1.79 to 2.28), and significant interaction was found between CA19-9 and CEA (P for interaction = 0.001). Increased risk and interaction with CEA were also observed for OS. In the Cox multivariable analysis, elevated CA19-9 was associated with shorter RFS and OS regardless of preoperative CEA level, even after adjustment for other prognostic factors (HR: 2.08, 95% CI:1.75 to 2.47; HR: 2.25, 95% CI:1.80 to 2.81). Subgroup analyses and sensitivity analyses yielded largely similar results. These associations were maintained in patients with stage II disease (n = 2724). Conclusions Preoperative CA19-9 is an independent prognostic factor in CRC patients. Preoperative CA19-9 can be clinically used as a routine biomarker for CRC patients, especially with preoperative normal serum CEA.
基金：
National Key R&D Program of China [2021YFF1201003]; National Natural Scientific Foundation of China [82001986, 81973147, 82073569]; High-level Hospital Construction Project [DFJHBF202105]; Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application [2022B1212010011]; Outstanding Youth Science Foundation of Yunnan Basic Research Project [202101AW070001, 202001AW070021]; National Science Fund for Distinguished Young Scholars [81925023]; Key Science Foundation of Yunnan Basic Research [202101AS070040]; Innovation Team of Kunming Medical University [CXTD202110]; Yunnan Digitalization, Development and Application of Biotic Resource [202002AA100007]
第一作者机构：[1]Department of Radiology, Guangdong Provincial People’s Hospital, GuangdongAcademy of Medical Sciences, Guangzhou 510080, China[2]GuangdongCardiovascular Institute, Guangzhou 510080, China[3]Guangdong ProvincialKey Laboratory of Artificial Intelligence in Medical Image Analysis and Application,Guangdong Provincial People’s Hospital, Guangdong Academyof Medical Sciences, Guangzhou 510080, China[4]Department of Radiology,Third Affiliated Hospital of Kunming Medical University, Yunnan CancerHospital, Yunnan Cancer Center, Kunming 650118, China
共同第一作者：
通讯作者：
通讯机构：[1]Department of Radiology, Guangdong Provincial People’s Hospital, GuangdongAcademy of Medical Sciences, Guangzhou 510080, China[3]Guangdong ProvincialKey Laboratory of Artificial Intelligence in Medical Image Analysis and Application,Guangdong Provincial People’s Hospital, Guangdong Academyof Medical Sciences, Guangzhou 510080, China
推荐引用方式(GB/T 7714)：
Li Zhenhui,Zhu Haibin,Pang Xiaolin,et al.Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study[J].BMC CANCER.2022,22(1):doi:10.1186/s12885-022-10051-2.
APA：
Li, Zhenhui,Zhu, Haibin,Pang, Xiaolin,Mao, Yun,Yi, Xiaoping...&Liu, Zaiyi.(2022).Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study.BMC CANCER,22,(1)
MLA：
Li, Zhenhui,et al."Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study".BMC CANCER 22..1(2022)
医学