Value of perioperative carcinoembryonic antigen combined with carbohydrate antigen 19-9 and carbohydrate antigen 125 in predicting prognosis of patients with colorectal cancer in stages Ⅰ to Ⅲ

  Objective  To explore the relationship between the change of perioperative carcinoembryonic antigen (CEA) level and clinical features, disease progression in patients with stage Ⅰ to Ⅲ colorectal cancer, and to analyze the values of postoperative carbohydrate antigen 125 (CA125) and carbohydrate antigen 19-9 (CA19-9) in evaluating prognosis of patients with postoperative CEA negative result.

  Methods  Totally 287 patients with radical operation for colorectal cancer from January 2013 to December 2016 in the First Hospital Affiliated to Soochow University were selected. Chi-square test, Kaplan-Meier method, Log-rank test, and Cox risk regression model were used to analyze the relationships between the perioperative CEA, combination of postoperative CA125 and CA19-9 and clinical pathological characteristics and prognosis.

  Results  The median follow-up time was 49 months. Postoperative CEA positive was significantly correlated with adverse T stage (T₃, T₄), N stage (N₁, N₂) and TNM stage (P < 0.01), and was significantly correlated with cancer nodule and nerve invasion (P < 0.05). Univariate analysis showed that N stage, TNM stage, tumor differentiation, tumor nodule, vascular tumor thrombus, nerve invasion, CA19-9 and CA125 were the related factors affecting disease free survival (DFS) (P < 0.05), and N stage, tumor differentiation, tumor nodule, CA19-9 and CA724 were the related factors affecting overall survival (OS) (P < 0.05). Multivariate analysis showed that postoperative CA125 positive (P < 0.001) and tumor nodule (P < 0.05) were independent prognostic factors for DFS in patients with CEA negative. Tumor nodule (P < 0.05) and tumor differentiation (P < 0.05) were important factors affecting OS. The DFS and OS of patients with both preoperative and postoperative CEA negative were significantly higher than those of patients with preoperative or postoperative CEA positive, the DFS and OS of patients with postoperative CEA returning to normal were significantly higher than those of patients without postoperative CEA returning to normal, and the DFS and OS of patients with both postoperative CA19-9 and CA125 negative were higher than those of patients with postoperative CA19-9 or CA125 positive (P < 0.05 or P < 0.01).

  Conclusion  The change of serum CEA level in perioperative period can directly affect the prognosis of CRC patients, and the prognosis of patients with both preoperative and postoperative CEA negative or CEA decreasing to normal level in the early postoperative period are better. For patients with CEA negative after operation, the positive expression of CA125 or CA19-9 after operation indicates that the risks of recurrence and metastasis are increasing, and the prognosis is poor.