Intest Res.  2018 Jul;16(3):467-474. 10.5217/ir.2018.16.3.467.

Clinical significance of carcinoembryonic antigen in peritoneal fluid detected during operation in stage I–III colorectal cancer patients

Affiliations
  • 1Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea. parksj6406@daum.net
  • 2Department of Colorectal Surgery, Kosin University College of Medicine, Busan, Korea.

Abstract

BACKGROUND/AIMS
Early diagnosis of peritoneal metastases in patients with colorectal cancer (CRC) can influence patient prognosis. The aim of this study was to identify the clinical significance of carcinoembryonic antigen (CEA) in peritoneal fluid detected during operation in stage I-III CRC patients.
METHODS
Between April 2009 and April 2015, we reviewed medical records from a total of 60 stage I-III CRC patients who had peritoneal fluid collected during operation. Patients who had positive cytology in the assessment of peritoneal fluid were excluded. We evaluated the values of CEA in peritoneal fluid (pCEA) to predict the long-term outcomes of these patients using Kaplan-Meier curves and Cox regression models.
RESULTS
The median follow-up duration was 37 months (interquartile range, 21-50 months). On receiver operating characteristic analysis, pCEA had the largest area under the curve (0.793; 95% confidence interval, 0.635-0.950; P=0.001) with an optimal cutoff value of 26.84 (sensitivity, 80.0%; specificity, 76.6%) for predicting recurrence. The recurrence rate was 8.1% in patients with low pCEA ( < 26.84 ng/mL, n=37), and 52.2% in patients with high pCEA (≥26.84 ng/mL, n=23). In multivariate Cox regression analysis, high pCEA (≥26.84 ng/mL) was a risk factor for poor cancer-free survival (CFS) in stage I-III patients.
CONCLUSIONS
In this study, we determined that high pCEA (≥26.84 ng/mL) detected during operation was helpful for the prediction of poor CFS in patients with stage I-III CRC.

Keyword

Carcinoembryonic antigen; Peritoneal fluid; Operation; Colorectal neoplasms

MeSH Terms

Ascitic Fluid*
Carcinoembryonic Antigen*
Colorectal Neoplasms*
Early Diagnosis
Follow-Up Studies
Humans
Medical Records
Neoplasm Metastasis
Prognosis
Recurrence
Risk Factors
ROC Curve
Sensitivity and Specificity
Carcinoembryonic Antigen

Figure

  • Fig. 1 Receiver operating characteristics curves for predicting recurrence of stage I–III colorectal cancer.

  • Fig. 2 Recurrence rates of stage III colorectal cancer according to CEA in peritoneal fluid (pCEA).

  • Fig. 3 Correlation between CEA in peritoneal fluid (pCEA) and CEA in serum (sCEA).

  • Fig. 4 Kaplan-Meier curves shows the cancer-free survival for patients with stage I–III colorectal cancer according to the level of (CEA in peritoneal fluid) pCEA.


Reference

1. Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010; 116:544–573. PMID: 19998273.
Article
2. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol. 2007; 18:581–592. PMID: 17287242.
Article
3. Brodsky JT, Cohen AM. Peritoneal seeding following potentially curative resection of colonic carcinoma: implications for adjuvant therapy. Dis Colon Rectum. 1991; 34:723–727. PMID: 1855433.
Article
4. Segelman J, Granath F, Holm T, Machado M, Mahteme H, Martling A. Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2012; 99:699–705. PMID: 22287157.
Article
5. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136:E359–E386. DOI: 10.1002/ijc.29210. PMID: 25220842.
Article
6. Loupakis F, Cremolini C, Masi G, et al. Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N Engl J Med. 2014; 371:1609–1618. PMID: 25337750.
Article
7. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016; 66:7–30. PMID: 26742998.
Article
8. Lemmens VE, Klaver YL, Verwaal VJ, Rutten HJ, Coebergh JW, de Hingh IH. Predictors and survival of synchronous peritoneal carcinomatosis of colorectal origin: a population-based study. Int J Cancer. 2011; 128:2717–2725. PMID: 20715167.
Article
9. Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC. Peritoneal carcinomatosis in nongynecologic malignancy: a prospective study of prognostic factors. Cancer. 1989; 63:364–367. PMID: 2910444.
Article
10. Runyon BA. Care of patients with ascites. N Engl J Med. 1994; 330:337–342. PMID: 8277955.
Article
11. Sangisetty SL, Miner TJ. Malignant ascites: a review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrointest Surg. 2012; 4:87–95. PMID: 22590662.
Article
12. Norton JA. Carcinoembryonic antigen: new applications for an old marker. Ann Surg. 1991; 213:95–97. PMID: 1992947.
Article
13. Kaleta EJ, Tolan NV, Ness KA, O'Kane D, Algeciras-Schimnich A. CEA, AFP and CA 19-9 analysis in peritoneal fluid to differentiate causes of ascites formation. Clin Biochem. 2013; 46:814–818. PMID: 23454392.
Article
14. Liu F, Kong X, Dou Q, et al. Evaluation of tumor markers for the differential diagnosis of benign and malignant ascites. Ann Hepatol. 2014; 13:357–363. PMID: 24756011.
Article
15. Ahadi M, Tehranian S, Memar B, et al. Diagnostic value of carcinoembryonic antigen in malignancy-related ascites: systematic review and meta-analysis. Acta Gastroenterol Belg. 2014; 77:418–424. PMID: 25682632.
16. Lee IK, Kim DH, Gorden DL, et al. Prognostic value of CEA and CA 19-9 tumor markers combined with cytology from peritoneal fluid in colorectal cancer. Ann Surg Oncol. 2009; 16:861–870. PMID: 19189191.
Article
17. Kanellos I, Zacharakis E, Kanellos D, Pramateftakis MG, Betsis D. Prognostic significance of CEA levels and positive cytology in peritoneal washings in patients with colorectal cancer. Colorectal Dis. 2006; 8:436–440. PMID: 16684089.
Article
18. Nishikawa T, Sunami E, Tanaka T, et al. Incidence and prognostic significance of positive peritoneal lavage in colorectal cancer. Surg Today. 2015; 45:1073–1081. PMID: 25373362.
Article
19. Hess KR, Varadhachary GR, Taylor SH, et al. Metastatic patterns in adenocarcinoma. Cancer. 2006; 106:1624–1633. PMID: 16518827.
Article
20. Bosanquet DC, Harris DA, Evans MD, Beynon J. Systematic review an meta-analysis of intraoperative peritoneal lavage for colorectal cancer staging. Br J Surg. 2013; 100:853–862. PMID: 23536330.
Article
21. Passot G, Mohkam K, Cotte E, Glehen O. Intra-operative peritoneal lavage for colorectal cancer. World J Gastroenterol. 2014; 20:1935–1939. PMID: 24616569.
Article
22. Hase K, Ueno H, Kuranaga N, Utsunomiya K, Kanabe S, Mochizuki H. Intraperitoneal exfoliated cancer cells in patients with colorectal cancer. Dis Colon Rectum. 1998; 41:1134–1140. PMID: 9749497.
Article
23. Horattas MC, Evasovich MR, Topham N. Colorectal carcinoma and the relationship of peritoneal cytology. Am J Surg. 1997; 174:334–337. PMID: 9324149.
Article
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