Cancer Res Treat.  2020 Apr;52(2):446-454. 10.4143/crt.2019.261.

Carcinoembryonic Antigen Improves the Performance of MagneticResonance Imaging in the Prediction of Pathologic Response afterNeoadjuvant Chemoradiation for Patients with Rectal Cancer

  • 1Department of Radiation Oncology, Internal Medicine
  • 2Division of Hematology-Oncology, Internal Medicine
  • 3Departments of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 4Departments of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 5Departments of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea


The purpose of this study was to investigate the role of carcinoembryonic antigen (CEA) levels in improving the performance of magnetic resonance imaging (MRI) for the prediction of pathologic response after the neoadjuvant chemoradiation (NCRT) for patients with rectal cancer.
Materials and Methods
We retrospectively reviewed the medical records of 524 rectal cancer patients who underwent NCRT and total mesorectal excision between January 2009 and December 2014. The performances of MRI with or without CEA parameters (initial CEA and CEA dynamics) for prediction of pathologic tumor response grade (pTRG) were compared by receiver-operating characteristic analysis with DeLong’s method. Cox regression was used to identify the independent factors associated to pTRG and disease-free survival (DFS) after NCRT.
The median follow-up was 64.0 months (range, 3.0 to 113.0 months). On multivariate analysis, poor tumor regression grade on MRI (mrTRG; p < 0.001), initial CEA (p < 0.001) and the mesorectal fascia involvement on MRI before NCRT (mrMFI; p=0.054) showed association with poor pTRG. The mrTRG plus CEA parameters showed significantly improved performances in the prediction of pTRG than mrTRG alone. All of mrTRG, mrMFI, and initial CEA were also identified as independent factors associated with DFS. The initial CEA further discriminated DFS in the subgroups with good mrTRG or that without mrMFI.
The CEA parameters significantly improved the performance of MRI in the prediction of pTRG after NCRT for patients with rectal cancer. The DFS was further discriminated by initial CEA level in the groups with favorable MRI parameters.


Rectal neoplasms; Neoadjuvant; Chemoradiation; Carcinoembryonic antigen; Magnetic resonance imaging; Pathology; Response; Disease-free survival
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