Meta-analysis Of The Relationship Between CEA And CA199 Levels And Prognosis In Patients With Advanced Colorectal Cancer

Objective: CEA and CA199 are commonly used tumor markers for colorectal cancer,especially for diagnostic purposes.However,their prognostic value in patients with advanced colorectal cancer is poorly studied and the studies done are controversial.In this study,we tried to clarify this point by conducting a meta-analysis of related studies.This study conducted a meta-analysis of a series of studies on the relationship between CEA and CA199 levels before conventional systemic medical treatment and prognosis in patients with advanced colorectal cancer.Methods: First,several databases including Pub Med,EMBASE and Cochrane library were searched based on the predetermined inclusion exclusion criteria,and literature from the three databases were retrieved,a series of studies on the relationship between the CEA and CA199 levels before treatment and the prognosis were evaluated respectively,in order to obtain data on the relationship between pre-treatment serum CEA or CA 199 levels and prognosis in patients with advanced colorectal cancer.We use Revman software(version 5.3)for statistical analysis.The overall survival(OS),progression-free survival(PFS)risk ratio(HR)reported in the study was compared and analyzed by a fixed effect model or a random effects model.Each study was conducted for each outcome variable.Results: A total of 14 articles(15 studies)were included in the literature search for serum CEA,including 2840 patients.Among them,11 studies confirmed a close correlation between CEA level and OS in patients with advanced colorectal cancer,HR=1.49,95% CI(1.31,1.70),I2=26%,P<0.001.Nine studies confirmed a close association between CEA levels and PFS in patients with advanced colorectal cancer,HR=1.53,95% CI(1.34,1.74),I2=46%,P<0.00001.A total of 9 articles(9 studies)including 2026 patients were included in the literature search of serum CA199.Among them,8 studies confirmed that CA199 level is closely related to OS in patients with advanced colorectal cancer,HR=1.53,95% CI(1.36,1.73),I2=28%,P<0.00001.Five studies confirmed the close correlation between CA199 level and PFS in patients with advanced colorectal cancer,HR=1.47,95% CI(1.22,1.77),I2=4%,P<0.0001).In CEA related studies,in the Asian study area,or when the critical value is 5ng/ml,high CEA level indicates poor OS and PFS.And in different subgroups of CA199 related studies,high level of CA199 predicts poor OS.However,the relationship between the high level of CA199 and PFS is not suitable for exploring the subgroup types that may be affected due to the lack of studies.Conclusion: High-level expression of CEA or CA199 before treatment predicts a poor prognosis for OS and PFS of patients.However,can it be used as an indicator to assess the risk of stratification in patients with advanced CRC pending further research data support.