Tumor Markers In Predicting Prognosis And Curative Effect Of The Colorectal Cancer

Part I:The Prognostic Value of Preoperative Serum CEA and CA199Levels in Stage Ⅰ-Ⅲ Colorectal CancerPurpose:The clinical use of preoperative CEA for prognosis and follow-up of patients in breast, gastrointestinal cancers has been well studied. Preoperative serial CEA level has been proved to be an independent prognostic factor in colorectal cancer. Serial CEA level determination may be ordered preoperatively. However, present data are insufficient to recommend routine use of CA19-9.Material and methods:Preoperative serum CEA and CA19-9levels were measured in491UICC Ⅱ-Ⅲ stage patients who underwent radical surgical resection for colorectal cancer between2004and2006, and their relationships to clinicopathological factors and overall survival (OS) and disease-free survival (DFS) were analyzed with univariate and multivariate methods.Results:Multivariate analysis revealed that CA19-9levels≥37U/ml was the only independent preoperative predictor of worse relapse-free survival (DFS) and overall survival (OS).Patients with a preoperative elevation of both CEA and CA19-9had a worse prognosis compared to those had CEA or CA19-9elevation alone.Conclusion:Preoperative serum CEA is still the reliable and important predictive indictors of prognosis. Preoperative CA19-9was a predictive factor for both survival and recurrence. Part Ⅱ:The study of CEA and CA199in predicting the tumor response in patients who receive preoperative chemoradiotherapy for rectal cancerPurpose:Preoperative neoadjuvant chemoradiotherapy has become the standard treatment of locally advanced rectal cancer. However, the factors that predict response to neoadjuvant chemoradiotherapy have not been well characterized. The purpose of this study was to identify the value of CEA, CA199and other predictors of influencing CRT response and prognosis to guide clinical practice.Material and methods:1. a total of eligible131patients, who were treated with preoperative chemoradiotherapy and curative resection at the Fudan University Cancer Hospital from October2006to June2011. The clinical and pathological data of patients were collected for analysis to identify the factors that predict response to preoperative chemoradiotherapy and prognosis.2. Classified variables were compared using chi-Square/fisher’s exact test, and continuous variables were compared using wilcoxon rank sum test or kruskal-wallis test. Disease-free survival (DFS), metastases-free survival (MFS), and locoregional control (LC) were estimated according to the Kaplan-Meier method and compared by log-rank test. Factors identified as having an influence on outcome by univariate analysis were then analyzed using Cox proportional hazards regression analysis. Tests for nonproportional hazards using Schoenfeld residuals resulted in nonsignificant findings in all analyses. All data analysis was performed with R software for Windows (R version2.13.2, A language for statistics, URL http://www.R-project.org) and P<0.05was considered statistically significant.Results:Univariate analysis and multivariate indicated that lower distance from the anal verge predicted a good response rate. A longer interval from completion of chemoradiotherapy to surgery was associated with an increase in pathologic complete response rate. Delay in surgery after neoadjuvant chemoradiotherapy negatively affects postoperative complications, sphincter-saving rate and disease relapse. The3-year locoregional control rate was92.6%. On univariate analysis, prechemoradiotherapy neutrophil-lymphocyte ratio (NLR), ypT, ypN, lymphovascular invasion, perineural invasion and surgical approach were associated with disease-free survival. On multivariate analysis, perineural invasion (p=0.048), surgical type (Hartmann p=0.0014) and NLR (p=0.0005) were identified as independent prognostic factors for disease-free survival.Conclusion:Distance from the anal verge is relationship with the pathologic response. The role of preoperative chemoradiotherapy in sphincter preservation is inconclusive. A longer interval from completion of chemoradiotherapy to surgery was associated with an increase in pathologic complete response rate. The degree of the involvement of systemic inflammation is associated with cancer development and progression. Pre-chemoradiotherapy NLR could be useful as a prognostic factor for disease-free survival in patients with rectal cancer who undergo treatment with neoadjuvant chemoradiotherapy and curative resection.