CEA preoperatorio como factor pronóstico en cáncer de colon y recto: Análisis de 532 pacientes

Abstract

Background: The real usefulness of preoperative carcinoembrionic antigen (CEA) as prognostic factor in colorectal cancer is not clearly defined. Aim: To assess the prognostic value of CEA in colorectal cancer. Material and methods: Follow up, during 2 to 186 months, of 532 patients aged 21 to 92 years (54% females) operated for a colorectal cancer and in whom a preoperative determination of CEA was available. Tumor staging was done using the American Joint Committee on Cancer classification. Survival was determined using life tables. A Cox regression model was used to determine relevant prognostic factors. Results: Mean preoperative CEA was 21.4 ± 70.7 ng/ml and was over 5 ng/ml in 38% of patients. There was a strong association between CEA and tumor stage. Multivariate analysis disclosed location (rectum), lymph node involvement and preoperative CEA as independent prognostic factors. If TNM tumor stage is introduced in the Cox model, a significant difference in survival among patients with abnormal CEA values, is observed for rectal tumors with a Odds ratio of 2.02 and 95% confidence intervals (CI) of 1.35-3.03, for stage III tumors, with an odds ratio of 4.19 (95% CI 10.8-16.24) and for stage IV tumors, with an odds ratio of 30.36 (95% CI 8.39-109.8). Conclusions: Preoperative CEA and the extension of colorectal tumors are independent prognostic factors for survival. The strong association between tumor stage and CEA values, determines that the latter outweigh the former as prognostic factor.