Carcinoembryonic antigen and albumin predict survival in patients with advanced colon and rectal cancer

Abstract

Hypothesis: Patients with stage IV colon or rectal cancer at initial diagnosis have characteristics that will predict subsequent survival time. Design: Retrospective cohort study. Setting: Urban county teaching hospital providing tertiary care. Patients: Patients who came to the study institution with stage IV colon or rectal cancer between 1991-1999. Main Outcome Measure: Survival duration (days) after diagnosis. Results: One hundred five patients were identified, with a median survival of 225 days (interquartile range, 72-688 days). Univariate analysis identified carcinoembryonic antigen (CEA) and albumin (ALB) as possible predictors for survival. Classification and regression tree analysis, a form of binary recursive partitioning, was used to identify optimal cut points for CEA (275 ng/mL) and ALB (2.7 g/dL) levels. Based on the cut points, patients were stratified into the following groups: (1) low CEA, high ALB; (2) low CEA, low ALB; (3) high CEA, high ALB; and (4) high CEA, low ALB. The median survival times for the first group and the fourth group were 287 days (interquartile range, 150-851 days) and 39 days (interquartile range, 14-168 days), respectively. A Kaplan-Meier analysis was performed, and a statistically significant difference was identified across all strata (P = .004). Additionally, groups 1 and 4 demonstrated the largest overall survival difference (P