AUTHOR=Jiao Zonglin , Cao Shoubo , Li Jianhua , Hu Nan , Gong Yinghui , Wang Linduo , Jin Shi 

TITLE=Clinical Associations of Preoperative and Postoperative Serum CEA and Lung Cancer Outcome

JOURNAL=Frontiers in Molecular Biosciences

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/molecular-biosciences/articles/10.3389/fmolb.2021.686313

DOI=10.3389/fmolb.2021.686313

ISSN=2296-889X

ABSTRACT=<p><bold>Background:</bold> Serum carcinoembryonic antigen (CEA), a classic tumour marker, is widely used in lung cancer in clinical practice. Nevertheless, few studies have elucidated the influence of dynamic changes in CEA in the perioperative phases, as a prognostic indicator, on lung cancer prognosis.</p><p><bold>Methods:</bold> This retrospective cohort analysis included consecutive patients with stage I-III lung cancer who underwent curative resection between December 2010 and December 2014. The patients were grouped into three cohorts: group A included patients with normal preoperative CEA, group B included patients with elevated preoperative CEA but normal postoperative CEA, and group C included patients with elevated preoperative and postoperative CEA. Five-year overall survival (OS) was estimated by Kaplan-Meier analysis (log-rank test). Multivariate analyses were performed with Cox proportional hazard regression.</p><p><bold>Results:</bold> A total of 1662 patients with stage I-III lung cancer were enrolled in our study. Patients with normal preoperative CEA had 15.9 and 20.1% better 3- and 5-year OS rates than the cohort with elevated preoperative CEA (<italic>p</italic> &lt; 0.001). Furthermore, group C had 36.0 and 26.6% lower 5-year OS rates (<italic>n</italic> = 74, 32.4%) than group A (<italic>n</italic> = 1188, 68.4%) and group B (<italic>n</italic> = 139, 59.0%) (<italic>p</italic> &lt; 0.001). Group B had poorer OS than group A (<italic>p</italic> = 0.016). For patients with different pathological TNM stages, subgroup analyses showed that group C had the shortest OS in stages I and II (<italic>p</italic> &lt; 0.05), and patients with a post-preoperative CEA increment had poorer OS than those without an increment (<italic>p</italic> = 0.029). Multivariate analyses suggested that group C (HR = 2.0, 95% CI, 1.5–2.7, <italic>p</italic> &lt; 0.001) rather than the group with normalized postoperative CEA (HR = 1.2, 95% CI, 0.9–1.5, <italic>p</italic> = 0.270) was an independent prognostic factor. In subgroup analysis of adenocarcinoma (ADC), survival analyses suggested that group C predicted a worse prognosis. Multivariate analysis of ADC indicated that group C was an independent adverse prognostic factor (HR = 1.9, 95% CI, 1.4–2.7, <italic>p</italic> &lt; 0.001).</p><p><bold>Conclusions:</bold> Combined elevated preoperative and postoperative CEA is an independent adverse prognostic factor for stage I-III lung adenocarcinoma. Additionally, routine perioperative detection of serum CEA can yield valuable prognostic information for patients after lung cancer surgery.</p>