Prognosis of carcinoembryonic antigen (CEA) in stage I colorectal adenocarcinoma and development of a prediction model: a retrospective study based on the SEER database

• Published in: Journal of cancer research and clinical oncology Vol. 149; no. 18; pp. 16623 - 16633
• Main Authors: Chen, Zhongbiao, Lin, Zhimin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2023; Springer Nature B.V
• Subjects: Adenocarcinoma; Antigens; Cancer; Cancer Research; Carcinoembryonic antigen; Colorectal cancer; Hematology; Internal Medicine; Medical prognosis; Medicine; Medicine & Public Health; Nomograms; Oncology; Prediction models; Prognosis; Risk factors; Carcinoembryonic antigen; Stage I; Mucinous adenocarcinoma; Nomogram model; Colorectal adenocarcinoma
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-023-05410-w

Background
To investigate the prognostic significance of preoperative carcinoembryonic antigen (CEA) status in stage I colorectal classical adenocarcinoma (CCA) and mucinous adenocarcinoma (MUC), and to construct a nomogram model of stage I CCA.
Methods
The SEER database was used to collect 14,226 patients diagnosed with stage I colorectal adenocarcinoma (CA) from 2010 to 2015. The prognostic significance of preoperative CEA status in stage I CA and MUC was examined by propensity-matching score (PSM). We analyzed the factors affecting the prognosis of patients with stage I CCA, and constructed and verified the prognostic model.
Results
After PSM, the cancer-specific survival rate (CCS) of CEA-positive patients in stage T1 and T2 CCA was significantly lower than that of CEA-negative patients in stage T1 and T2 [HR = 0.37 (0.29–0.48),
P
 < 0.001], [HR = 0.52 (0.41–0.65),
P
 < 0.001]. However, there was no significant difference in CSS between CEA-positive and CEA-negative patients in T1 and T2 MUC [HR = 0.58 (0.43–0.79),
P
 = 0.096], [HR = 0.76 (0.36–1.62),
P
 = 0.477]. A nomogram was constructed based on the results of the multivariate COX regression model. Based on the AUC of ROC analysis, calibration plot and decision curve analysis (DCA), we concluded that the risk and prognosis model of CCA showed excellent performance.
Conclusion
Elevated CEA is a risk factor for stage I CCA, but not for MUC. And the nomogram is accurate enough to predict the risk and prognostic factors of CCA.