Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 21, 2013; 19(3): 389-393
Published online Jan 21, 2013. doi: 10.3748/wjg.v19.i3.389
Preoperative carcinoembryonic antibody is predictive of distant metastasis in pathologically T1 colorectal cancer after radical surgery
Zheng Lou, Rong-Gui Meng, Wei Zhang, En-Da Yu, Chuan-Gang Fu
Zheng Lou, Rong-Gui Meng, Wei Zhang, En-Da Yu, Chuan-Gang Fu, Department of Colorectal Surgery, Changhai Hospital, Shanghai 200433, China
Author contributions: Lou Z, Meng RG, Zhang W and Yu ED performed the majority of patient treatment; Meng RG and Fu CG coordinated and collected all the clinical data in addition to providing financial support for this work; Lou Z and Meng RG designed the study, wrote and revised the manuscript.
Supported by Changhai Hospital 1255 Project Fund, No. CH125542500
Correspondence to: Dr. Rong-Gui Meng, Department of Colorectal Surgery, Changhai Hospital, No. 168, Changhai Road, Shanghai 200433, China. rongguimeng@163.com
Telephone: +86-21-31161608 Fax: +86-21-31161608
Received: September 19, 2012
Revised: December 12, 2012
Accepted: December 22, 2012
Published online: January 21, 2013
Abstract

AIM: To identify the predictors of distant metastasis in pathologically T1 (pT1) colorectal cancer (CRC) after radical resection.

METHODS: Variables including age, gender, preoperative carcinoembryonic antibody (CEA) level, tumor location, tumor size, lymph node status, and histological grade were recorded. Patients with and without metastasis were compared with regard to age, gender, CEA level and pathologic tumor characteristics using the independent t test or χ2 test, as appropriate. Risk factors were determined by logistic regression analysis.

RESULTS: Metastasis occurred in 6 (3.8%) of the 159 patients during a median follow-up of 67.0 (46.5%) mo. The rates of distant metastasis in patients with pT1 cancer of the colon and rectum were 6.7% and 2.9%, respectively (P < 0.001). The rates of distant metastasis between male and female patients with T1 CRC were 6.25% and 1.27%, respectively (P < 0.001). The most frequent site of distant metastasis was the liver. Age (P = 0.522), gender (P = 0.980), tumor location (P = 0.330), tumor size (P = 0.786), histological grade (P = 0.509), and high serum CEA level (P = 0.262) were not prognostic factors for lymph node metastasis. Univariate analysis revealed that age (P = 0.231), gender (P = 0.137), tumor location (P = 0.386), and tumor size (P = 0.514) were not risk factors for distant metastasis after radical resection for T1 colorectal cancer. Postoperative metastasis was only significantly correlated with high preoperative serum CEA level (P = 0.001). Using multivariate logistic regression analysis, high preoperative serum CEA level (P = 0.004; odds ratio 15.341; 95%CI 2.371-99.275) was an independent predictor for postoperative distant metastasis.

CONCLUSION: The preoperative increased serum CEA level is a predictive risk factor for distant metastasis in CRC patients after radical resection. Adjuvant chemotherapy may be necessary in such patients, even if they have pT1 colorectal cancer.

Keywords: Colorectal cancer, Risk factor, Metastasis, Pathologically T1, Carcinoembryonic antigen