Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2025; 17(5): 104341
Published online May 15, 2025. doi: 10.4251/wjgo.v17.i5.104341
Novel tumor marker index combining carcinoembryonic antigen and carbohydrate antigen 19-9: New prognostic factor for metastatic colorectal cancer
Yusuf Ilhan, Onur Yazdan Balcik, Halil Goksel Guzel, Arif Hakan Onder, Bilgin Demir, Mehmet Nuri Baser, Ibrahim Karadag, Mehmet Fatih Ozbay, Tugrul Burak Genc, Sahnura Uzuntas, Oguz Poyrazoglu, Ismail Beypinar, Yakup Ergun, Banu Ozturk
Yusuf Ilhan, Department of Medical Oncology, Antalya City Hospital, Antalya 07080, Türkiye
Onur Yazdan Balcik, Ismail Beypinar, Department of Medical Oncology, Alanya Alaaddin Keykubat University, Antalya 07400, Türkiye
Halil Goksel Guzel, Arif Hakan Onder, Banu Ozturk, Department of Medical Oncology, Antalya Training and Research Hospital, Antalya 07100, Türkiye
Bilgin Demir, Mehmet Nuri Baser, Department of Medical Oncology, Adnan Menderes University, Aydın 09100, Türkiye
Ibrahim Karadag, Department of Medical Oncology, Hitit University, Erol Olcok Education and Research Hospital, Corum 19169, Türkiye
Mehmet Fatih Ozbay, Department of Medical Oncology, Kırsehir Training and Research Hospital, Kırsehir 40200, Türkiye
Tugrul Burak Genc, Department of Medical Oncology, Mus State Hospital, Mus 49000, Türkiye
Sahnura Uzuntas, Department of Internal Medicine, Alanya Alaaddin Keykubat University, Antalya 07425, Türkiye
Oguz Poyrazoglu, Department of Internal Medicine, Hitit University, Erol Olcok Education and Research Hospital, Corum 19169, Türkiye
Yakup Ergun, Department of Medical Oncology, Bower Hospital, Diyarbakir 21100, Türkiye
Author contributions: Ilhan Y contributed to the study conception and design; Ilhan Y, Balcik OY, Guzel HG, Onder AH, Demir B, Baser MN, Karadag I, Genc TB, Uzuntas S, Poyrazoglu O, and Beypinar I participated in material preparation and data collection; Ozbay MF and Ergun Y contributed to the literature review; Ilhan Y and Ergun Y were done the statistical analysis; Ergun Y and Ozturk B conducted a critical evaluation of the article’s findings. Ilhan Y wrote the first draft of the manuscript; and all authors commented on previous versions of the manuscript and on revision. All authors read and approved the final manuscript.
Institutional review board statement: This research was designed and conducted following Good Clinical Practice and the Declaration of Helsinki and was approved by the Alanya Alaaddin Keykubat University, Faculty of Medicine Clinical Research Ethics Committee (approval No. 10354421-2024/23-04).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data are available upon reasonable request from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yusuf Ilhan, MD, Department of Medical Oncology, Antalya City Hospital, Gocerler, No. 5379 Street, Antalya 07080, Türkiye. dryusufilhan@gmail.com
Received: December 18, 2024
Revised: February 2, 2025
Accepted: February 28, 2025
Published online: May 15, 2025
Processing time: 148 Days and 13.3 Hours
Abstract
BACKGROUND

Metastatic colorectal cancer (mCRC) is a global health challenge with a poor prognosis. Prognostic markers are critical for survival prediction.

AIM

To evaluate a novel tumor marker index (TMI) combining carcinoembryonic antigen and carbohydrate antigen 19-9.

METHODS

This multicenter, retrospective study measured baseline carcinoembryonic antigen and carbohydrate antigen 19-9 levels to calculate a TMI as the geometric mean of values normalized to their upper limits of normal. Receiver operating characteristic curve analysis assessed TMI’s prognostic accuracy, and patients were stratified into high-TMI (≥ 1.39) and low-TMI (< 1.39) groups. The primary endpoint was overall survival (OS), with progression-free survival and treatment response as secondary endpoints.

RESULTS

The study included 305 mCRC patients with a median follow-up of 22.9 months. The median OS for high-TMI patients was 29.5 months, significantly lower than the 45.6 months observed in the low-TMI group (P = 0.02). The 2-year OS rates for the high- and low-TMI groups were 59.4% and 72.9%, respectively. Median progression-free survival was also shorter for the high-TMI group (14.0 vs 16.0 months, P = 0.84). High TMI is an independent prognostic factor for worse OS.

CONCLUSION

TMI is a simple, cost-effective prognostic tool for mCRC, with high TMI associated with poorer survival outcomes.

Keywords: Colorectal cancer biomarkers; Metastatic colorectal cancer; Carcinoembryonic antigen; Carbohydrate antigen 19-9; Tumor marker index

Core Tip: The tumor marker index (TMI), derived from the combination of carcinoembryonic antigen and carbohydrate antigen 19-9, offers a novel and cost-effective approach to prognostication in metastatic colorectal cancer. This study demonstrates that a high TMI is independently associated with significantly shorter overall survival, with potential implications for risk stratification and individualized patient management. These findings highlight the clinical value of integrating TMI into routine practice for better outcome prediction.