American Journal of Surgery, vol.243, 2025 (SCI-Expanded)
Background: The definitive treatment of stage-III colon cancer is surgery and adjuvant chemotherapy. A combined assessment of pre-operative and post-adjuvant chemotherapy carcinoembryonic antigen (CEA) levels may better prognosticate early recurrence and survival. Methods: A cohort of patients who underwent surgery and adjuvant chemotherapy was assessed. The CEA-Square (CEA2) score was defined as the multiplication of preoperative and post-adjuvant chemotherapy CEA levels and was grouped as “≤25(ng/mL)2” and “>25(ng/mL)2. Results: Among the 432 patients,137 were eligible. CEA2 score (>25 vs ≤ 25 (ng/mL)2) was significantly prognostic for early recurrence (34.5 % vs. 14.3 %, log-rank, p < 0.001). In the multivariable analysis, only the CEA2 score remained associated with early recurrence [HR:3.375, (95 % CI:1.488–7.655), p = 0.004]. In a median follow-up of 37.5 months (2.5–101.0), a high CEA2 score [>25 (ng/mL)2] was significantly associated with a worse OS (log-rank, p < 0.001). Conclusion: CEA2 is a simple, practical score combining prognostic values of preoperative and post-adjuvant chemotherapy CEA levels.