Combined preoperative and post-adjuvant-chemotherapy carcinoembryonic antigen levels are prognostic for early recurrence and survival in stage III colon cancer

AKKUŞ E., KARAOĞLAN B. B., Akçadağ B., BAHÇEKAPILI B., AKYOL C., UTKAN G.

American Journal of Surgery, vol.243, 2025 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 243
  • Publication Date: 2025
  • Doi Number: 10.1016/j.amjsurg.2025.116256
  • Journal Name: American Journal of Surgery
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, Biotechnology Research Abstracts, CAB Abstracts, CINAHL, EMBASE
  • Keywords: Adjuvant chemotherapy, Carcinoembryonic antigen, CEA, Colon cancer, Preoperative, Stage III
  • Ankara University Affiliated: Yes

Abstract

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.