TY - JOUR
T1 - C-stage in colon cancer
T2 - Implications of carcinoembryonic antigen biomarker in staging, prognosis, and management
AU - Thirunavukarasu, Pragatheeshwar
AU - Sukumar, Shyamsunder
AU - Sathaiah, Magesh
AU - Mahan, Meredith
AU - Pragatheeshwar, Kothai Divya
AU - Pingpank, James F.
AU - Zeh, Herbert
AU - Bartels, Christopher J.
AU - Lee, Kenneth K.W.
AU - Bartlett, David L.
PY - 2011/4/20
Y1 - 2011/4/20
N2 - BackgroundThe American Joint Committee on Cancer (AJCC) has proposed the inclusion of pretreatment serum carcinoembryonic antigen (CEA) level (C-stage) into the conventional TNM staging system of colon cancer. We assessed the prognosis of various stages of colon cancer after such an inclusion.MethodsData for all patients (N = 17910) diagnosed with colonic adenocarcinoma (AJCC stages I, IIA, IIB, IIC, IIIA, IIIB, IIIC, and IV, based on TNM staging system) between January 1, 2004, and December 31, 2004, with a median follow-up of 27 months (range 0-35 months), were collected from the Surveillance, Epidemiology, and End Results database. C-stage (C0-stage = normal CEA level; C1-stage = elevated CEA level) was assigned to all patients with available CEA information (n = 9083). Multivariable analyses using Cox proportional hazards models were used to identify independent factors associated with prognosis. Prognosis of overall stages (AJCC stages I-IV and C0 or C1) was analyzed using Kaplan-Meier survival curves. All statistical tests were two-sided.ResultsC1-stage was independently associated with a 60% increased risk of overall mortality (hazard ratio of death = 1.60, 95% confidence interval = 1.46 to 1.76, P <. 001). Overall survival was decreased in patients with C1-stage cancer compared with C0-stage cancer of the respective overall stages (P <. 05). Similarly, decreased overall survival was noted in patients with stage I C1 cancer compared with stage IIA C0 or stage IIIA C0 cancer (P <. 001), in patients with stage IIA C1 cancer compared with stage IIIA C0 (P <. 001), and in patients with stage IIB C1 or stage IIC C1 cancer compared with stage IIIB C0 cancer (P <. 001).ConclusionsC-stage was an independent prognostic factor for colon cancer. The results support routine preoperative CEA testing and C-staging upon diagnosis of colon cancer and the inclusion of C-stage in the conventional TNM staging of colon cancer.
AB - BackgroundThe American Joint Committee on Cancer (AJCC) has proposed the inclusion of pretreatment serum carcinoembryonic antigen (CEA) level (C-stage) into the conventional TNM staging system of colon cancer. We assessed the prognosis of various stages of colon cancer after such an inclusion.MethodsData for all patients (N = 17910) diagnosed with colonic adenocarcinoma (AJCC stages I, IIA, IIB, IIC, IIIA, IIIB, IIIC, and IV, based on TNM staging system) between January 1, 2004, and December 31, 2004, with a median follow-up of 27 months (range 0-35 months), were collected from the Surveillance, Epidemiology, and End Results database. C-stage (C0-stage = normal CEA level; C1-stage = elevated CEA level) was assigned to all patients with available CEA information (n = 9083). Multivariable analyses using Cox proportional hazards models were used to identify independent factors associated with prognosis. Prognosis of overall stages (AJCC stages I-IV and C0 or C1) was analyzed using Kaplan-Meier survival curves. All statistical tests were two-sided.ResultsC1-stage was independently associated with a 60% increased risk of overall mortality (hazard ratio of death = 1.60, 95% confidence interval = 1.46 to 1.76, P <. 001). Overall survival was decreased in patients with C1-stage cancer compared with C0-stage cancer of the respective overall stages (P <. 05). Similarly, decreased overall survival was noted in patients with stage I C1 cancer compared with stage IIA C0 or stage IIIA C0 cancer (P <. 001), in patients with stage IIA C1 cancer compared with stage IIIA C0 (P <. 001), and in patients with stage IIB C1 or stage IIC C1 cancer compared with stage IIIB C0 cancer (P <. 001).ConclusionsC-stage was an independent prognostic factor for colon cancer. The results support routine preoperative CEA testing and C-staging upon diagnosis of colon cancer and the inclusion of C-stage in the conventional TNM staging of colon cancer.
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U2 - 10.1093/jnci/djr078
DO - 10.1093/jnci/djr078
M3 - Article
C2 - 21421861
AN - SCOPUS:79955382480
SN - 0027-8874
VL - 103
SP - 689
EP - 697
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 8
ER -