Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

The Significance of Serum Carcinoembryonic Antigen in Lung Adenocarcinoma

  • Kim, Jae Jun (Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Hyun, Kwanyong (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Park, Jae Kil (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Moon, Seok Whan (Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, The Catholic University of Korea College of Medicine)
  • Received : 2014.09.25
  • Accepted : 2014.12.05
  • Published : 2015.10.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: A raised carcinoembryonic antigen (CEA) may be associated with significant pathology during the postoperative follow-up of lung adenocarcinoma. Methods: We reviewed the medical records of 305 patients who underwent surgical resections for primary lung adenocarcinoma at a single institution between April 2006 and February 2013. Results: Preoperative CEA levels were significantly associated with age, smoking history, pathologic stage including pT (pathologic tumor stge), pN (pathologic nodal stage) and overall pathological stage, tumor size and differentiation, pathologically positive total lymph node, N1 and N2 lymph node, N2 nodal station (0/1/2=1.83/2.94/7.21 ng/mL, p=0.019), and 5-year disease-free survival (0.591 in group with normal preoperative CEA levels vs. 0.40 in group with high preoperative CEA levels, p=0.001). Preoperative CEA levels were significantly higher than postoperative CEA levels (p<0.001, Wilcoxon signed-rank test). Postoperative CEA level was also significantly associated with disease-free survival (p<0.001). A follow-up serum CEA value of >2.57 ng/mL was found to be the appropriate cutoff value for the prediction of cancer recurrence with sensitivity and specificity of 71.4% and 72.3%, respectively. Twenty percent of patients who had recurrence of disease had a CEA level elevated above this cutoff value prior to radiographic evidence of recurrence. Postoperative CEA, pathologic stage, differentiation, vascular invasion, and neoadjuvant therapy were identified as independent predictors of 5-year disease-free survival in a multivariate analysis. Conclusion: The follow-up CEA level can be a useful tool for detecting early recurrence undetected by postoperative imaging studies. The perioperative follow-up CEA levels may be helpful for providing personalized evaluation of lung adenocarcinoma.

Keywords

References

  1. Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/american thoracic society/ european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011;6:244-85. https://doi.org/10.1097/JTO.0b013e318206a221
  2. Grunnet M, Sorensen JB. Carcinoembryonic antigen (CEA) as tumor marker in lung cancer. Lung Cancer 2012;76:138-43. https://doi.org/10.1016/j.lungcan.2011.11.012
  3. Takamochi K, Yoshida J, Nishimura M, et al. Prognosis and histologic features of small pulmonary adenocarcinoma based on serum carcinoembryonic antigen level and computed tomographic findings. Eur J Cardiothorac Surg 2004;25:877-83. https://doi.org/10.1016/j.ejcts.2004.01.049
  4. Tomita M, Matsuzaki Y, Edagawa M, Shimizu T, Hara M, Onitsuka T. Prognostic significance of preoperative serum carcinoembryonic antigen level in lung adenocarcinoma but not squamous cell carcinoma. Ann Thorac Cardiovasc Surg 2004;10:76-80.
  5. Hatzakis KD, Froudarakis ME, Bouros D, Tzanakis N, Karkavitsas N, Siafakas NM. Prognostic value of serum tumor markers in patients with lung cancer. Respiration 2002;69:25-9. https://doi.org/10.1159/000049366
  6. Kawachi R, Nakazato Y, Takei H, Koshi-ishi Y, Goya T. Clinical significance of preoperative carcinoembryonic antigen level for clinical stage I non-small cell lung cancer: can preoperative carcinoembryonic antigen level predict pathological stage? Interact Cardiovasc Thorac Surg 2009;9:199-202. https://doi.org/10.1510/icvts.2009.206698
  7. Lim YK, Kam MH, Eu KW. Carcinoembryonic antigen screening: how far should we go? Singapore Med J 2009;50:862-5.
  8. Hang ZQ, Zheng MF, Huang JH. Detection and diagnostic value of serum carcinoembryonic antigen and cytokeratin 19 fragment in lung cancer patients. Zhonghua Zhong Liu Za Zhi 2011;33:847-9.
  9. Sakao Y, Tomimitsu S, Takeda Y, Natsuaki M, Itoh T. Carcinoembryonic antigen as a predictive factor for postoperative tumor relapse in early-stage lung adenocarcinoma. Eur J Cardiothorac Surg 2004;25:520-2. https://doi.org/10.1016/j.ejcts.2004.01.029
  10. Fukai R, Sakao Y, Sakuraba M, et al. The prognostic value of carcinoembryonic antigen in T1N1M0 and T2N1M0 non-small cell carcinoma of the lung. Eur J Cardiothorac Surg 2007;32:440-4. https://doi.org/10.1016/j.ejcts.2007.06.011
  11. Matsuoka K, Sumitomo S, Nakashima N, Nakajima D, Misaki N. Prognostic value of carcinoembryonic antigen and CYFRA21-1 in patients with pathological stage I non-small cell lung cancer. Eur J Cardiothorac Surg 2007;32:435-9. https://doi.org/10.1016/j.ejcts.2007.05.014
  12. Nonaka M, Kataoka D, Yamamoto S, et al. Pre- and post-operative serum carcinoembryonic antigen in primary lung adenocarcinoma. Ann Thorac Cardiovasc Surg 2004;10:281-4.
  13. Igai H, Matsuura N, Tarumi S, et al. Clinicopathological study of p-T1aN0M0 non-small-cell lung cancer, as defined in the seventh edition of the TNM classification of malignant tumors. Eur J Cardiothorac Surg 2011;39:963-7. https://doi.org/10.1016/j.ejcts.2010.09.008
  14. Igai H, Matsuura N, Tarumi S, et al. Prognostic factors in patients after lobectomy for p-T1aN0M0 adenocarcinoma. Eur J Cardiothorac Surg 2012;41:603-6. https://doi.org/10.1093/ejcts/ezr006
  15. Shoji F, Yoshino I, Yano T, et al. Serum carcinoembryonic antigen level is associated with epidermal growth factor receptor mutations in recurrent lung adenocarcinomas. Cancer 2007;110:2793-8. https://doi.org/10.1002/cncr.23101
  16. Lee S, Lee CY, Kim DJ, Hong DJ, Lee JG, Chung KY. Pathologic correlation of serum carcinoembryonic antigen and cytokeratin 19 fragment in resected nonsmall cell lung cancer. Korean J Thorac Cardiovasc Surg 2013;46:192-6. https://doi.org/10.5090/kjtcs.2013.46.3.192

Cited by

  1. Assessment of Seven Clinical Tumor Markers in Diagnosis of Non-Small-Cell Lung Cancer vol.2018, pp.None, 2018, https://doi.org/10.1155/2018/9845123