Diagnostic and Prognostic Value of CEA and CA19-9 in Colorectal Cancer

TLDR

Colorectal cancer is the third most common cancer worldwide, and early-stage diagnosis through improved screening is critical because metastases and recurrences increase mortality. The study aimed to evaluate the combined diagnostic and prognostic value of tumor markers CEA and CA19‑9 in colorectal cancer. The authors retrospectively analyzed 1,487 colorectal cancer patients from 2000 to 2015, assessing overall and recurrence‑free survival relative to preoperative CEA and CA19‑9 levels and performing multivariate analysis. High preoperative CEA or CA19‑9 (≥200) and especially combined elevation were associated with markedly lower 5‑year overall and recurrence‑free survival, and multivariate analysis confirmed their prognostic significance, supporting routine preoperative measurement of these markers.

Abstract

Colorectal cancer (CRC) is the third most common cancer worldwide. A diagnosis at early stages with enhanced screening methods is vital as metastases and recurrences increase mortality. The aim of this study was to analyze the tumor markers CEA and CA19-9 combined in correlation with diagnostics and prognosis. Therefore, 1487 patients with CRC who were diagnosed and treated between 2000 and 2015 at the University Hospital Ulm, Germany, were retrospectively evaluated. Overall and recurrence-free survival was analyzed in association with preoperative CEA and CA19-9 separately and combined and a multivariate analysis was performed. The 5-year overall survival was significantly shorter in patients with a CEA or CA19-9 level ≥200 compared to patients with an increased, but <200, or normal level (CEA: 69%/44%/7%; CA19-9: 66%/38%/8%). Patients with both tumor markers increased also showed a remarkably shorter 5-year survival rate (CEA+/CA19-9+: 23%). The multivariate analysis emphasizes these results (p-value < 0.0001). Patients with both tumor markers elevated had the shortest 5-year recurrence-free survival rate, followed by patients with either CEA or CA19-9 elevated (CEA-/CA19-9-: 79%; CEA+/CA19-9; CEA-/CA19-9+: 65%; CEA+/CA19-9+: 44%). In conclusion, measuring CEA and CA19-9 preoperatively in CRC patients is reasonable and could be useful as a prognostic factor.