Background: CEA is a CC biological marker that correlates with tumor stage. Its measurement is recommended for follow up after surgery. CEA above 5 ng/mL is of poor prognosis, however this cutoff is debated. Thus, we explored the prognostic value of postoperative CEA, in its continuous form. Methods: Eligible patients (pts) in MOSAIC and PETACC-8 studies had postoperative CEA available. The association between CEA and overall (OS) and disease free survival (DFS) was explored in the MOSAIC discovery cohort. It was assessed in 3 groups of pts (group 1: 0 to 1.30 ng/ml, n = 630; group 2: 1.30 to 5 ng/ml, n = 613; group 3: > 5 ng/ml, n = 49) by the Kaplan Meier method. Then relation of CEA and outcomes was continuously modelled with the restricting cubic splines (RCS) and multiple polynomial fractional (MFP) methods. Cox uni- and multivariate models were constructed. Findings were confirmed in a PETACC-8 validation cohort. Results: CEA was available in 1292 (96%) and 2477 (97%) pts in the discovery and validation cohorts, respectively with 96.2% and 95.9% of pts having a CEA below 5 ng/ml. In the discovery cohort, 5y OS were 79% (95%CI: 76-82), 70% (95%CI: 66-74) and 47% (95% CI: 35-64) in groups 1, 2 and 3, p < 0.001. Five-year DFS rate were 68% (95%CI: 65-72), 58% (95%CI: 54-62) and 42% (95%CI: 31-61), in groups 1, 2 and 3, p < 0.001. RCS and MFP showed that relation between CEA and survival was following a square root function, suggesting that values over 1.3 ng/ml were associated with prognosis. CEA over 1.3 ng/ml was an independent prognostic factor for OS and DFS (Table 1). All those results were confirmed in the validation cohort (Table 1). Conclusions: In 2 cohorts from large phase III trials, we showed that postoperative CEA was highly prognostic for OS and DFS. This was true for CEA levels above and below 5 ng/ml, suggesting that this single cutoff is not sufficient and that CEA should be used more precisely as stratification factors in future adjuvant trials.
Association of postoperative carcinoembryonic antigen (CEA) levels with survival in stage III colon cancer (CC): Post hoc analysis of the MOSAIC and PETACC-8 studies / Auclin, Edouard; Taieb, Julien; Lepage, Come; Aparicio, Thomas; Faroux, Roger; Mini, Enrico; Folprecht, Gunnar; Salazar, Ramon; Banzi, Maria; Louvet, Christophe; Van Laethem, Jean-Luc; Tabernero, Josep; Hickish, Tamas; De Gramont, Aimery; Andre, Thierry; Vernerey, Dewi. - In: JOURNAL OF CLINICAL ONCOLOGY. - ISSN 0732-183X. - STAMPA. - 36:(2018), pp. 3568-3568. [10.1200/JCO.2018.36.15_suppl.3568]
Association of postoperative carcinoembryonic antigen (CEA) levels with survival in stage III colon cancer (CC): Post hoc analysis of the MOSAIC and PETACC-8 studies
Mini, Enrico;
2018
Abstract
Background: CEA is a CC biological marker that correlates with tumor stage. Its measurement is recommended for follow up after surgery. CEA above 5 ng/mL is of poor prognosis, however this cutoff is debated. Thus, we explored the prognostic value of postoperative CEA, in its continuous form. Methods: Eligible patients (pts) in MOSAIC and PETACC-8 studies had postoperative CEA available. The association between CEA and overall (OS) and disease free survival (DFS) was explored in the MOSAIC discovery cohort. It was assessed in 3 groups of pts (group 1: 0 to 1.30 ng/ml, n = 630; group 2: 1.30 to 5 ng/ml, n = 613; group 3: > 5 ng/ml, n = 49) by the Kaplan Meier method. Then relation of CEA and outcomes was continuously modelled with the restricting cubic splines (RCS) and multiple polynomial fractional (MFP) methods. Cox uni- and multivariate models were constructed. Findings were confirmed in a PETACC-8 validation cohort. Results: CEA was available in 1292 (96%) and 2477 (97%) pts in the discovery and validation cohorts, respectively with 96.2% and 95.9% of pts having a CEA below 5 ng/ml. In the discovery cohort, 5y OS were 79% (95%CI: 76-82), 70% (95%CI: 66-74) and 47% (95% CI: 35-64) in groups 1, 2 and 3, p < 0.001. Five-year DFS rate were 68% (95%CI: 65-72), 58% (95%CI: 54-62) and 42% (95%CI: 31-61), in groups 1, 2 and 3, p < 0.001. RCS and MFP showed that relation between CEA and survival was following a square root function, suggesting that values over 1.3 ng/ml were associated with prognosis. CEA over 1.3 ng/ml was an independent prognostic factor for OS and DFS (Table 1). All those results were confirmed in the validation cohort (Table 1). Conclusions: In 2 cohorts from large phase III trials, we showed that postoperative CEA was highly prognostic for OS and DFS. This was true for CEA levels above and below 5 ng/ml, suggesting that this single cutoff is not sufficient and that CEA should be used more precisely as stratification factors in future adjuvant trials.
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