J Cancer 2019; 10(16):3757-3766. doi:10.7150/jca.31660

Research Paper

The difference in prognosis of stage II and III colorectal cancer based on preoperative serum tumor markers

Weiqiang You1, Nengquan Sheng1, Li Yan1, Hongqi Chen1, Jianfeng Gong1, Zhenghui He2, Kaiwen Zheng2, Zhaohuan Chen2, Yafang Wang2, Gewen Tan1✉, Lu Xie3, Zhigang Wang1✉

1. Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
2. Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
3. Shanghai Center for Bioinformation Technology, Shanghai 201203, China
These authors contributed equally: Weiqiang You, Nengquan Sheng

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Citation:
You W, Sheng N, Yan L, Chen H, Gong J, He Z, Zheng K, Chen Z, Wang Y, Tan G, Xie L, Wang Z. The difference in prognosis of stage II and III colorectal cancer based on preoperative serum tumor markers. J Cancer 2019; 10(16):3757-3766. doi:10.7150/jca.31660. Available from http://www.jcancer.org/v10p3757.htm

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Abstract

Background: Preoperative serum tumor markers have been widely used to predict prognosis in stage II and III colorectal cancer (CRC). However, few previous studies addressed the effect of increased preoperative numbers of tumor markers.

Methods: Patients with stage II and III CRC who underwent curative resection were included from January 2009 to October 2015. The relationship between serum tumor markers and clinicopathological parameters was analyzed. DFS and OS were compared in stage II and III CRC.

Results: The median follow-up was 45 months. In this study, 735 enrolled patients were assessed based on the numbers of increased tumor markers. We found that these increased tumor markers were closely associated with clinical stage, T stage, N stage, tumor location, pathology type, differentiation, lymphatic invasion and vascular invasion (all p values < 0.05). Furthermore, the number of increased tumor markers directly affected the survival of patients with CRC after curative surgery. The 3-year DFS and OS of patients with a score of 0 were 84.0% and 91.0%, respectively, which are much higher than those of patients with a score of 4 (42.9% and 37.8%, respectively) (p < 0.05). The 5-year DFS and OS of patients with a score of 0 were 75.9% and 77.9%, respectively, which are much higher than those of patients with a score of 4 (31.7% and 23.6%, respectively). Interestingly, our results suggested that stage III CRC patients with a score of 0 had longer DFS and OS times than stage II patients with scores of 3 and 4. Further analysis revealed statistically significant differences in OS (p < 0.05) but not in DFS.

Conclusions: The number of increased tumor markers could significantly predict prognosis in stage II and III CRC. In addition, these increased tumor markers had direct impacts on metastasis as well as the recurrence status and survival time of stage II and III CRC patients.

Keywords: CRC, CEA, CA19-9, CA242, CA125, prognosis