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Original article

Prognostic relevance of preoperative CA 19-9 values in stage III rectal adenocarcinoma: retrospective analysis and clinical implications

By
Edin Hodžić Orcid logo ,
Edin Hodžić
Contact Edin Hodžić

Clinic for General and Abdominal Surgery, Clinical Centre of the University of Sarajevo , Sarajevo , Bosnia and Herzegovina

Sadat Pušina ,
Sadat Pušina

Clinic for General and Abdominal Surgery, Clinical Centre of the University of Sarajevo , Sarajevo

Adi Mulabdić ,
Adi Mulabdić

Clinic for General and Abdominal Surgery, Clinical Centre of the University of Sarajevo , Sarajevo , Bosnia and Herzegovina

Mirhan Salibašić ,
Mirhan Salibašić

Clinic for General and Abdominal Surgery, Clinical Centre of the University of Sarajevo , Sarajevo , Bosnia and Herzegovina

Emsad Halilović ,
Emsad Halilović

Clinic for General and Abdominal Surgery, Clinical Centre of the University of Sarajevo , Sarajevo , Bosnia and Herzegovina

Mujo Kadrić
Mujo Kadrić

Clinic for Oncology, Clinical Centre of the University of Sarajevo , Sarajevo , Bosnia and Herzegovina

Abstract

Aim
To investigate prognostic significance of preoperative levels of the Carbohydrate anti-gen 19-9 (CA 19-9) in patients with stage III rectal adenocarcinoma who underwent a treatment at the Clinical Centre of the University of Sarajevo.
Methods
A retrospective cohort study included 84 patients who underwent radical anterior rectal resection due to grade III rectal adenocarcinoma, followed by adjuvant chemotherapy according to the FOLFOX protocol (Oxaliplatin, Leucovorin, 5-Fluorouracil (5-FU)). The patients were divided into two groups according to CA 19-9 values (≥27 U/mL and <27 U/mL, respectively). 
Results
High pre-operative CA 19-9 values predicted an increased probability of postoperative metastases, especially liver, lung and abdominopelvic metastases, as well as three-year disease-free survival (3Y-DFS) and three-year overall survival (3Y-OS). The 3Y-DFS rate for patients with high CA 19-9 was 64.5%, while for those with low CA 19-9 it was 87.2%. The 3Y-OS rate for patients with high CA 19-9 was 89.8%, while for those with low CA 19-9 it was 65.7%. Univariate and multivariate regression analysis confirmed that a high level of CA 19-9 is an independent predictor for DFS and OS shorter than three years.
Conclusion Pre-operatively elevated values of CA 19-9 in rectal adenocarcinoma have a significant role in predicting the outcome in patients with stage III rectal adenocarcinoma.

References

1
Wang J, Li S, Liu Y, Zhang C, Li H, Lai B. Metastatic patterns and survival outcomes in patients with stage IV colon cancer: A population-based analysis. Cancer Med 2020;(9):361–73. doi: 10.1002/cam4.2673.
2
Mcshane J, De A. Retrospective Analysis of the Safety of FOLFOX Compared to CAPOX for Adjuvant Treatment of Stage III Colorectal Cancer in Newfoundland Patients. Gastrointest Disord 2022;(3):214–22. doi: 10.3390/gidisord4030020.
3
Doyle D, Hendrix J, Garmon E. American society of anesthesiologists classification 2023.
4
Weiser M. AJCC 8th Edition: Colorectal Cancer. Ann Surg Oncol 2018;(6):1454–5. doi: 10.1245/s10434-018-6462-1.
5
Townsend C, Beauchamp R, Evers B. Sabiston Textb. Surg. 21st edition 2022:1381.
6
Motoi F, Murakami Y, Okada K-I, Matsumoto I, Uemura K, Satoi S. Sustained Elevation of Postoperative Serum Level of Carbohydrate Antigen 19-9 is High-Risk Stigmata for Primary Hepatic Recurrence in Patients with Curatively Resected Pancreatic Adenocarcinoma. World J Surg 2019:43.
7
N.d.:634–41. doi: 10.1007/s00268-018-4814-4.
8
Hong S, Song K, Hwang D, Lee J, Lee W, Jun E. Preoperative serum carbohydrate antigen 19-9 levels predict early recurrence after the resection of early-stage pancreatic ductal adenocarcinoma. World J Gastrointest Surg 2021;(11):1423–35. doi: 10.4240/wjgs.v13.i11.1423.
9
Zhou W, Yang F, Peng J, Wang F, Lin Y, Jiang W. High pretreatment serum CA19-9 level predicts a poor prognosis for patients with stage III colon cancer after curative resection and adjuvant chemotherapy. J Cancer 2019;(16):3810–8. doi: 10.7150/jca.31375.
10
Kurniawan A, Lusikooy R, Mappincara M, Rauf M, Labeda I, Warsinggih W. The relationship between triple tumor marker (CEA, CA 19-9, and CA 125) and colorectal cancer metastases at Makassar, Indonesia. Int J Med Rev Case Rep 2020;(0):1. doi: 10.5455/IJMRCR.colorectalcancer-indonesia.
11
Subki A, Buttns A, Alkahtani A. CEA and CA19-9 levels and KRAS mutation status as biomarkers for colorectal cancer. Clin Oncol 2021:1–8.
12
Li Z, Zhu H, Pang X, Mao Y, Yi X, Li C. Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study. BMC Cancer 2022;(1):962. doi: 10.1186/s12885-022-10051-2.
13
Patel S. Med News Today 2023 2023.
14
Bostancı M, Mollaoğlu M, Karadayı K. Relationship Between Serum CA 19-9 Levels and Lymphovascular and Perineural Invasion of the Tumor and Lymph Node Metastasis in Patients Operated due to Pancreatic Carcinoma. J Ank Univ Fac Med 2022;(1):113–8. doi: 10.4274/atfm.galenos.2021.40412.
15
Desai S, Guddati A, Carcinoembryonic Antigen. Carbohydrate Antigen 19-9. Cancer Antigen 2023;(1):4–14. doi: 10.14740/wjon1425.
16
Lin P-C, Lin J-K, Lin C-C, Wang H-S, Yang S-H, Jiang J-K. Carbohydrate antigen 19-9 is a valuable prognostic factor in colorectal cancer patients with normal levels of carcinoembryonic antigen and may help predict lung metastasis. Int J Colorectal Dis 2012;(10):1333–8. doi: 10.1007/s00384-012-1447-1.
17
Shin J, Kim H, Lee W, Yun S, Cho Y, Huh J. High preoperative serum CA 19-9 levels can predict poor oncologic outcomes in colorectal cancer patients on propensity score analysis. Ann Surg Treat Res 2019;(3):107–15. doi: 10.4174/astr.2019.96.3.107.
18
Lakemeyer L, Sander S, Wittau M, Henne-Bruns D, Kornmann M, Lemke J. Diagnostic and Prognostic Value of CEA and CA19-9 in Colorectal Cancer. Dis Basel Switz 2021;(9):21. doi: 10.3390/diseases9010021.
19
Graziosi L, Elisabetta M, Rebonato A, Donini A. Preoperative Serum Markers Prognostic Evaluation in Colon Cancer Patients. J Cancer Sci Ther 2018;(2). doi: 10.4172/1948-5956.1000511.
20
Li Y, Hua R, He J, Zhang H. Survival Contradiction in Stage II, IIIA, And IIIB Colon Cancer: A Surveillance. Epidemiology, and End Result-Based Analysis Evid-Based Complement Altern Med ECAM 2022:4088117. doi: 10.1155/2022/4088117.
21
Murcia O, Juárez M, Rodríguez-Soler M, Hernández-Illán E, Giner-Calabuig M, Alustiza M. Colorectal cancer molecular classification using BRAF, KRAS, microsatellite instability and CIMP status: Prognostic implications and response to chemotherapy. PloS One 2018;(9):203051. doi: 10.1371/journal.pone.0203051.
22
Grunnet M, Christensen I, Lassen U, Jensen L, Lydolph M, Knox J. Decline in CA19-9 during chemotherapy predicts survival in four independent cohorts of patients with inoperable bile duct cancer. Eur J Cancer Oxf Engl 1990:51.
23
Cancer A. Rectal cancer treatment by stage. Am Cancer Soc n.d.
24
Chen V, Hsieh M-C, Charlton M, Ruiz B, Karlitz J, Altekruse S. Analysis of stage and clinical/prognostic factors for colon and rectal cancer from SEER registries: AJCC and collaborative stage data collection system. Cancer 2014:3793–806. doi: 10.1002/cncr.29056.
25
Argilés G, Tabernero J, Labianca R, Hochhauser D, Salazar R, Iveson T. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol 2020;(10):1291–305. doi: 10.1016/j.annonc.2020.06.022.
26
Giesen L, Olthof P, Elferink M, Verhoef C, Dekker J. Surgery for rectal cancer: Differences in resection rates among hospitals in the Netherlands. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 2021;(9):2384–9. doi: 10.1016/j.ejso.2021.04.030.
27
André T, De Gramont A, Vernerey D, Chibaudel B, Bonnetain F, Tijeras-Raballand A. Adjuvant Fluorouracil, Leucovorin, and Oxaliplatin in Stage II to III Colon Cancer: Updated 10-Year Survival and Outcomes According to BRAF Mutation and Mismatch Repair Status of the MOSAIC Study. J Clin Oncol Off J Am Soc Clin Oncol 2015;(35):4176–87. doi: 10.1200/JCO.2015.63.4238.
28
Baxter N, Kennedy E, Bergsland E, Berlin J, George T, Gill S. Adjuvant Therapy for Stage II Colon Cancer: ASCO Guideline Update. J Clin Oncol Off J Am Soc Clin Oncol 2022.
29
N.d.:892–910. doi: 10.1200/JCO.21.02538.
30
Grothey A, Sobrero A, Shields A, Yoshino T, Paul J, Taieb J. Duration of Adjuvant Chemotherapy for Stage III Colon Cancer. N Engl J Med 2018;(13):1177–88. doi: 10.1056/NEJMoa1713709.
31
Chan A, Prassas I, Dimitromanolakis A, Brand R, Serra S, Diamandis E. Validation of biomarkers that complement CA19.9 in detecting early pancreatic cancer. Clin Cancer Res Off J Am Assoc Cancer Res 2014;(22):5787–95. doi: 10.1158/1078-0432.CCR-14-0289.
32
Chen J, Zhao T, Jia S, Zhou S, Zhou L, Wang S. High Expression of P38α and Preoperative Carbohydrate Antigen 19-9 Indicate Poor Prognosis in Patients with Pancreatic Ductal Adenocarcinoma. J Cancer 2018;(4):650–9. doi: 10.7150/jca.21683.
33
Siegel R, Miller K, Jemal A. Cancer statistics. CA Cancer J Clin 2018;(1):7–30. doi: 10.3322/caac.21442.
34
N.d. doi: 10.1016/j.ejca.2015.04.011.
35
Benson A, Venook A, Al-Hawary M, Cederquist L, Chen Y-J, Ciombor K. NCCN Guidelines Insights: Colon Cancer, Version 2. J Natl Compr Cancer Netw JNCCN 2018;(4):359–69. doi: 10.6004/jnccn.2018.0021.
36
Kawamura H, Honda M, Takano Y, Kinuta S, Kamiga T, Saji S. Prognostic Role of Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 in Stage IV Colorectal Cancer. Anticancer Res 2022;(8):3921–8. doi: 10.21873/anticanres.15886.
37
Yu Z, Chen Z, Wu J, Li Z, Wu Y. Prognostic value of pretreatment serum carbohydrate antigen 19-9 level in patients with colorectal cancer: A metaanalysis. PloS One 2017;(11):188139. doi: 10.1371/journal.pone.0188139.
38
Hidaka E, Maeda C, Nakahara K, Wakamura K, Ishiyama Y, Shimada S. High Serum CA19-9 Concentration Predicts Poor Prognosis in Elderly Patients with Stage IV Colorectal Cancer. Gastrointest Tumors 2019;(3–4):117–24. doi: 10.1159/000493793.
39
Chan G, Chee C. Making sense of adjuvant chemotherapy in colorectal cancer. J Gastrointest Oncol 2019;(6):1183–92. doi: 10.21037/jgo.2019.06.03.
40
Inci F, Karatas F. The relationship of preoperative and postoperative serum CEA and CA 19-9 levels with tumor localization, stage and overall survival in patients with colorectal cancer. Ann Med Res 2021;(4):726. doi: 10.5455/annalsmedres.2020.09.979.
41
Serdarevic N. The Comparison Between Different Immunoassays for Serum Carbohydrate Antigen (CA 19-9) Concentration Measurement. Acta Inform Medica AIM J Soc Med Inform Bosnia Herzeg Cas Drustva Za Med Inform BiH 2018.
42
N.d.;(4):235–9. doi: 10.5455/aim.2018.26.235-239.

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