Serum carcinoembryonic antigen pre‐operative level in colorectal cancer: revisiting risk stratification.

Background: Biomarkers may play a role as predictive and prognostic factors in colorectal cancer patients. The aims of the study were to verify the prognostic role of pre‐operative serum carcinoembryonic antigen (CEA) level in predicting overall survival and risk of recurrence in a cohort of colorectal cancer patients and to evaluate optimal cut‐off values. Methods: A retrospective cohort analysis was performed on colorectal cancer patients undergoing elective curative surgery between 2004 and 2019 at an Italian Academic Hospital. Main outcomes were overall survival, disease‐free survival at 3‐years and risk of local, loco‐regional and distant recurrence during follow‐up. A receiver operating characteristic (ROC) curve analysis was plotted using CEA pre‐operative values and follow‐up data in order to estimate the optimal cut‐off values. Results: A total of 559 patients were considered. The mean CEA value was 12.1 ± 54.1 ng/mL, and the median 29.3 (0–4995) ng/mL. The ROC curve analysis identified 12.5 ng/mL as the best CEA cut‐off value to predict the risk of metastatic development after surgery in stage I–III colorectal cancer patients, and 10 ng/mL as the best CEA cut‐off value to predict overall survival and disease‐free survival in stage III–IV patients. These data suggest a stratification of colorectal cancer patients in three classes of risk: a low risk class (CEA <10 ng/mL), a moderate risk class (CEA 10–12.5 ng/mL) and a high risk class (CEA >12.5 ng/mL). Conclusion: In conclusion, pre‐operative serum CEA measurements could integrate information to enhance patient risk stratification and tailored therapy. [ABSTRACT FROM AUTHOR]