Elevated Pretreatment CEA and CA19-9 Levels are Related to Early Treatment Failure in Esophageal Adenocarcinoma

• Published in: American journal of clinical oncology Vol. 42; no. 4; p. 345
• Main Authors: van der Kaaij, Rosa T, Voncken, Francine E M, van Dieren, Jolanda M, Snaebjornsson, Petur, Korse, Catharina M, Grootscholten, Cecile, Aleman, Berthe M P, van Sandick, Johanna W
• Format: Journal Article
• Language: English
• Published: United States 01.04.2019
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers, Tumor - blood; CA-19-9 Antigen - blood; Carcinoembryonic Antigen - blood; Chemoradiotherapy - mortality; Combined Modality Therapy; Esophageal Neoplasms - blood; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagectomy - mortality; Female; Follow-Up Studies; GPI-Linked Proteins - blood; Humans; Male; Middle Aged; Retrospective Studies; Survival Rate; Treatment Failure
• ISSN: 1537-453X
• DOI: 10.1097/coc.0000000000000525

Chemoradiotherapy and surgery are the basis of the potentially curative treatment for esophageal cancer. Approximately 1 in 5 patients, however, do not benefit from this intensive treatment due to early treatment failure. The aim of this study was to evaluate levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 at diagnosis, in relation to survival and early treatment failure (disease recurrence or death within 1 year after surgery). Patients with esophageal adenocarcinoma scheduled for chemoradiotherapy followed by surgery between 1998 and 2014 were selected from a retrospectively collected database if both CEA and CA19-9 levels were measured before the start of treatment. Pretreatment CEA and CA19-9 levels were known in 102 patients. Median overall survival differed (P<0.001) between patients with normal levels of both CEA and CA19-9 (n=59; 51 mo), patients with elevated CEA only (n=13; 43 mo), patients with elevated CA19-9 only (n=19; 24 mo), and those with elevated levels of both CEA and CA19-9 (n=11; 11 mo). Elevation of both CEA and CA19-9 was associated with early treatment failure (odds ratio: 10.4; 95% confidence interval: 2.4-45.5, P=0.002). Median time to tumor recurrence was 34 months in patients with normal CEA and CA19-9 levels, and 7 months in those with elevated levels of both (P=0.003). Pretreatment elevated CEA and CA19-9 levels were significantly associated with early treatment failure and decreased overall survival in this esophageal adenocarcinoma patient cohort treated with curative intent. Until prospective validation, CEA and CA19-9 might play a role in identifying high-risk patients before the start of intensive locoregional therapy.