C-stage in colon cancer: Implications of carcinoembryonic antigen biomarker in staging, prognosis, and management

Pragatheeshwar Thirunavukarasu, Shyamsunder Sukumar, Magesh Sathaiah, Meredith Mahan, Kothai Divya Pragatheeshwar, James F. Pingpank, Herbert Zeh, Christopher J. Bartels, Kenneth K.W. Lee, David L. Bartlett

Research output: Contribution to journalArticlepeer-review

127 Scopus citations


BackgroundThe American Joint Committee on Cancer (AJCC) has proposed the inclusion of pretreatment serum carcinoembryonic antigen (CEA) level (C-stage) into the conventional TNM staging system of colon cancer. We assessed the prognosis of various stages of colon cancer after such an inclusion.MethodsData for all patients (N = 17910) diagnosed with colonic adenocarcinoma (AJCC stages I, IIA, IIB, IIC, IIIA, IIIB, IIIC, and IV, based on TNM staging system) between January 1, 2004, and December 31, 2004, with a median follow-up of 27 months (range 0-35 months), were collected from the Surveillance, Epidemiology, and End Results database. C-stage (C0-stage = normal CEA level; C1-stage = elevated CEA level) was assigned to all patients with available CEA information (n = 9083). Multivariable analyses using Cox proportional hazards models were used to identify independent factors associated with prognosis. Prognosis of overall stages (AJCC stages I-IV and C0 or C1) was analyzed using Kaplan-Meier survival curves. All statistical tests were two-sided.ResultsC1-stage was independently associated with a 60% increased risk of overall mortality (hazard ratio of death = 1.60, 95% confidence interval = 1.46 to 1.76, P <. 001). Overall survival was decreased in patients with C1-stage cancer compared with C0-stage cancer of the respective overall stages (P <. 05). Similarly, decreased overall survival was noted in patients with stage I C1 cancer compared with stage IIA C0 or stage IIIA C0 cancer (P <. 001), in patients with stage IIA C1 cancer compared with stage IIIA C0 (P <. 001), and in patients with stage IIB C1 or stage IIC C1 cancer compared with stage IIIB C0 cancer (P <. 001).ConclusionsC-stage was an independent prognostic factor for colon cancer. The results support routine preoperative CEA testing and C-staging upon diagnosis of colon cancer and the inclusion of C-stage in the conventional TNM staging of colon cancer.

Original languageEnglish (US)
Pages (from-to)689-697
Number of pages9
JournalJournal of the National Cancer Institute
Issue number8
StatePublished - Apr 20 2011
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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