PREOPERATIVE MEASUREMENTS OF CARCINOEMBRYONIC ANTIGEN MAY PREDICT EARLY RECURRENCE IN PATIENTS WITH RESECTABLE NON-SMALL CELL LUNG CANCER

Running head:
CEA in the preoperative evaluation of NSCLC

From the Cuneo Lung Cancer Study Group at the "S. Croce e Carle" Hospital, Cuneo I-12100, Italy

Authors:
1. Gianfranco Buccheri, M.D.
Divisione di Pneumologia, Ospedale "S. Croce e Carle", Cuneo, I-12100, Italy. Tel. 0039.0171.441733, Fax. 0039.0171.441764, e-mail: buccheri@culcasg.org
2. Domenico Ferrigno, M.D.

Corresponding author and Reprint requests to: Gianfranco Buccheri, M.D.

ABSTRACT
Background In 1965, Gold and Freedman discovered the Carcinoembryonic Antigen (CEA). This study describes the CEA capability to predict early tumour recurrence after pulmonary resection for non-small cell lung cancer (NSCLC).

Methods We studied prospectively 118 consecutive NSCLC patients, who were judged clinically operable and were eventually operated on. Anthropometric, clinical and CEA data, along with the results of both preoperative and postoperative stage classifications - were recorded. All patients were carefully followed-up and the length of time to the first clinical recurrence was recorded. Receiver-operating characteristic (ROC) curves and diagnostic formulas were used for data analysis.

Results In this series, the CEA test was the most accurate method to predict early recurrences (ROC area: 0.72, 95% CI: 0.60-0.85, p=0.001; accuracy rate for a CEA threshold of 10 ng/ml: 83%, CI: 76-90%). Also predictive was the postoperative pathologic stage of disease (ROC area: 0.68, CI: 0.56-0.80, p=0.007). In the subgroup of patients classified in stage Ia-IIb after radical resection, a preoperative CEA level higher than 10 ng/ml was associated with a 67% probability of recurrence. In the same subjects, a CEA level up to 10 ng/ml increased the baseline probability of no recurrence for one year after surgery from 80% to 88%.

Conclusions In operable patients with NSCLC, the frequency of abnormal serum concentrations of CEA is rather low (17% in our series). However, many patients showing increased or very increased levels of CEA will develop an early postoperative recurrence. Such patients should be extensively investigated before operation and then carefully followed up.

Key words:
Lung neoplasm, non-small cell lung cancer, carcinoembryonic antigen, serum tumour markers, postoperative tumour recurrence

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