CEA and Survival in Patients with Stage IA-B NSCLC

Marked elevation of serum carcinoembryonic antigen (CEA) predicts a poor prognosis and plays an adjunctive role in the staging of non-small cell lung cancer (NSCLC). However, previous studies on serum CEA levels for prognosis of NSCLC patients included stage I as well as II-IIIA NSCLC diseases [1] [2] [3] [4] [5]. There is minimal information available as to whether CEA levels can be a predictor of survival in stage IA-B patients, while stage IA-B NSCLC patients with elevated CEA tend to demonstrate poorer survival rates than those with normal levels of CEA. This study examined the relationship between CEA levels and survival in patients with stage IA-B disease in order to determine whether elevated levels of CEA correlate with poorer outcome.

Ninety-five patients (58 adenocarcinomas, 27 squamous-cell carcinomas, 7 large-cell carcinomas, 3 others) with clinical stage IA-B NSCLC were identified in our division over a 18-year period (from 1983 to 2001). 58 men and 37 women with a mean age of 64 years (range: 39 to 80 years) were included in the study. Among the 95 patients, fifteen patients had elevated CEA levels (> 5.0 ng/ml, median 9.6 ng/ml, range 5.1 - 157.0 ng/ml). In univariate analyses, no statistical difference in survival rates could be found between the stage IA-B NSCLC patients with elevated serum CEA levels and those with normal CEA levels (p = 0.398; generalized Wilcoxon test, p = 0.157; log rank test). Multivariate analysis using Cox's proportional hazards model did not show any statistical difference in survival rates between the two groups (p = 0.192).

Our results revealed that, in stage IA-B NSCLC patients, elevated serum CEA level does not indicate poorer survival compared with those with normal levels of CEA. Therefore, in patients with staging IA-B disease, elevated CEA levels should not be a reason to exclude the standard surgical resection from consideration.

References

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