ANTICANCER RESEARCH 26: 3845-3848 (2006)
Relationship Between Serum Carcinoembryonic Antigen Level and T Status in Non-small Cell Lung Cancer MASAKI TOMITA, YASUNORI MATSUZAKI, TETSUYA SHIMIZU, MASAKI HARA, TAKANORI AYABE and TOSHIO ONITSUKA
Department of Surgery II, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, 889-1692, Japan
Abstract. Background: Controversy exists regarding the relationship between serum carcinoembryonic antigen (CEA) level and T status in non-small cell lung cancer. Materials and Methods: Two hundred and forty-seven lung cancer patients with pN0 disease were included in the study and the relationship between serum CEA level and T status, tumor size and degree of local extension was investigated. Results: Patients with tumors 0 to 1.5 cm in diameter had significantly low serum CEA level. However, there were no significant differences in serum CEA level among other tumor size groups. Serum CEA level was not related to the degree of local extension. The 5-year survival of patients with both normal serum CEA levels and T1 disease was significantly better than that of patients with high serum CEA level and T2-4 disease. Conclusion: Serum CEA levels do not always relate to T status. The combined use of these factors might be useful in predicting the prognosis of pN0 non-small cell lung cancer patients. At present, one of the most commonly used tumor markers for non-small cell lung cancer is the serum carcinoembryonic antigen (CEA). Apart from TNM classification, several reports have indicated that pre-operative elevated serum CEA levels are associated with more advanced disease and with very poor survival rates following surgical resection (1-7). Although it is generally accepted that serum CEA levels are associated with more advanced stages, some studies found that serum CEA levels are not always related to TNM staging (4, 5). On the other hand, other previous studies found that serum CEA levels showed a clear relationship with tumor stage (6, 7). Takamochi et al. (8) reported that the serum CEA level is one of the clinical predictors of N2 disease. Based on current TNM staging system, T status refers to the characteristics of the primary tumor: T1-2 diseases are stated by tumor size and the limit of T status is a tumor 3 cm
Correspondence to: Masaki Tomita, MD, Department of Surgery II, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, 889-1692, Japan. Tel: 81-985-85-2291, Fax: 81985-85-5563, e-mail:
[email protected] Key Words: Serum CEA, T status, non-small cell lung cancer.
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in diameter. On the other hand, T3-4 diseases refer mainly to the degree of local extension. Controversy also exists regarding the relationship between serum CEA level and T status (tumor size and degree of local extension). In the present study, therefore, the serum CEA levels of lung cancer patients were measured, and the relationship between serum CEA level and T status was examined. To avoid the effect of N status, pN0 patients were selected.
Materials and Methods The present study was conducted from 1997 through 2003, including all patients with lung cancer who had a thoracotomy for intended surgical resection. Lung cancer patients (n=247) who fulfilled the inclusion criteria and underwent surgical resection were included in this study. There were 90 men and 157 women and their ages ranged from 37 to 90 years, with an average of 66.2 years. The baseline characteristics are summarized in Table I. The clinical investigation section of our hospital measured serum CEA levels using the two-site immunoenzymometric assay; with the normal upper limit at 5 ng/mL. The time interval between serum CEA determination and staging or surgical resection was less than one month in all patients. All patients underwent thoracotomy. Pathological (p) TNM staging was recorded in all patients. Comparisons of data between the 2 groups were made using the Mann-Whitney U-test. Survival curves were obtained according to the Kaplan-Meier method. A comparison of survival curves was carried out using the log-rank test. Statistical calculations were conducted with JMP (SAS Institute Inc. Cary, NC, USA) and values of p less than 0.05 were accepted as significant.
Results Patient survival based on T status is presented in Figure 1A. The 5-year survival of patients with T1, T2 and T3-4 disease was 88.5%, 72.42% and 29.74%, respectively. There was a significant relationship between T status and patient survival (p
