|Year : 2020 | Volume
| Issue : 2 | Page : 175-179
Variation of serum carcinoembryonic antigen with grading and radiological staging in colorectal malignancy
Akshaya Mohan, MR Rajesh, MP Sreejayan
Department of General Surgery, Government Medical College, Kozhikode, Kerala, India
|Date of Submission||29-Jul-2020|
|Date of Decision||04-Aug-2020|
|Date of Acceptance||13-Aug-2020|
|Date of Web Publication||07-Nov-2020|
Dr. Akshaya Mohan
Department of General Surgery, Government Medical College, Kozhikode, Kerala
Source of Support: None, Conflict of Interest: None
Introduction: Serum carcinoembryonic antigen (CEA) is used universally as a tumour marker for colorectal malignancies. The study aims to compare the serum CEA levels in different histopathological grades and radiological stages and to see if there is a relation between them so that advanced stage can be predicted early with serum CEA level. Methodology: An observational study was done on 101 patients with colorectal malignancies. Pre-operative serum CEA value, radiological staging and pathological grading were compared. Results: Fifty-eight patients were male and 43 female. The mean age was 62.6 years. The mean serum CEA value was 14.99 ng/ml. There was a significant relation between CEA and T staging. There was no significant relation with nodal status or metastases or grading. Conclusion: The study revealed a relationship of higher T staging with CEA. No relationship was found with nodal/metastasis status/grading. We can suspect tumours with advanced T stage clinically, if CEA is elevated in patients with colorectal malignancies.
Keywords: Carcinoembryonic antigen, colorectal malignancies, histopathological grade radiological stage
|How to cite this article:|
Mohan A, Rajesh M R, Sreejayan M P. Variation of serum carcinoembryonic antigen with grading and radiological staging in colorectal malignancy. Kerala Surg J 2020;26:175-9
|How to cite this URL:|
Mohan A, Rajesh M R, Sreejayan M P. Variation of serum carcinoembryonic antigen with grading and radiological staging in colorectal malignancy. Kerala Surg J [serial online] 2020 [cited 2020 Nov 26];26:175-9. Available from: http://www.keralasurgj.com/text.asp?2020/26/2/175/300244
| Introduction|| |
Colorectal malignancies are increasing in number compared to older times. We use imaging, histopathology and tumour markers to diagnose, stage and follow up patients with carcinoma colon. Serum carcinoembryonic antigen (CEA) is used as a tumour marker universally for colorectal malignancies. The goal of the present study was to see if this tumour marker can be used to predict the severity of the disease in terms of staging and grading and if advanced diseases can be identified early with CEA.
| Methodology|| |
The study aimed to study the relationship between pre-operative serum CEA levels and histological grading of colorectal malignancies and to find if there is any relation between pre-operative serum CEA levels and radiological staging of colorectal malignancies. An observational study was conducted in the Department of General Surgery, Calicut Medical College, on patients with colorectal malignancy from February 2018 to August 2019 and who underwent surgery. All patients with colorectal malignancy whose pre-operative serum CEA and contrast-enhanced computed tomography (CECT) abdomen were done were included. Patients whose pre-operative serum CEA and CECT abdomen were not done were excluded. The variables pre-operative serum CEA value, histological grading and radiological staging of colorectal malignancy were considered.
| Results|| |
In the 101 patients, the mean age was 62.6 years (range, 28–87 years). Majority of the patients were observed in the range of 61–90 years [Figure 1]. Male: female ratio was 58:43. The pre-operative serum CEA value ranged from 0.1 to 216 ng/ml, with a mean CEA of 14.99 ng/ml. Fifty-five patients had CEA values ≤5 ng/ml and 46 had more. Tumour, node and metastasis (TNM) staging showed that majority of the patients were in Stage 3 (78). T3 lesions and N1 nodes were most common [Figure 2]. There was a significant relation between CEA and T stage but no relation with node, metastasis status or stage grouping. Assessing of the CEA values in the different TNM stages of carcinoma of the colon, it was seen that amongst the 101 patients, there was no patient with T1 lesion. Of 33 patients with T2 lesion, 24 had normal CEA and 9 had high value. Amongst the 51 patients in T3 stage, 22 had normal CEA and 29 had high value. In this stage, the high value of CEA appeared to be more in larger number of patients, however, the difference in mean values was not statistically significant. Of 17 patients with T4 lesion, 9 had normal CEA and 8 had high value. The Chi-square test did not show any statistical significance of difference [Figure 3]. Amongst 21 patients studied with N0 lesion, 16 had normal CEA and 5 had high value. Of the 51 patients with N1 lesion, 25 had normal value and 26 had high value. Of the 29 patients N2 lesion, 14 had normal value and 15 had high value. The Chi-square test showed that there was no statistically significant variation amongst the patients with various node statuses [Figure 4]. A study of the metastatic level showed that 97 had no metastasis. Amongst them, 53 had normal CEA and 44 had high value. Amongst the four patients with distant metastasis, two had normal value and two had elevated CEA. There was no statistically significant difference [Figure 5]. Considering the stage grouping, the maximum number of patients was seen in the Stage 3 level, and in them, of the total of 78, 40 had high CEA level against 38 who had normal CEA level. This difference was not statistically significant. In Stage 1, Stage 2 and Stage 4, more patients had normal CEA than elevated levels [Figure 6]. The grading of the tumours showed that 83 were well differentiated, 12 moderately differentiated and 6 poorly differentiated. Of the 83 patients with well-differentiated carcinoma, 45 had normal CEA values and 38 had > 5 ng/ml. Of the 12 patients with moderately differentiated cancer, 8 had normal CEA and 4 had high CEA. Amongst the six patients with poorly differentiated malignancy, two had normal and four had high CEA. The Chi-square test showed that the differences were not statistically significant relation between CEA and various grades of cancer [Figure 7].
| Discussion|| |
Different values obtained from the analysis were compared with those reported in the literature [Table 1]. As per Huang et al., patients with high (>5.0 ng/mL) pre-chemoradiotherapy (CRT) CEA concentrations were likely to have more advanced clinical T stage than those with normal (5.0 ng/mL) pre-CRT CEA.
As per Riaz et al., pre-operative CEA levels were associated with age, BMI, American Society of Anaesthesiologists score and tumour stage. Tumour characteristics associated with higher CEA levels were higher AJCC stage, signet cell subtype and both undifferentiated and poorly differentiated tumours. Barone et al. demonstrated a correlation of CEA with performance status and with metastatic pattern. Fletcher  reviewed the sensitivity and specificity of CEA levels and found that sensitivity decreased while the specificity increased for higher CEA cut-off points (5 ng and 10 ng). Vukobrat-Bijedic et al. found that well-differentiated adenocarcinoma is accompanied by higher CEA serum concentration.
Ochiai et al. did not find significantly higher CEA and CA19-9 levels in patients who had recorded metastases into lymph nodes. As per the study by the American Society of Clinical Oncology, serum CEA was elevated in 50% of the patients with tumour extension to the lymph nodes and in 75% of the patients with distant metastasis. Elevated serum CEA predicted a more advanced stage in earlier reports.
Bhatnagar et al. showed that more CEA per gram of total protein was produced by well-differentiated colorectal cancers than by poorly differentiated specimens. Serum CEA has also been reported to trend higher in patients with well-differentiated tumours than in those with poorly differentiated tumours in a study by Goslin et al. Duffy  suggested that a lack of differentiation or poor differentiation may explain why some patients with advanced colorectal cancer do not show increased serum concentrations of CEA. Rognum  have shown lower serum CEA in patients with tumours having a near diploid pattern. Levy et al. also stated that CEA and CA19-9 are statistically significantly different in early and metastatic colorectal cancer. CEA might play a role in the metastatic process. The role of CEA in cancer dissemination was revealed by Hostetter et al.
Priolli et al. found an association between increased CEA and loss of histological differentiation. Advanced-staged neoplasia exhibits increased CEA. Hamada et al. also showed that well-differentiated tumours had low CEA in the blood. Wang et al. found well-differentiated tumours to have low levels of CEA in the blood. The exact pre-operative serum CEA value did not correlate with tumour grade in the study by Zeng et al. Midiri et al. found low concentration in early stage but no significant correlations with cancer grading. Thus, comparing our study, most of the previous reports suggest a relation between the advanced stage and CEA. However, relation with grading varied with the different studies.
| Conclusion|| |
The present study revealed a relationship with higher T staging with CEA in patients with colorectal malignancies. Most of the previous studies supported this finding. No relation was found with nodal/metastasis status/grading. We can suspect tumours with advanced T stage clinically, if CEA is elevated in patients with colorectal malignancies.
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Conflicts of interest
There are no conflicts of interest.
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