Elevation of pretreatment carcinoembryonic antigen level as a prognostic factor for colon cancer
Menée à partir des données des registres américains des cancers portant sur 16 619 patients atteints d'un cancer du côlon (durée médiane de suivi : 71 mois), cette étude évalue l'intérêt d'intégrer dans le système TNM de l'"American Joint Committee on Cancer" le stade C, défini par la mesure du niveau sérique avant traitement de l'antigène carcino-embryonnaire, pour estimer la survie à 5 ans
Thirunavukarasu and colleagues1 use data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database to determine whether preoperative serum carcinoembryonic antigen (CEA) status, dichotomized as elevated (C1) or normal (C0), can become a staging component in colon cancer, the C stage, akin to the more common T, N, M, R, and G stages. In their analysis, the authors reveal that C1 stage is independently associated with overall and disease-specific mortality. Of interest, this effect was strong enough that upstaging could occur, as happened for patients with node-negative C1 disease who in some cases had worse outcomes than patients with node-positive C0 disease. These findings are potentially important and reinforce the long-standing2 body of evidence that elevation in CEA level can be a stage-independent prodrome of advanced disease. This finding is in line with earlier recommendations of the American Society of Clinical Oncology3 and the European Society for Medical Oncology,4 which call for the incorporation of pretreatment measurement of CEA levels into the standard of care.
JAMA Surgery , commentaire, 2014