Clinical Significance of Early Carcinoembryonic Antigen Change in Patients With Nonmetastatic Colorectal Cancer

Prognostic value of preoperative and postoperative serum CEA in colorectal signet ring cell carcinoma

Background

Colorectal signet ring cell carcinoma (SRCC) is a rare and poorly prognosed tumor with limited established prognostic indicators. This study aims to investigate the prognostic value of serum carcinoembryonic antigen (CEA) in patients with colorectal SRCC.

Methods

A retrospective, multicenter study was conducted to assess the association between CEA levels and survival outcomes in 942 patients with colorectal SRCC.

Results

Patients exhibiting preoperative CEA (preCEA)-positivity demonstrated significantly lower cancer-specific survival (CSS) compared to those with preCEA-negativity in both Chinese and SEER datasets (5-year CSS: 27.50% vs. 48.27%, P = 0.01; 34.37% vs. 48.47%, P < 0.05). This disparity in outcomes was particularly notable in advanced stages (III, IV and N2; all P values < 0.05), while no statistical significance was observed in earlier stages (I/II, N0 and N1; all P values > 0.05). Patients with preCEA and postoperative CEA (postCEA)-negativity showed similar CSS to those with preCEA-positivity and postCEA-negativity, but those with postCEA-positivity had worse prognosis. After accounting for potential confounders, preCEA and postCEA maintained as independent predictors for CSS (P < 0.05). The nomogram model incorporating preCEA (preCEA-model) showed a C-index value of 0.75, whereas the model incorporating postCEA (postCEA-model) exhibited a C-index value of 0.73.

Conclusions

Both preoperative and postoperative elevation of CEA levels were associated with adverse outcomes, with preoperative CEA demonstrating particularly significant predictive value in advanced-stage tumors. These findings propose that CEA could be a valuable tool for dynamically monitoring the prognosis of colorectal SRCC patients.

High-Level Lanthanide-Doped Upconversion Nanoparticles-Based Aptasensor to Increase Carcinoembryonic Antigen Detection Sensitivity

Boosting the accuracy and speed of cancer detection is highly desirous in tumor detection, and sensors capable of detecting carcinoembryonic antigen (CEA) have great application prospects in this field. A highly sensitive sensor is constructed based on the fluorescence resonance energy transfer (FRET) with heavily rare-earth-doped upconversion nanoparticles (UCNPs) as energy donors and polydopamine nanoparticles (PDA NPs) as energy acceptors. This sensor detects the fluctuations in CEA molecules via luminescence quenching and recovery resulting from a competitive binding assay between CEA and PDA NPs. The high-level-doped design of UCNPs (i.e., NaYF4@NaYbF4:1%Tm@NaYF4) is beneficial, providing upconversion luminescence intensity that is more than 10 times higher than that of the conventional low-level-doped UCNPs (i.e., NaYF4@NaYF4:20%Yb, 0.2%Tm@NaYF4). The sensor exhibits impressive sensitivity. Specifically, in diluted fetal bovine serum, the detection limit reaches 0.013 ng/mL in the range of 0-1.5 ng/mL (S/N = 3), while the detection limit is 1.38 ng/mL in the range of 1.5-250 ng/mL (S/N = 3). This method has great potential for future applications in the rapid and early diagnosis and treatment of cancer.

CEA-delta could be a biomarker of tumor phenotype, clinical stage, and chemotherapeutic response in rectal cancer with OCT4-positive cancer stem cells

Background

There is very limited evidence on biomarkers for evaluating the clinical behavior and therapeutic response in rectal cancer (RC) with positive expression of cancer stem cells (CSCs).

Methods

An exploratory prospective study was conducted, which included fresh samples of tumor tissue from 109 patients diagnosed with primary RC. Sociodemographic, pathological and clinical characteristics were collected from medical records and survey. The OCT4 protein was isolated using the Western Blot technique. It was calculated the ΔCEA, ΔOCT4, and ΔOCT4/GUSB values by assessing the changes before and after chemotherapy, aiming to evaluate the therapeutic response.

Results

Patients had an average age of 69.9 years, with 55% (n=60) being male. Approximately 63.3% of the tumors were undifferentiated, and the most frequent staging classification was pathological stage III (n=64; 58.7%). Initial positive expression was observed in 77.1% of the patients (n=84), and the median ΔCEA was -1.03 (-3.82 - 0.84) ng/ml, with elevated levels (< -0.94 ng/ml) found in 51.4% of the subjects (n=56). Being OCT4 positive and having an elevated ΔCEA value were significantly associated with undifferentiated tumor phenotype (p=0.002), advanced tumor progression stage (p <0.001), and negative values of ΔOCT4 (p <0.001) (suggestive of poor therapeutic response) compared to those without this status.

Conclusion

This study identified a significant and directly proportional association among the values of ΔCEA, ΔOCT4, and ΔOCT4/GUSB. These findings suggest that ΔCEA holds potential as a clinical biomarker for determining the undifferentiated tumor phenotype, advanced clinical stage, and poor therapeutic response in RC with CSCs positive expression.

Effect of High-Versus Low-Frequency of Abdominopelvic Computed Tomography Follow-Up Testing on Overall Survival in Patients With Stage II Or III Colon Cancer

BACKGROUND

Intensive surveillance of colon cancer by using the abdominopelvic computed tomography (AP-CT) is common in real world practice; however, it is still unclear whether high-frequency surveillance using AP-CT in patients with these risk factors is superior to that in the low-frequency surveillance.

PATIENTS AND METHODS

We retrospectively reviewed 1803 patients with stage II-III colon cancer receiving curative surgery between January 1, 2005 to December 31, 2015. We evaluated the average scan-to-scan intervals of postoperative AP-CT testing and assigned patients with an interval of 5 to 8 and 9 to 13 months to the high-frequency (HF) and low-frequency (LF) groups, respectively. The cutoff value of preoperative and postoperative CEA levels was 5 ng/mL. We also applied propensity score matching (PSM) and inverse probability of treatment weighting to adjust clinicopathologic differences between the 2 groups.

RESULTS

We matched 1:1 for each surveillance group yielding a cohort of 776 matched patients. After PSM, Baseline demographics were overall well balanced between 2 groups. Stage III (OR, 2.00; 95% Confidence interval [CI], 1.21-3.30) and postoperative CEA elevation (OR, 2.30; 95% CI, 1.08-4.92) were independent risk factors of recurrence in multivariate analyses. Patient in the HF group had more surgery plus chemo- or radiotherapy as postrecurrence treatment than patient in the LF group (46.2% vs. 23.1%, P = .017). This trend was retained after PSM, although it is not significant (44.4% vs. 23.1%, P = .060). However, survival outcomes of high-frequency AP-CT surveillance were not superior to those of low-frequency surveillance in all subgroups, including stage III (HR 0.99, 95% CI 0.40-2.47) and postoperative CEA elevation (HR 1.36, 95% CI 0.45-4.11).

CONCLUSION

High-frequency AP-CT testing is associated with a higher proportion of surgery plus chemo- or radiotherapy as postrecurrence treatment, without improvement in 5-year overall survival.

Carbon Nanopowder-Based Stochastic Sensor for Ultrasensitive Assay of CA 15-3, CEA and HER2 in Whole Blood

Two microsensors obtained by the physical immobilization of 5,10,15,20-tetraphenyl-21H,23H-porphine (TPP) and 5,10,15,20-tetrakis (pentafluorophenyl chloride)-21H,23H-iron (III) porphyrin (Fe(TPFPP)Cl) in carbon nanopowder decorated with gold nanoparticles (AuNp) were designed, characterized, validated and used for the molecular recognition and simultaneous ultrasensitive determination of CEA, CA15-3 and HER2 in whole blood. High sensitivities were recorded for both microsensors. Low limits of quantification were recorded for all biomarkers: CEA (12.8 pg mL-1 by using Fe(TPFPP)Cl/AuNp, and 190 fg mL-1 by using TPP/AuNp), CA 15-3 (100 fU mL-1 for both microsensors) and HER2 (3.9 fg mL-1 by using Fe(TPFPP)Cl/AuNp, and 35 fg mL-1 by using TPP/AuNp). A very good correlation between the results obtained using the proposed microsensors and ELISA, certified by the Student t-test, proves that the screening test can be used for ultrasensitive assays of the three biomarkers in whole blood.