Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study

Table 3 Joint effect of preoperative CEA and CA19-9 on colorectal cancer outcomes

Outcome	Model 1		Model 2		Model 3		Model 4
Outcome	Hazard Ratio (95% CI)	P Value	Hazard Ratio (95% CI)	P Value	Hazard Ratio (95% CI)	P Value	Hazard Ratio (95% CI)	P Value
RFS
Normal CEA & normal CA19-9	Reference		Reference		Reference		Reference
Normal CEA & elevated CA19-9	2.32 (1.87–2.88)	< 0.001	2.38 (1.92–2.96)	< 0.001	2.08 (1.65–2.62)	< 0.001	2.00 (1.46–2.72)	< 0.001
Elevated CEA & normal CA19-9	1.54 (1.37–1.73)	< 0.001	1.52 (1.35–1.71)	< 0.001	1.50 (1.32–1.70)	< 0.001	1.65 (1.40–1.95)	< 0.001
Elevated CEA & elevated CA19-9	2.41 (2.08–2.8)	< 0.001	2.38 (2.05–2.76)	< 0.001	2.31 (1.97–2.71)	< 0.001	2.76 (2.24–3.39)	< 0.001
OS
Normal CEA & normal CA19-9	Reference		Reference		Reference		Reference
Normal CEA & elevated CA19-9	2.85 (2.18–3.72)	< 0.001	3.02 (2.31–3.94)	< 0.001	2.52 (1.88–3.37)	< 0.001	2.20 (1.46–3.32)	< 0.001
Elevated CEA & normal CA19-9	1.76 (1.51–2.05)	< 0.001	1.70 (1.46–1.98)	< 0.001	1.70 (1.45–2.01)	< 0.001	1.90 (1.52–2.38)	< 0.001
Elevated CEA & elevated CA19-9	2.89 (2.40–3.48)	< 0.001	2.75 (2.28–3.32)	< 0.001	2.62 (2.14–3.21)	< 0.001	3.23 (2.46–4.24)	< 0.001

Note: CA 19–9 carbohydrate antigen 19–9, CEA carcinoembryonic antigen, OS overall survival, RFS recurrence-free survival
Elevated CEA ≥ 5 ng/ml, normal CEA < 5 ng/ml; elevated CA 19–9 ≥ 37 U/ml, normal CA 19–9 < 37 U/ml
Model 1 was unadjusted. Model 2 was adjusted for sex (female vs. male), age. Model 3 was adjusted for sex (female vs. male), age, primary site (rectum vs. colon), surgical approach (open resection vs. laparoscopic resection), pathology stage (III → II), lymph node yield (≥ 12 vs. < 12), tumor differentiation (poor-undifferentiated vs. moderate vs. well), mucinous (colloid) type (yes vs. no), lymphovascular invasion / perineural invasion (yes vs. no), adjuvant chemotherapy (yes vs. no). Model 4 was adjusted for sex (female vs. male), age, primary site (rectum vs. colon), surgical approach (open resection vs. laparoscopic resection), pathology stage (III → II), lymph node yield (≥ 12 vs. < 12), tumor differentiation (poor-undifferentiated vs. moderate vs. well), mucinous (colloid) type (yes vs. no), lymphovascular invasion / perineural invasion (yes vs. no), adjuvant chemotherapy (yes vs. no), microsatellite instability (yes vs. no)

ISSN: 1471-2407