Intest Res  
Clinical significance of carcinoembryonic antigen in peritoneal fluid detected during operation in stage I-III colorectal cancer patients
Jae Hyun Kim1*, Seunghun Lee2*, Seung Hyun Lee2, Byung Kwon Ahn2, Sung Uhn Baek2, Won Moon1, Seun Ja Park1
Departments of 1Gastroenterology and 2Colorectal Surgery, Kosin University College of Medicine, Busan, Korea
Correspondence to: Seun Ja Park, Department of Gastroenterology, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea. Tel: +82-51-990-5061, Fax: +82-51-990-5055, E-mail: parksj6406@daum.net
*These authors contributed equally to this study.
Received: December 13, 2017; Revised: January 15, 2018; Accepted: January 29, 2018; Published online: April 17, 2018.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: Early diagnosis of peritoneal metastases in patients with colorectal cancer (CRC) can influence patient prognosis. The aim of this study was to identify the clinical significance of carcinoembryonic antigen (CEA) in peritoneal fluid detected during operation in stage I-III CRC patients. Methods: Between April 2009 and April 2015, we reviewed medical records from a total of 60 stage I-III CRC patients who had peritoneal fluid collected during operation. Patients who had positive cytology in the assessment of peritoneal fluid were excluded. We evaluated the values of CEA in peritoneal fluid (pCEA) to predict the long-term outcomes of these patients using Kaplan-Meier curves and Cox regression models. Results: The median follow-up duration was 37 months (interquartile range, 21–50 months). On receiver operating characteristic analysis, pCEA had the largest area under the curve (0.793; 95% confidence interval, 0.635–0.950; P=0.001) with an optimal cutoff value of 26.84 (sensitivity, 80.0%; specificity, 76.6%) for predicting recurrence. The recurrence rate was 8.1% in patients with low pCEA (<26.84 ng/mL, n=37), and 52.2% in patients with high pCEA (≥26.84 ng/mL, n=23). In multivariate Cox regression analysis, high pCEA (≥26.84 ng/mL) was a risk factor for poor cancer-free survival (CFS) in stage I-III patients. Conclusions: In this study, we determined that high pCEA (≥26.84 ng/mL) detected during operation was helpful for the prediction of poor CFS in patients with stage I-III CRC.
Keywords: Carcinoembryonic antigen; Peritoneal fluid; Operation; Colorectal neoplasms


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