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Invited Commentary
August 2015

Elevation of Pretreatment Carcinoembryonic Antigen Level as a Prognostic Factor for Colon CancerIncorporating a C Stage in the AJCC TNM Classification

Author Affiliations
  • 1Division of General Surgery and Gastrointestinal Surgery, Massachusetts General Hospital, Boston
  • 2Department of Surgery, Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2015;150(8):755-756. doi:10.1001/jamasurg.2015.0901

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.

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