PURPOSE: In recent years, several authors had reported that high carcinoembryonic antigen (CEA) level might be a poor prognosis in non-small cell lung cancer. The purpose of this study was to assess the outcome of adenocarcinoma patients with extremely high level of preoperative serum CEA.
METHODS: Between January 1999 and December 2007, 343 patients underwent surgical resection of primary pulmonary adenocarcinoma in our department. Of those, 49 patients had elevated levels of CEA >5ng/ml. Clinical implication of preoperative CEA level was examined by clinicopathological findings in those patients.
RESULTS: Overall survival rate at 5 years for 49 patients was 50.5%. Five patients among them had very high preoperative CEA level (>90ng/ml). Three of them alive with no evidence of recurrence nor metastasis(8years, 6years, 3years), one still alive for 27 months after surgery with bone metastasis, and one patient died due to hepatocellular carcinoma at 34 month after pulmonary resection without any recurrence. Histological subtypes of these 5 cases were 3 acinar types, 1 solid type, and 1 unclassified type. All of them were non-papillary adenocarcinoma. In the patients with c-Stage I or II adenocarcinoma, the pathological stage was upgraded 18.5% in cases with CEA< 10 and 43.8% in cases with CEA>10.
CONCLUSION: When the preoperative CEA >10ng/ml, clinical evaluation might be estimated smaller than pathological staging. When the preoperative CEA level was >90ng/ml in the resectable adenocarcinoma cases, most of their histological subtypes were non-papillary adenocarcinoma.
CLINICAL IMPLICATIONS: (1) Patients with a high CEA level should receive special attention and careful staging, including mediastinoscopy, EBUS, or PET. (2) Patients with a very high CEA level and with histological subtype of non-papillary adenocarcinoma have a potential of good long term results.(3) Even if preoperative CEA level of >90ng/ml, pulmonary resection could be a curative therapy in Stage I or II adenocarcinoma. Therefore, such cases should not exclude from surgical treatment.
DISCLOSURE: Masahiro Mitsuoka, No Financial Disclosure Information; No Product/Research Disclosure Information