Combined Evaluation of Postoperative Serum Levels of Carcinoembryonic Antigen Less than or Equal to 2.5 ng/ml and Absence of Vascular Invasion may Predict no Recurrence of Stage I Adenocarcinoma Lung Cancer

Study ObjectivesIt has been reported that high levels of serum carcinoembryonic antigen (CEA) after surgery, or the presence of vascular invasion or both, are strong indicators of postoperative recurrence in patients with non-small cell lung cancer. The purpose of this study is to evaluate which kind of patients with p-stage I adenocarcinoma need adjuvant chemotherapy, using those predictors.Patients and MethodsWe studied 136 patients with curatively resected p-stage I adenocarcinoma during the 7-year period of January 1, 2000 to December 31, 2006. Receiver operating characteristics curves were constructed using postoperative CEA levels measured 2 months after surgery. Clinical variables were examined as possible predictors of disease recurrence by multivariate analysis using the Cox proportional-hazards model.ResultsThe median time of follow-up after surgery was 28.3 months. Fifteen (11%) of 136 patients had postoperative recurrence (7 p-stage IA cases and 8 p-stage IB cases). The presence of vascular invasion (hazard ratio: 10.229, 95% confidence intervals: 2.811–37.223, p = 0.0004) and high postoperative CEA levels (hazard ratio: 1.650, 95% confidence intervals: 1.196–2.275, p = 0.0023) increased the risk of recurrence. There was no recurrence in patients who had both postoperative CEA levels less than or equal to 2.5 ng/ml and no vascular invasion.ConclusionCombined evaluation of postoperative CEA levels and vascular invasion makes it possible to predict disease recurrence in the curatively resected p-stage I adenocarcinoma patients.