Carcinoembryonic Antigen Messenger
RNA
in Pelvic Lavage Fluid Predicts Local Recurrence After Curative‐Intent Resection of Rectal Cancer
Hiroyuki Asai, Yushi Yamakawa, Kazuyoshi Shiga, Shuhei Uehara, Akira Kato, Takuya Suzuki, Hajime Ushigome, Hiroki Takahashi, Yoichi Matsuo, Shuji Takiguchi ABSTRACT
Purpose
To evaluate whether pelvic lavage carcinoembryonic antigen (CEA) mRNA is associated with local recurrence after curative‐intent resection for rectal cancer and whether it provides additional prognostic information beyond circumferential resection margin (CRM) status.
Methods
We retrospectively analyzed 178 patients who underwent curative‐intent resection for primary rectal cancer. Pelvic lavage fluid was collected intraoperatively before enterotomy, and CEA mRNA levels were quantified using quantitative reverse‐transcription polymerase chain reaction (qRT‐PCR). CEA mRNA positivity was defined as ≥ 0.26, and CRM positivity as ≤ 1 mm. Local recurrence was evaluated using Kaplan–Meier analysis and Cox proportional hazards modeling.
Results
During a median follow‐up of 59.1 months, local recurrence occurred in 8 patients (4.5%). CEA mRNA was positive in 7 patients (3.9%), and CRM was positive in 11 patients (6.2%). Local recurrence rates were 36.4% (4/11) in CRM‐positive patients and 42.9% (3/7) in CEA mRNA–positive patients. All patients who tested positive for both markers (3/3) developed local recurrence, whereas the rate was only 2.5% (4/163) among those who tested negative for both markers. In multivariable analysis, CRM positivity (HR 11.09, 95% CI 2.06–59.68, p = 0.005) and CEA mRNA positivity (HR 5.99, 95% CI 1.06–33.81, p = 0.043) remained associated with local recurrence.
Conclusions
Pelvic lavage CEA mRNA levels were associated with local recurrence beyond CRM status and may improve risk stratification. Further validation in larger multicenter cohorts is warranted.