Research Papers:

CEA as a blood-based biomarker in anal cancer

Robert Hester, Shailesh Advani, Asif Rashid, Emma Holliday, Craig Messick, Prajnan Das, Yi-Qian N. You, Cullen Taniguchi, Eugene J. Koay, Brian Bednarski, Miguel Rodriguez-Bigas, John Skibber, Robert Wolff, George J. Chang, Bruce D. Minsky, Wai Chin Foo, Nicole Rothschild, Van K. Morris _ and Cathy Eng

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Oncotarget. 2021; 12:1037-1045. https://doi.org/10.18632/oncotarget.27959

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Robert Hester1,*, Shailesh Advani2,*, Asif Rashid3, Emma Holliday4, Craig Messick5, Prajnan Das4, Yi-Qian N. You5, Cullen Taniguchi4, Eugene J. Koay4, Brian Bednarski5, Miguel Rodriguez-Bigas5, John Skibber5, Robert Wolff6, George J. Chang5, Bruce D. Minsky4, Wai Chin Foo3, Nicole Rothschild6, Van K. Morris6,* and Cathy Eng7,*

1 Division of Cancer Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA

2 Division of Oncology, Terasaki Foundation of Biomedical Sciences, Los Angeles, CA, USA

3 Department of Pathology, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA

4 Department of Radiation Oncology, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA

5 Department of Surgical Oncology, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA

6 Department of Gastrointestinal Medical Oncology, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA

7 Department of Hematology/Oncology, Vanderbilt Ingram Cancer Center, Nashville, TN, USA

* These authors contributed equally to this work

Correspondence to:

Van K. Morris,email: [email protected]

Keywords: carcinoembryonic antigen; squamous cell carcinoma of anal canal; anal cancer; biomarkers; HPV

Abbreviations: SCCA: squamous cell carcinoma of anus; CEA: carcinoembryonic antigen; ctDNA: circulating tumor DNA; SD: standard deviation

Received: March 08, 2021     Accepted: April 19, 2021     Published: May 25, 2021

Copyright: © 2021 Hester et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: The clinical utility of a blood-based biomarker in squamous cell carcinoma of the anus (SCCA) is unknown. We analyzed carcinoembryonic antigen (CEA), a commonly employed assay for patients with colorectal adenocarcinoma, as a serum biomarker for patients with biopsy-proven SCCA.

Materials and Methods: Medical records from 219 patients with biopsy-proven SCCA at the University of Texas MD Anderson Cancer Center were reviewed under an IRB-approved protocol from 2013 to 2020 to assess for correlations between CEA levels and corresponding clinical and pathologic characteristics.

Results: The mean CEA among subgroups by clinical status at the time of presentation to our institution was highest among those patients with metastatic SCCA to visceral organs (M-V, 20.7 ng/mL), however this finding was not statistically significant by ANOVA (p = .74). By clinical subgroup, the percentage of patients with an abnormally elevated CEA was highest in those patients with metastatic disease to lymph nodes (M-L, 41.2%) followed by recurrent/unresectable SCCA (36.8%), and metastatic SCCA to visceral organs (M-V, 35.2%), and was statistically significant between groups (Fisher’s exact test p = .02). Using RECIST criteria for tumor progression and disease response, the mean change in CEA for patients with progression was an increase in 19 ng/mL, compared to a change of –7.3 ng/mL in those with disease response (p = .004). We likewise assessed whether CEA levels were associated with survival outcomes for all patients with metastatic SCCA, and found no correlation between CEA and likelihood for survival in a ROC analysis (multivariate, age-adjusted analysis for CEA cutoff of 8, HR = 1.01, 95% CI 0.52–1.96).

Conclusions: Despite interesting patterns of abnormally high CEA in SCCA patients with advanced disease, and correlation of increased CEA with disease progression (and conversely decreased CEA with disease response), CEA is not associated with survival outcomes in SCCA, and is not a clinically relevant biomarker in this disease.

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