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Ann Thorac Surg 2007;83:424
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Invited commentary

Department of Thoracic Surgery, Vanderbilt University, 2971 The Vanderbilt Clinic, 1301 22nd Ave S, Nashville, TN 37232-5734

(Email: bill.putnam{at}vanderbilt.edu).

The authors [1] examined the role of serum carcinoembryonic antigen (CEA) level as a prognostic factor in patients with nonsmall cell lung cancer (NSCLC). Small studies have examined this serum marker; however CEA has not yet reached the level of evidence necessary for incorporation into consensus conference guidelines for staging or prognosis. Still, studies from Japan [2, 3] and the current study from Taiwan, have suggested that increased levels of CEA may be associated with poorer prognosis.

In this article, the authors describe a population of nonsmoking Taiwanese women (92.4% without a history of cigarette smoking) with predominantly adenocarcinoma and bronchoalveolar carcinoma (83.4%). Lobectomy was performed in 87% of these individuals. Elevated preoperative CEA levels (>6.0 ng/mL) and larger tumor size were associated with poorer prognosis. Are these findings related to histology, ethnicity, or other genetic alterations that may predispose to adenocarcinoma in nonsmoking women? The answer to these and other questions will require a larger analysis of prospectively collected serum, tissue, and clinical data.

However, until completion of these analyses, patients with an adenocarcinoma of the lung, particularly in women nonsmokers, may be considered for serum CEA level determination. Patients with CEA 6 ng/mL may represent a population with poorer survival mandating closer follow-up and consideration for multimodality or other targeted therapies [4]. Although adjuvant chemotherapy is not a current recommendation for stage I NSCLC, the ability to predict those stage I patients with poor prognosis would be helpful. Early-stage, poor-prognosis patients could be selected for specific therapies for subsequent survival benefit compared with current models of observation alone.

The poorer survival with increased preoperative CEA in nonsmoking Asian women must be considered in relationship to women (and men) of various ethnicities and smoking status. These small retrospective independent studies, may provide models for subsequent evaluation of CEA and other serum markers for staging, prognosis, and therapy for patients with early stage NSCLC.

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1. Hsu W-H, Huang C-S, Hsu H-S, et al. Preoperative serum carcinoembryonic antigen level is a prognostic factor in women with early non-small-cell lung cancer Ann Thorac Surg 2007;83:419-424.[Abstract/Free Full Text]
2. Inoue M, Minami M, Shiono H, Sawabata N, Ideguchi K, Okumura M. Clinicopathologic study of resected, peripheral, small-sized, non-small cell lung cancer tumors of 2 cm or less in diameter: pleural invasion and increase of serum carcinoembryonic antigen level as predictors of nodal involvement J Thorac Cardiovasc Surg 2006;131:988-993.[Abstract/Free Full Text]
3. Sawabata N, Maeda H, Yokota S, et al. Postoperative serum carcinoembryonic antigen levels in patients with pathologic stage IA nonsmall cell lung carcinoma: subnormal levels as an indicator of favorable prognosis Cancer 2004;101:803-809.[Medline]
4. Okamoto T, Nakamura T, Ikeda J, et al. Serum carcinoembryonic antigen as a predictive marker for sensitivity to gefitinib in advanced non-small cell lung cancer Eur J Cancer 2005;41:1286-1290.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Putnam, J. B. Search for Related Content PubMed PubMed Citation Articles by Putnam, J. B., Jr Related Collections Lung - cancer Related Article