Preoperative carcinoembryonic antigen level as a prognostic indicator in resected primary lung cancer

The aim of this study was to evaluate the prognostic significance of elevated preoperative carcinoembryonic antigen (CEA) levels in cases of resected primary lung cancer. Between 1985 and 1989, 152 patients with tumors and CEA levels above 10 ng/mL underwent operation. One hundred twenty-five of them underwent resection of their tumors and the other 27 underwent exploratory thoracotomy only. Fifty-two percent of cancers were adenocarcinomas and 33% were epidermoid. Forty-two resected tumors were classified as stage I, 29 as stage II, 45 as stage IlIa, 7 as stage IIIb, and 2 as stage IV. The 3-year actuarial survival rate was 54% for patients with stage I tumors, 28% for those with stage II, 18% for those with stage IIIa, 44% for those with stage IIIb, and 0% for those with stage IV tumors. The 5 year actuarial survival was 40% for those with stage I tumors, 28% for those with stage II, 7% for those with stage IlIa, and 0% for those with stage IIIb tumors. Preoperative CEA levels increased from stage I to stage IlIa ( p < 0.05). However, based on preoperative CEA levels we were not able to predict resectabiliry, because levels were not significantly different between stage IlIa and exploratory thoracotomy-only groups. Adenocarcinoma was not significantly associated with higher CEA levels than was epidermoid, except in stage IlIa disease ( p < 0.05). We found a critical unfavorable level of prognostic significance at 30 ng/mL. Within patients who underwent resection of stage I or II tumors, those with preoperative CEA levels under 30 ng/mL demonstrated significantly prolonged survival over those with CEA above 30 ng/mL ( p < 0.05). Virtually all patients with marked elevations of CEA levels (>50 ng/mL) died within 2 years. Therefore, these patients must be highly suspected of having metastases even if operative staging may appear limited. Determining preoperative CEA levels provides prognosis information which may supplement that available by staging.