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Archive > Volume 33 Issue 5 > 2026,33(5):545-553. DOI:10.3872/j.issn.1007-385X.2026.05.009 Prev Next
Clinical Research
Predictive and prognostic role of serum CA19-9 in metachronous peritoneal metastasis following surgery for stage Ⅱ-Ⅲ colorectal cancer
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Abstract:
[Abstract] Objective: To evaluate the predictive and prognostic role of preoperative serum carbohydrate antigen 19-9 (CA19-9) levels in the occurrence of metachronous peritoneal metastasis (mPM) after resection surgery for stage Ⅱ-Ⅲ colorectal cancer. Methods: We retrospectively analyzed clinical and pathological data in stage Ⅱ-Ⅲ colorectal cancer patients treated at Department of Oncology, The First Affiliated Hospital of Shandong First Medical University from January 2019 to January 2024, including preoperative CA19-9 and carcinoembryonic antigen (CEA) levels. Diagnostic performance was evaluated using ROC curves and area under the curve (AUC). Univariate and multivariate logistic regression and Cox proportional hazards models were used to identify risk and prognostic factors, respectively. Using propensity score matching, differences in disease-free survival (DFS) and peritoneal metastasis-free survival (PMFS) between the elevated CA19-9 group and the normal group were compared, and the Log-rank test was used for survival analysis. Results: This study included a total of 286 patients. Elevated preoperative CA19-9 levels were associated with mucinous adenocarcinoma histology (P = 0.005), T4 stage (P < 0.001), lymph node metastasis (P = 0.02), elevated preoperative CEA levels (P = 0.024), nerve invasion (P = 0.02), and poorly differentiated grade (P = 0.045). Elevated CA19-9 levels demonstrated superior predictive accuracy for mPM compared to CEA (AUC: 0.73, 95% CI: 0.61-0.85 vs AUC: 0.64, 95% CI: 0.55-0.73). Multivariate logistic regression analysis revealed that elevated preoperative CA19-9 was an independent predictor of mPM occurrence (OR = 5.59, 95% CI: 2.00-15.58, P = 0.001). Patients with elevated CA19-9 levels had a significantly shorter median DFS (54.27 months vs not reached [NR], HR = 3.55, 95% CI: 1.96-6.44, P < 0.001) and PMFS (NR vs NR, HR = 6.93, 95% CI: 3.25-14.76, P < 0.001) compared to patients with normal · · 545 中国肿瘤生物治疗杂志, 2026, 33(5) CA19-9 levels. After propensity score matching, significant differences in DFS (54.27 months vs NR, HR = 4.26, 95% CI: 1.40-12.98, P = 0.006) and PMFS (NR vs NR, HR = 4.28, 95% CI: 1.19-15.34, P = 0.015) were maintained. Multivariate Cox regression analysis revealed that the elevated preoperative CA19-9 was an independent predictor of poor prognosis for PMFS (HR = 3.70, 95% CI: 1.55- 8.83, P = 0.003). Conclusion: Elevated preoperative serum CA19-9 serves as a sensitive biomarker for postoperative development of mPM in patients with stage Ⅱ-Ⅲ colorectal cancer, providing an independent risk prediction and prognostic stratification.
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