Trajectories of perioperative serum CEA and non-small cell lung cancer prognosis: a retrospective longitudinal cohort study

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Background: The role of postoperative carcinoembryonic antigen (CEA) levels in non-small lung cancer (NSCLC) prognostic evaluation remains unclear. Additionally, the dynamic changes in CEA levels during the perioperative period have not been fully characterized. Methods: We retrospectively reviewed stage I-IIIA NSCLC patients who underwent curative resection. A latent class growth mixed model was employed to categorize patients into distinct CEA trajectory groups. The Kaplan-Meier method assessed the relationship between CEA trajectory groups and recurrence-free survival (RFS) and overall survival (OS). Multivariate analysis of perioperative CEA levels in relation to RFS and overall survival OS was performed using Cox proportional hazards regression. Results: A total of 5733 patients were included in our study. Elevated postoperative CEA levels were associated with higher risks of recurrence (HR = 2.64, 95% CI: 1.65-4.23) and mortality (HR = 3.34, 95% CI: 2.09-5.80) compared to normal CEA levels. Furthermore, patients with normal preoperative CEA but elevated postoperative levels also had higher risks of recurrence (HR = 3.00, 95% CI: 1.77-5.10) and mortality (HR = 3.30, 95% CI: 1.79-6.07). Three CEA trajectory categories were identified: low-stable, early-rising, and later-rising. Compared to the low-stable group, the early-rising group had significantly higher risks of recurrence (HR = 10.84, 95% CI: 5.57-21.10) and mortality (HR = 13.37, 95% CI: 5.45-32.81). The later-rising group had lower, but still significant, risks of recurrence (HR = 3.56, 95% CI: 1.62-7.81). Conclusion: Continuous postoperative monitoring of CEA levels in NSCLC patients is essential, especially for those with elevated postoperative CEA levels.

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