Preoperative CRP(−)/CEA(−)/CA19-9(−)/non-T4 in Stage III Colorectal Cancer Is Favorable Risk for Recurrence

OBJECTIVES: We evaluated the prognostic impact of a novel C-reactive protein (CRP) cut-off value (0.6 mg/dl) and carcinoembryonic antigen (CEA)/carbohydrate antigen 19-9 (CA19-9) in stage II/III colorectal cancer. METHODS: Four hundred ninety-eight patients with stage II (n = 275) or stage III (n = 223) colorectal cancer, surgically treated between January 2010 and December 2016, were analyzed. The optimal CRP cut-off value was fixed at 0.6 mg/dl to predict recurrence based on the receiver operating characteristic curve. Prognostic factors, including CRP/CEA/CA19-9 status, for relapse-free survival (RFS) were evaluated by multivariate analysis. RESULTS: Recurrent rates were 15% and 32% in stages II and III, respectively. In stage II, CRP, CEA, and CA19-9 were not significant prognostic factors for RFS. In stage III, the RFS of the low CRP group was significantly better than that of the high CRP group (p = 0.002). In stage III, the RFS of CRP(−)/CEA(−) or CRP(−)/CA19-9(−) was significantly better than the other group, as opposed to the RFS of the CEA(−)/CA19-9(−) group that was not. The CRP(−)/CEA(−)/CA19-9(−) group recurrence rate in stage III was significantly better than the CRP(+)/CEA(−)/CA19-9(−) group (20% vs. 50%, p = 0.006). Multivariate analysis revealed that CRP(−)/CEA(−)/CA19-9(−) (p = 0.04) and non-T4 (p < 0.001) were good independent prognostic factors in stage III. The CRP(−)/CEA(−)/CA19-9(−)/non-T4 group recurrence rate in stage III was 11% (8 out of 73). CONCLUSIONS: In stage III, the CRP(−)/CEA(−)/CA19-9(−)/non-T4 group is favorable risk for recurrence.