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Analysis and exploration of the association between serum tumor marker status and clinical pathological features, as well as efficacy, in colorectal cancer

  • Authors:
    • Zhenzhu Xing
    • Yifan Xiao
    • Shaobing Li
    • Gang Jia
    • Peng Cheng
    • Yuming Chen
    • Jianwei Zhou
    • Liang Sun
    • Chuangxin Lu
  • View Affiliations / Copyright

    Affiliations: Department of Oncology, Zhengzhou University People's Hospital (Henan Provincial People's Hospital), Zhengzhou, Henan 450003, P.R. China, Department of Oncology, Henan University People's Hospital, Zhengzhou, Henan 450003, P.R. China, Department of Medical Records Management, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China, Department of Oncology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China, School of Public Health, Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
    Copyright: © Xing et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 438
    |
    Published online on: July 9, 2025
       https://doi.org/10.3892/ol.2025.15184
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Abstract

Colorectal cancer (CRC) remains a major global health challenge, necessitating improved prognostic and predictive tools. The aim of the present study was to investigate the associations between elevated serum tumor markers (TMs) and clinicopathological features in patients with colorectal cancer, to evaluate their prognostic ability in advanced‑stage disease cases and to identify patients most likely to respond to treatment. This retrospective study analyzed data from 293 patients treated for colorectal adenocarcinoma between January 1, 2020, and June 30, 2023. Carcinoembryonic antigen and cancer antigen (CA)19‑9, CA72‑4 and CA125 positivity were evaluated to classify patients into negative, single elevation (higher expression than normal in 1 TM) and multiple elevation (≥2 TMs expressed at higher than normal levels) groups. Clinical characteristics were evaluated using χ2 tests, and a Kaplan‑Meier survival analysis was conducted. The number of elevated TMs was associated with T stage (P=0.01), poor differentiation (P<0.001), later clinical stages (P<0.001), metastatic sites (P<0.001) and larger metastatic diameter (P<0.001). TM elevation was not associated with the N stage, primary site and microsatellite instability status (MSI) status, or the objective response rate and disease control rate after first‑line treatment. Having multiple TM elevations was associated with poorer progression‑free survival (PFS). With regard to non‑MSI‑H/deficient mismatch repair (dMMR) [immune checkpoint inhibitor (ICI) + tyrosine kinase inhibitor (TKI)] therapy, the single TM elevation dMMR patient group receiving third‑line ICI + TKI benefited the most, regardless of tumor burden, especially those with a neutrophil‑to‑lymphocyte ratio (NLR) <3. In conclusion, multiple TM elevations were associated with the T stage, poor differentiation, later clinical staging, metastatic site, tumor burden and worse PFS. Non‑MSI‑H/dMMR patients with single TM elevations benefited most from ICI + TKI therapy, particularly those with an NLR <3.
View Figures

Figure 1

(A) Survival curves for PFS depending
on TM positivity in patients with stage IV colorectal cancer
receiving first-line treatment. (B) Comparison of PFS between the
negative and single TM elevation groups P=0.246. (C) Comparison of
PFS between the negative and multiple TM elevation groups P=0.012.
(D) Comparison of PFS between the single and multiple TM elevation
groups P=0.098. PFS, progression-free survival; TM, tumor
marker.

Figure 2

(A) Survival curves for PFS for
third-line immune checkpoint inhibitor + tyrosine kinase inhibitor
treatment regimens according to TM status among the non-high
microsatellite instability/deficient mismatch repair patients. (B)
Comparison of PFS between the negative TM and single TM elevation
groups P=0.048. (C) Comparison of PFS between the negative TM and
multiple TM elevation groups P=0.141. (D) Comparison of PFS between
the single and multiple TM elevation groups P<0.001. PFS,
progression-free survival; TM, tumor marker.

Figure 3

(A) Survival curves for PFS depending
on TM status among non-MSI-H/dMMR patients with metastatic lesion
diameter ≥6 cm. (B) Survival curves for PFS depending on TM status
among non-MSI-H/dMMR patients with metastatic lesion diameter <6
cm. (C) Survival curves for PFS depending on TM status among
non-MSI-H/dMMR patients with an NLR <3. (D) Survival curves for
PFS depending on TM status among non-MSI-H/dMMR patients with an
NLR >3. PFS, progression-free survival; TM, tumor marker;
MSI-H/dMMR, high microsatellite instability/deficient mismatch
repair; NLR, neutrophil-to-lymphocyte ratio.
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Copy and paste a formatted citation
Spandidos Publications style
Xing Z, Xiao Y, Li S, Jia G, Cheng P, Chen Y, Zhou J, Sun L and Lu C: Analysis and exploration of the association between serum tumor marker status and clinical pathological features, as well as efficacy, in colorectal cancer. Oncol Lett 30: 438, 2025.
APA
Xing, Z., Xiao, Y., Li, S., Jia, G., Cheng, P., Chen, Y. ... Lu, C. (2025). Analysis and exploration of the association between serum tumor marker status and clinical pathological features, as well as efficacy, in colorectal cancer. Oncology Letters, 30, 438. https://doi.org/10.3892/ol.2025.15184
MLA
Xing, Z., Xiao, Y., Li, S., Jia, G., Cheng, P., Chen, Y., Zhou, J., Sun, L., Lu, C."Analysis and exploration of the association between serum tumor marker status and clinical pathological features, as well as efficacy, in colorectal cancer". Oncology Letters 30.3 (2025): 438.
Chicago
Xing, Z., Xiao, Y., Li, S., Jia, G., Cheng, P., Chen, Y., Zhou, J., Sun, L., Lu, C."Analysis and exploration of the association between serum tumor marker status and clinical pathological features, as well as efficacy, in colorectal cancer". Oncology Letters 30, no. 3 (2025): 438. https://doi.org/10.3892/ol.2025.15184
Copy and paste a formatted citation
x
Spandidos Publications style
Xing Z, Xiao Y, Li S, Jia G, Cheng P, Chen Y, Zhou J, Sun L and Lu C: Analysis and exploration of the association between serum tumor marker status and clinical pathological features, as well as efficacy, in colorectal cancer. Oncol Lett 30: 438, 2025.
APA
Xing, Z., Xiao, Y., Li, S., Jia, G., Cheng, P., Chen, Y. ... Lu, C. (2025). Analysis and exploration of the association between serum tumor marker status and clinical pathological features, as well as efficacy, in colorectal cancer. Oncology Letters, 30, 438. https://doi.org/10.3892/ol.2025.15184
MLA
Xing, Z., Xiao, Y., Li, S., Jia, G., Cheng, P., Chen, Y., Zhou, J., Sun, L., Lu, C."Analysis and exploration of the association between serum tumor marker status and clinical pathological features, as well as efficacy, in colorectal cancer". Oncology Letters 30.3 (2025): 438.
Chicago
Xing, Z., Xiao, Y., Li, S., Jia, G., Cheng, P., Chen, Y., Zhou, J., Sun, L., Lu, C."Analysis and exploration of the association between serum tumor marker status and clinical pathological features, as well as efficacy, in colorectal cancer". Oncology Letters 30, no. 3 (2025): 438. https://doi.org/10.3892/ol.2025.15184
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