Prognostic impact of Creatine Kinase (CK)-MB to total-CK ratio following curative resection of stage I-III colorectal cancer

Abstract

Abstract Objectives: The purpose of this study was to evaluate the prognostic significance of Creatine Kinase (CK)-MB to total-CK ratio (CK-MB/CK) in patients with stage I-III colorectal cancer (CRC) after radical resection. Methods: This study was a single-center retrospective cohort analysis. Subjects were stage I-III CRC patients hospitalized in Sichuan Cancer Hospital from January 2017 to May 2021, who underwent curative resection. The overall survival (OS), disease-free survival rate (DFS), and recurrence were analyzed between two groups according to the serum CK-MB/CK levels after surgery, as follows: patients with postoperative CK-MB/CK greater than 1 (CK-MB/CK > 1) classified as the elevated group, and patients without postoperative CK-MB/CK greater than 1 (CK-MB/CK ≤ 1) classified as the normal group. Cox regression analyses, Kaplan-Meier method, and receiver-operating characteristic (ROC) curve were performed. Results: CK-MB/CK > 1 was the strongest independent prognostic factor for OS, DFS, and recurrence. Compared to the normal group (n = 1177), the elevated group (n = 95) had worse OS (HR, 5.64; 95% CI, 2.533–12.536; p < 0.0001), worse DFS (HR, 8.34; 95% CI, 5.205–13.366; p < 0.0001), and higher recurrence rate (HR, 9.44; 95% CI, 6.014–14.828; p < 0.0001). Serum CK-MB/CK levels in patients with hepatic metastasis after surgery were significantly higher than those in patients without hepatic metastasis (median 0.35 and 0.09, respectively; Mann-Whitney p = 0.000). For the diagnosis of hepatic metastases after surgery, the ROC area under the curve (AUC) of CK-MB/CK was 0.720 [95% confidence interval (CI) 0.695–0.745; p < 0.001], CA19-9 was 0.723 (95% CI 0.692–0.753; p < 0.001), and CA242 was 0.687 (95% CI 0.661–0.713; p < 0.001). When CK-MB/CK > 1.01, the specificity was 94.84% and the negative predictive value (NPV) was 96.7%. Combined CK-MB/CK and CA19-9, the AUC value increased from 0.720 to 0.799 (p = 0.0362), with a sensitivity of 77.46% and a specificity of 97.25%. Conclusions: In stage I-III CRC patients with radical resection, patients with postoperative CK-MB/CK > 1 had a worse prognosis, a shorter survival time, and a higher risk of recurrence. CK-MB/CK might be a new biomarker for the diagnosis of hepatic metastasis in CRC patients after surgery, with high specificity and NPV.