Affiliation:
1. Department of Clinical Laboratory, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Scie
2. Department of Gastrointestinal Surgery, Sichuan Cancer Hospital and Institute
3. Department of Information, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
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.
Publisher
Research Square Platform LLC