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已发表论文
饮酒、冠心病和高血压会改变术前癌胚抗原（CEA）对中国结直肠癌患者 TNM 分期预测准确性的研究
Authors Kuai D , Cheng J, Li R, Gao X, Sun L, Li Y, Sun W, Hu Y, Li C, Xu B
Received 6 September 2025
Accepted for publication 17 December 2025
Published 31 December 2025 Volume 2025:17 Pages 3373—3382
DOI https://doi.org/10.2147/CMAR.S565785
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 5
Editor who approved publication: Professor Bilikere Dwarakanath
Dayu Kuai,1,* Juan Cheng,2,* Ruofan Li,3 Xu Gao,3 Lixin Sun,3 Yaqiang Li,1 Wei Sun,1 Yanping Hu,4 Chunguang Li,5 Baohong Xu1
1Department of Gastroenterology, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Affectionate Clinic of the Department of Infectious Diseases, Fifth Medical Center of the PLA General Hospital, Beijing, People’s Republic of China; 3Department of Gastrointestinal Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China; 5Clinical Laboratory, Affiliated Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Baohong Xu, Department of Gastroenterology, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, People’s Republic of China, Email bhxu_22@126.com
Objective: To evaluate the effects of comorbidities and lifestyle factors on the prognostic value of preoperative carcinoembryonic antigen (CEA) for tumor-node-metastasis (TNM) staging in Chinese patients with colorectal cancer (CRC).
Methods: A retrospective cohort study of 307 patients with CRC from Beijing Luhe Hospital (2020– 2024) was performed. Clinicopathological data, including TNM and Numerical staging (AJCC 8th edition), serum CEA levels, and covariates (comorbidities and lifestyle factors), were analyzed using univariate and multivariate logistic regression. Multivariable logistic regression with multiplicative interaction terms (CEA × modifier) was used to test for effect modification.
Results: Elevated CEA levels were significantly associated with advanced TNM staging (Stage III–IV vs stage I–II, p < 0.001). Multivariate analysis confirmed that CEA was an independent predictor of T stage progression (HR = 1.15, p= 0.017), lymph node metastasis (N stage: HR = 1.17, p = 0.046), and distant metastasis (M stage: HR = 1.06, p = 0.018). Formal interaction analysis revealed that alcohol use significantly amplified the CEA-stage association (HR = 3.11, 95% CI 1.11– 8.74, p = 0.031), whereas coronary heart disease attenuated the relationship (HR = 0.40, 95% CI 0.18– 0.87, p = 0.022), yielding a paradoxical inverse association in affected patients. In addition, hypertension nullified the predictive utility of CEA, with a significant stage association observed only in the nonhypertensive subgroup.
Conclusion: Preoperative CEA exhibits robust predictive accuracy for TNM staging in Chinese patients with colorectal cancer; however, this performance is critically modulated by alcohol use, coronary heart disease, and hypertension. Systematic incorporation of these three effect modifiers into preoperative risk-stratification algorithms will refine staging accuracy and enable patient-tailored therapeutic strategies.
Keywords: carcinoembryonic antigen, colorectal cancer, TNM staging, effect modification, precision oncology
1Department of Gastroenterology, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Affectionate Clinic of the Department of Infectious Diseases, Fifth Medical Center of the PLA General Hospital, Beijing, People’s Republic of China; 3Department of Gastrointestinal Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China; 5Clinical Laboratory, Affiliated Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Baohong Xu, Department of Gastroenterology, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, People’s Republic of China, Email bhxu_22@126.com
Objective: To evaluate the effects of comorbidities and lifestyle factors on the prognostic value of preoperative carcinoembryonic antigen (CEA) for tumor-node-metastasis (TNM) staging in Chinese patients with colorectal cancer (CRC).
Methods: A retrospective cohort study of 307 patients with CRC from Beijing Luhe Hospital (2020– 2024) was performed. Clinicopathological data, including TNM and Numerical staging (AJCC 8th edition), serum CEA levels, and covariates (comorbidities and lifestyle factors), were analyzed using univariate and multivariate logistic regression. Multivariable logistic regression with multiplicative interaction terms (CEA × modifier) was used to test for effect modification.
Results: Elevated CEA levels were significantly associated with advanced TNM staging (Stage III–IV vs stage I–II, p < 0.001). Multivariate analysis confirmed that CEA was an independent predictor of T stage progression (HR = 1.15, p= 0.017), lymph node metastasis (N stage: HR = 1.17, p = 0.046), and distant metastasis (M stage: HR = 1.06, p = 0.018). Formal interaction analysis revealed that alcohol use significantly amplified the CEA-stage association (HR = 3.11, 95% CI 1.11– 8.74, p = 0.031), whereas coronary heart disease attenuated the relationship (HR = 0.40, 95% CI 0.18– 0.87, p = 0.022), yielding a paradoxical inverse association in affected patients. In addition, hypertension nullified the predictive utility of CEA, with a significant stage association observed only in the nonhypertensive subgroup.
Conclusion: Preoperative CEA exhibits robust predictive accuracy for TNM staging in Chinese patients with colorectal cancer; however, this performance is critically modulated by alcohol use, coronary heart disease, and hypertension. Systematic incorporation of these three effect modifiers into preoperative risk-stratification algorithms will refine staging accuracy and enable patient-tailored therapeutic strategies.
Keywords: carcinoembryonic antigen, colorectal cancer, TNM staging, effect modification, precision oncology