Background: During colorectal cancer (CRC) surveillance, tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), play important roles in the diagnosis, prediction, and monitoring of tumors. Herein, we devised a novel combined index comprising the CA19-9-to-CEA ratio and investigated its prognostic value in patients with stage I-III CRC after resection. Methods: This retrospective study included 306 patients who underwent radical resection between 2011 and 2020. CA19-9 and CEA levels were evaluated preoperatively. The CA19-9-to-CEA ratio cutoff value was determined via receiver-operating characteristic analysis using the survival status at the 5-year follow-up evaluation. Multivariate Cox proportional hazard models were used to assess disease-free survival (DFS) and overall survival (OS). Results: According to the multivariate analysis, T3 or T4 tumor (P = 0.041; hazard ratio [HR], 2.54), pathological stage III (P = 0.001; HR, 3.07), serum CEA level ≥5.0 ng/mL (P = 0.018; HR, 2.11), and high CA19-9-to-CEA ratio (P = 0.015; HR, 2.89) were independently associated with DFS. Age 65≥ years (P = 0.03; HR, 2.86), pathological stage III (P = 0.001; HR, 2.00), high neutrophil-to-lymphocyte ratio (P = 0.003; HR, 2.27), and high CA19-9-to-CEA ratio (P = 0.009; HR, 3.16) were independent prognostic factors for OS. Patients with high CA19-9-to-CEA ratios had significantly worse DFS (P < 0.001) and OS (P < 0.001). Discussion: A high CA19-9-to-CEA ratio can be used for detailed risk prediction in patients with CRC.
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