Serum basic fetoprotein in patients with renal cell carcinoma.

Serum basic fetoprotein (BFP), immunosuppressive acid protein (IAP), and tissue polypeptide antigen (TPA) levels were measured in patients with renal cell carcinoma. The positive rates of serum BFP, IAP, and TPA were 47%, 79%, and 42%, respectively. Serum levels and positive rates were found to be elevated according to the degree of disease advancement. Using a combined assay for the three markers, the positive rate for BFP, IAP, and TPA was 92%, and approximately 100% in Stages II, III, and IV of the disease. Therefore, the combined marker assay improved the diagnosis of renal cell carcinoma. In curative resection patients, the percent of patients whose serum BFP levels returned to normal 1 week after the operation was 85. This was higher than the IAP or TPA levels (18% and 67%, respectively). Moreover, in inoperable patients, serum BFP levels showed a better correlation with the clinical course than serum IAP or TPA levels. Serum BFP is useful for monitoring patients with renal cell carcinoma who have an elevated BFP value.     

Immunosuppressive substance in the sera of head and neck cancer patients

Serum levels of immunosuppressive substance (IS) and immunosuppressive acidic protein (IAP) were studied by single radial immunodiffusion in 108 patients with head and neck cancer. Mean values of serum IS and IAP in patients with head and neck cancers were as follows: laryngeal carcinoma, 955 +/- 447 micrograms/ml (IS), 604 +/- 324 micrograms/ml (IAP); maxillary carcinoma, 896 +/- 384 micrograms/ml (IS), 568 +/- 246 micrograms/ml (IAP); nasopharyngeal carcinoma, 871 +/- 313 micrograms/ml (IS), 673 +/- 395 micrograms/ml (IAP); hypopharyngeal carcinoma, 1034 +/- 495 micrograms/ml (IS), 669 +/- 335 micrograms/ml (IAP). Except for IAP in hypopharyngeal carcinoma, these values were significantly higher than those of controls (IS, P less than 0.01; IAP, P less than 0.05). The overall positive rates of IS and IAP in the patient group were 46% and 37%, respectively. In patients with laryngeal carcinoma the positive rates of serum IS and IAP were found to be elevated as the disease stage advanced. The IS showed a higher positive rate than IAP in the advanced disease stage. Serial studies revealed that all patients who had recurrent disease after the treatment exhibited marked elevation of serum IS levels; in addition, patients with recurrent cancer showed significantly higher IS levels (1507 +/- 464 micrograms/ml) compared to patients who had remained free of disease in the follow-up period (640 +/- 143 micrograms/ml) (P less than 0.001). These data strongly suggests that serum IS and IAP levels are useful parameters for monitoring the disease stage of head and neck cancer patients.     

Erythrocyte sedimentation rate as a prognostic factor in renal cell carcinoma

In a follow-up study of 193 adult patients with renal cell carcinoma diagnosed in northern Norway 1974-1980, ESR as a prognostic factor was studied with the Cox regression model. In 71 patients (37%) metastatic disease was known at diagnosis. In patients without metastatic disease an elevated ESR greater than 15 mm/h and renal vein involvement were significant prognostic factors indicating short survival. Multivariate survival analyses of all patients showed the presence of metastatic disease and elevated ESR (greater than 15 and greater than 30 mm/h) as significant prognostic factors indicating high-risk patients. This study concludes that ESR deserves attention as a prognostic discriminator in renal cell carcinoma.     

Interleukin-6, interleukin-10, and vascular endothelial growth factor in metastatic renal cell carcinoma: prognostic value of interleukin-6--from the Groupe Francais d'Immunotherapie.

PURPOSE: Few clinical prognostic factors have been identified for patients with metastatic renal cell carcinoma (MRCC), and no biomarker is known in this disease. Several endogenous cytokines have demonstrated interesting and significant correlations with survival in these patients. Our objective was to analyze the prognostic value of circulating vascular endothelial growth factor (VEGF), interleukin-10 (IL-10), and interleukin-6 (IL-6). PATIENTS AND METHODS: Serum levels of IL-6, IL-10, and VEGF were measured in patients with MRCC. Their prognostic value for response to treatment and progression-free and overall survival was evaluated. Pretreatment samples were obtained from 138 patients of a large randomized multicentric trial. Endogenous cytokine levels were determined using immunoassays. Univariate and multivariate analyses were performed to evaluate the prognostic value of each factor further controlled by an internal validation test. Threshold values for serum IL-6 and VEGF were determined using the quartile method. RESULTS: Serum IL-6 was detectable in 70% of the patients. IL-10 and VEGF were elevated in 8% and 71% of the patients, respectively. None of these circulating factors was correlated with response to treatment. IL-10 was not significantly correlated with progression-free or overall survival. Despite significant correlation with survival, VEGF was not an independent prognostic factor in the multivariate analysis. Finally, IL-6 was significantly correlated with progression-free survival and overall survival, and has prognostic value for overall survival. CONCLUSION: Circulating IL-6 level appears to be an important independent prognostic factor in patients with MRCC; if confirmed in further studies, it could be considered for treatment decisions in these patients.     

Clinical value of protein S100 and melanoma-inhibitory activity (MIA) in malignant melanoma

Serum protein S100 and melanoma-inhibitory protein (MIA) have been described as useful tumor markers for malignant melanoma. In this study, these two serum proteins were compared in 48 patients with melanoma at different stages of disease. Serum concentrations of S100 and MIA were measured by immunoradiometric and enzyme-linked immunosorbent assays, respectively. We found that the cut-off values were 17.4 ng/ml for MIA and 0.09 microg/l for S100. Five patients had stage I-II, 22 had stage III, and 21 had stage IV disease. Serum levels of two markers were elevated with metastatic disease (p < 0.05). Sensitivities of the MIA were found higher compared with S100 in patients with extensive (M1c) metastatic disease and with chemotherapy nonresponders (p > 0.05). We showed a trend for worsened outcome in patients with elevated MIA level in univariate analysis. MIA was found to be more sensitive and is a potential prognostic marker for patients with metastatic malignant melanoma in comparison with S100.     

High serum levels of vascular endothelial growth factor predict poor response to transarterial chemoembolization in hepatocellular carcinoma: a prospective study

Vascular endothelial growth factor (VEGF) is an important mediator of tumor angiogenesis. A high serum VEGF level has been shown to predict poor response to chemotherapy and poor survival in several cancers, but its prognostic value in hepatocellular carcinoma (HCC) remains unknown. We conducted a prospective study to evaluate the prognostic significance of pretreatment serum VEGF levels on tumor response to treatment and survival of patients with HCC undergoing transarterial chemoembolization (TACE). Pretreatment serum VEGF levels were measured by an enzyme-linked immunosorbent assay in 80 patients with inoperable HCC undergoing TACE. Serum VEGF levels were correlated with clinical data, tumor response to TACE and survival results. The median serum VEGF level was 240 pg/ml (range 9-1730). Serum VEGF levels were positively correlated with the presence of venous tumor thrombus (P=0.011). Pretreatment serum VEGF levels were significantly higher in patients with progressive disease (median 434 pg/ml) than those with stable (median 176 pg/ml, P=0.010) or responsive disease (median 142 pg/ml, P<0.001) after TACE. Patients with serum VEGF >240 pg/ml had significantly worse survival than those with serum VEGF <240 pg/ml (median survival 6.8 vs. 19.2 months, P=0.007). In a Cox multivariate analysis, serum VEGF >240 pg/ml was an independent prognostic factor of survival. In conclusion, the results of this study suggest that serum VEGF level may be useful as a novel prognostic predictor of tumor response and survival of patients with inoperable HCC undergoing TACE treatment.     

Significance of serum amyloid A on the prognosis in patients with renal cell carcinoma

BACKGROUND: Evidence of systemic inflammation, i.e., elevation of serum C-reactive protein, interleukin-6, and/or the erythrocyte sedimentation rate, is correlated to poorer prognosis of patients with renal cell carcinoma (RCC). Serum amyloid A (SAA) has been recognized mainly as acute-phase reactant. METHODS: Serum SAA from 72 patients with RCC were examined. Thirty-eight of 72 patients with RCC had elevated SAA compared with 17 healthy donors. RESULTS: The disease specific survival rate was significantly lower in the elevated SAA group, and SAA level was shown to be an independent prognostic factor by univariate and multivariate analysis. CONCLUSIONS: Evaluation of serum SM level in RCC patients may be a useful prognostic indicator.     

Immunosuppressive acidic protein serum levels in breast cancer patients in a reference to CA 15-3 levels

Summary Immunosuppressive acidic protein (IAP) has been described as a tumor marker in a number of malignant diseases. To evaluate the clinical importance of IAP in breast cancer patients, IAP serum level was determined in 75 breast cancer patients, using single radial immunodiffusion. Serum samples were also tested for CA 15-3. Cut off value for IAP was determined according to IAP serum level in 50 patients with benign, non inflammatory, diseases, and was set as 725 microgram/ml. Mean IAP serum level (623 mcg/ml) and positivity rate (20%) in 24 breast cancer patients with active disease were similar to those in 51 breast cancer patients with no evidence of disease (590 mcg/ml and 18%). The mean CA 15-3 serum level and positivity rate were significantly higher in patients with active disease (200 units/ml, 67%), compared to patients with no evidence of disease (18.3 units/ml, 6%). In our experience IAP was not found to be an effective tumor marker in breast cancer.     

Utility of the serum tumor markers: CYFRA 21.1, carcinoembryonic antigen (CEA), and squamous cell carcinoma antigen (SCC) in squamous cell lung cancer

The aim of this study is to assess the clinical usefulness of serum assays of carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), and CYFRA 21.1 in the diagnosis of squamous cell lung cancer. Sixty patients with squamous cell, and twenty-four patients with nonsquamous cell histology of nonsmall cell lung cancer were enrolled in this study. Serum CEA, SCC, and CYFRA 21.1 levels were obtained by commercially available kits. Upper cutoff levels were 10 ng/ml, 3.5 ng/ml, and 3.5 ng/ml, respectively. In squamous cell lung cancer, percentages and 95% confidence interval (CI) of the patients with elevated levels were as follows: for CEA 23.3% (13-36), for SCC 20.0% (10-32), and for CYFRA 21.1 85.0% (73-93). The positivity rate of CYFRA 21.1 was more significant than CEA and SCC in both squamous and nonsquamous cell lung cancer. None of the markers were significant in differentiating squamous/nonsquamous histology. Only tumor marker CEA was significantly elevated in metastatic squamous cell lung cancer (p=0.004). A novel tumor marker CYFRA 21.1 can be used as a reliable tumor marker in diagnosing squamous cell lung cancer. In addition, CEA has an important role in determining metastatic disease.     

Serum S100B is suitable for prediction and monitoring of response to chemoimmunotherapy in metastatic malignant melanoma

Serum S100B and lactate dehydrogenase (LDH) levels were evaluated for their ability to predict response in patients with metastatic malignant melanoma and to determine their usefulness in monitoring the results of chemoimmunotherapy. Levels were studied in 53 patients with metastatic malignant melanoma receiving chemoimmunotherapy and in 19 control patients with metastatic renal cell carcinoma receiving a similar immunotherapy regimen. The serum S100B level was elevated in 81% of the patients before treatment. Marker levels were significantly higher in patients who did not respond (n = 22). Patients with S100B levels >or= 1.0 microg/l were less likely to obtain remission or stable disease than the group with normal or moderately elevated serum concentrations (P < 0.01). After treatment, 17 of the 31 (55%) patients with stable or responsive disease had a S100B serum level below the cut-off point versus only one of the 22 (5%) patients in the group with progressive disease. For LDH the proportions of patients were 17 out of 31 (55%) and nine out of 22 (41%), respectively. In 15 melanoma patients there was a transient rise in the level of serum S100B at the beginning of systemic therapy. All 19 patients in the control group had an initial serum S100B level 相似文献   

Clinical significance of the measurement of serum neuron-specific enolase levels in patients with lung cancer

Subjects were comprised of 100 healthy adults, 85 patients with primary lung cancer, 20 with benign lung disease and 4 with metastatic lung cancer. Serum neuron-specific enolase (NSE) levels were estimated by means of an NSE RIA kit produced by Eiken Radiopharmaceutical Co., Ltd. The normal range of serum NSE level was between 4.5 and 10.30 (mean: 6.81) ng/ml in the 100 healthy adults. The serum NSE level in patients with small cell carcinoma was significantly higher than the mean in patients with other histological types. Positive rates of serum NSE levels were 80% in patients with small cell carcinoma, 54% in patients with adenocarcinoma, 52% in patients with squamous cell carcinoma and 1% in healthy adults, respectively. According to the progress of staging in lung cancer patients, serum NSE levels became increased. Serum NSE level seems to be specific marker in patients with small cell lung cancer and to be useful for diagnosis and the monitoring of cancer treatment.     

Soluble ectodomain of c-erbB-2 oncoprotein in relation to tumour stage and grade in human renal cell carcinoma.

The soluble ectodomain of c-erbB-2 oncoprotein was measured using a sandwich enzyme immunoassay in sera from 184 patients with renal cell carcinoma before initiation of treatment. The median serum level was 2062 U ml(-1) (range 865-4905 U ml(-1)). Levels were unaffected by sex, age and renal function. An inverse relation between disease stage (P = 0.0017) and tumour grade (P = 0.0009) and the serum level of c-erbB-2 ectodomain was observed. Survival time for patients with serum levels above median level was significantly longer than for patients with lower levels (P = 0.003). In a multivariate analysis, c-erbB-2 oncoprotein lost its prognostic information, while tumour stage and tumour grade were identified as independent prognostic factors.     

Impact of serum basic fibroblast growth factor on prognosis in human renal cell carcinoma

Renal cell carcinoma is often characterised by extensive vascularity and angiogenic factors may be of importance for disease progression. Using a sandwich enzyme immunoassay, basic fibroblast growth factor (bFGF) was analysed in the sera from 206 patients with renal cell carcinoma before the initiation of therapy. The median bFGF level was 3.0 pg/ml (range <1.0–70.9 pg/ml). The serum levels were significantly correlated to tumour stage and nuclear grade. Patients with tumour thrombus to the renal or the inferior caval vein had significantly higher serum bFGF levels compared with those with non-invading tumours (P=0.007). Patients with serum bFGF levels above 3.0 pg/ml had a worse prognosis, compared with those with lower levels (P=0.001). Furthermore, patients with tumours with vein invasion had a worse prognosis compared with those without invasion. After multivariate analysis, only tumour stage and grade remained as independent prognostic factors.     

Serum bone sialoprotein in patients with primary breast cancer is a prognostic marker for subsequent bone metastasis.

Bone sialoprotein (BSP) is a noncoflagenous bone matrix protein that is important for both mineralization and cell-cell interactions. Tissue studies in primary breast cancers have shown that immunohistochemical expression of BSP is associated with a high incidence of bone metastases in the course of the disease. We used a RIA to investigate the importance of serum BSP as a marker for subsequent bone metastases. Between 1994 and 1996, preoperative blood samples were collected from 388 consecutive patients with nonmetastatic breast cancer and from 30 control patients with benign breast disease. Serum BSP concentrations were measured in a blinded fashion by RIA. The cutoff for elevated serum BSP values was 24 ng/ml, ie., two SDs above the normal mean value. Serum BSP was correlated with the risk of metastasis and analyzed with regard to its prognostic value. After a median follow-up period of only 20 months, 28 patients had developed metastases. Fourteen patients had bone metastases only, 9 visceral metastases only, and 5 a combination of osseous and visceral metastases. Of the 19 women with skeletal metastases, 17 had preoperative serum BSP values in excess of 24 ng/ml (median BSP values: 48.3 ng/ml for isolated metastatic bone disease, 30.6 ng/ml for combined metastases), whereas none of the women with visceral metastases only had elevated serum BSP concentrations (median BSP value: 12.3 ng/ml). The median serum BSP value in the control group (benign breast disease) was 8.8 ng/ml serum BSP; levels correlated with the size of the primary tumor, but not with any other prognostic factors. Using a multivariate regression analysis, serum BSP was found to be the most important independent prognostic factor for the development of skeletal metastasis (P < 0.001; relative risk, 94); its specificity was 96.7%, and its sensitivity was 89.5%. Our study shows that patients with preoperatively elevated serum BSP levels are at high risk of subsequent bone metastases in the first years after primary surgery. The mechanism of BSP in the pathogenesis of skeletal metastases is unclear. Because BSP contains an integrin recognition sequence, its expression in tumor cells may facilitate their adhesion to the bone surface. However, it is possible that a proportion of circulation BSP is derived from normal or tumor-induced bone turnover. Breast cancer patients with elevated serum BSP levels may benefit from osteoprotective adjuvant therapy with bisphosphonates.     

Cancer-associated galactosyltransferase as a new tumor marker for ovarian clear cell carcinoma

Serum cancer-associated galactosyltransferase antigen (caGT) was assayed in gynecological cancer patients by means of a GT-II-reactive monoclonal antibody (MAb 3872)-based immunoassay. Thirty-six of 47 (75%) ovarian cancer patients showed a significant elevation of caGT in serum above the cutoff level of 200 milliunits/ml (mean +/- 2 SD) determined from normal controls. Particularly, serum caGT levels in eight of nine patients with ovarian clear cell carcinoma were above the cutoff value, and six of them gave more than 200 milliunits/ml. Elevation of caGT in serum from pregnant women was also detected, and the level increased during the course of gestation. Immunohistochemical study revealed that not only various ovarian carcinoma cells in vivo and in vitro, but also syncytiotrophoblast of early gestational placenta, fetal tissues such as mucus-producing cells in the lower alimentary tract, and renal tubules at the 11th week of gestation were stained with MAb 3872, thus indicating its oncofetal character. Compared with CA-125, caGT showed a lower false-positive rate (10%) in benign gynecological diseases, and there was no correlation between caGT and CA-125 values. Therefore, caGT will be a useful tumor marker for ovarian cancers, especially for clear cell carcinoma.     

Serum level of interleukin 6 as a prognosis factor in metastatic renal cell carcinoma.

Interleukin (IL) 6 was measured in the serum of 138 patients with metastatic renal carcinoma before the initiation of IL-2 treatment. IL-6 was detectable in 66 patients with renal cancer (48%) and in only 8 of 70 normal adults (11%). Serum C reactive protein (CRP) and IL-6 levels are correlated, suggesting that IL-6 is involved in CRP increase in these patients. The interval between diagnosis of the primary tumor and metastasis was shorter in patients with a detectable serum IL-6 and/or serum CRP level greater than 50 mg/liter. Serum IL-6 and CRP levels were higher in subgroups of patients previously defined as having a poor life expectancy according to the Eastern Cooperative Oncology Group criteria. Pretreatment concentrations of IL-6 and CRP were higher in patients who experienced progressive disease after IL-2 treatment. Patients with detectable IL-6 had a shorter survival from the beginning of IL-2 treatment than patients without circulating IL-6 (median, 8 versus 16 months). Similarly, the median survival from the beginning of IL-2 therapy of patients with CRP levels greater than 50 mg/liter was 6 months, compared to 16 months in those with CRP levels below this threshold. None of the 21 patients with serum IL-6 concentrations greater than 300 pg/ml achieved response to any of the three IL-2 regimens. This subgroup has a median survival of 5 months after IL-2 treatment and consisted of 15% of the patients in our series. These results indicate that serum IL-6 and CRP levels are adverse prognosis factors in patients with metastatic renal cell carcinoma. Serum IL-6 level could help in the selection or stratification of the patients in future IL-2 trials.     

Prognostic impact of in vivo soluble cell adhesion molecules in metastatic renal cell carcinoma

The purpose of the study was to determine prognostic significance of pretreatment serum levels of different molecules involved in cell to cell interactions along with other clinical parameters in patients with metastatic renal cell carcinoma. sICAM-1, sVCAM-1 and sELAM-1 serum levels were determined by ELISA assays in sera from 99 patients with histologically confirmed progressive metastatic renal cell carcinoma prior to initiation of systemic therapy. Kaplan-Meier survival analysis, log-rank statistics and two-proportional Cox regression analyses were employed to identify risk factors and to demonstrate statistical independence. In univariate analyses, the following pretreatment risk factors could be identified: serum sICAM-1 level > 360 ng ml(-1), erythrocyte sedimentation rate > 70 mm h(-1), serum C-reactive protein level > 8 mg l(-1), serum lactic dehydrogenase level > 240 U/l and neutrophil count > 6000 microl(-1). Multivariate analyses demonstrated statistical independence for serum sICAM-1 level, erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) level as pretreatment predictors of overall patient survival. The prognostic significance of sICAM-1 might indicate a role of this molecule for tumour progression, potentially in association with the abrogation of anti-tumour immune responses. The possibility of defining a pretreatment risk model based on sICAM-1 level, ESR and CRP also warrants further investigation, with regard to a possible linkage between acute phase proteins and sICAM-1 levels.     

Plasma levels of cellular fibronectin in patients with localized and metastatic renal cell carcinoma.

Clinical markers for renal cell carcinoma (RCC) are lacking. Fibronectin is a glycoprotein that plays an important role in cellular attachment and cell spread. The aim of this study was to test the clinical suitability of cellular fibronectin (cFN) in plasma as a tumor marker for RCC and to determine a possible relationship between cFN plasma levels and stage of disease. Therefore, cFN was determined in the plasma of patients with localized (n = 40) and metastatic (n = 20) RCC using a time-resolved fluorescence immunoassay. Fifty patients with different non-malignant urological disorders were recruited as a control group. In the control group, mean cFN plasma levels amounted to 553 ng/ml. In patients with localized RCC, plasma concentrations of cFN were increased (1,295 ng/ml; p < 0.01). Patients with metastatic disease had the highest concentrations (3,842 ng/ml). Statistical analysis demonstrated a significant difference between controls, and patients with localized and metastatic RCC (p < 0.01), with a sensitivity of 80%, a specificity of 78% and a positive predictive value of 81% using a cutoff value of 540 ng/ml (receiver-operating characteristic curve analysis). These data suggest that cFN is not a realistic marker for the detection of RCC. However, elevated plasma levels in more advanced disease and an acceptable predictive value could indicate that cFN is useful as a follow-up tool in the management of RCC patients.     

Prognostic value of serum S-100B in malignant melanoma

AIMS AND BACKGROUND: Although there is no established tumor marker of proven value for patients with melanoma, high serum levels of S-100B protein have been found in patients with melanoma and distant metastases. This study was performed to assess the prognostic value of this marker. METHODS AND STUDY DESIGN: Serum S-100B protein was measured by means of the LIA-mat System 300 (Sangtec S-100B LIA, AB Sangtec Medical, Bromma, Sweden) in 85 patients with melanoma. RESULTS: Mean serum S-100B protein was 0.075 microg/L (range, 0.001-0.470) in 66 patients with non-metastatic melanoma (stage I-III) versus 0.441 microg/L (range, 0.001-16.840) in 19 patients with metastatic melanoma (stage IV) (P <0.001, Mann Whitney U test). The median follow-up time was 329 days. Serum levels above 0.150 microg/L were found in 10 of patients with non-metastatic melanoma (15.2%) and in 17 of 19 patients with metastatic disease (89.4%). Median survival was 256 days for the 27 patients with serum S-100B levels above 0.150 microg/L versus 561 days for the 58 patients with normal values (P <0.3973). CONCLUSION: Serum S-100B is a useful tumor marker in melanoma.     

Postoperative serum carcinoembryonic antigen levels in patients with pathologic stage IA nonsmall cell lung carcinoma: subnormal levels as an indicator of favorable prognosis

BACKGROUND: Elevated serum carcinoembryonic antigen (CEA) levels are sometimes attributable to the production of CEA by malignant cells, and in turn, the antigen itself can enhance the metastatic potential of malignant cells. The authors speculated that low serum CEA levels might be indicative of relatively low levels of malignant cells and a low probability of disease recurrence. This hypothesis led them to investigate whether low CEA levels in serum represented a useful prognostic factor for patients with pathologic Stage IA nonsmall cell lung carcinoma. METHODS: Between 1993 and 2001, 724 patients underwent surgery for NSCLC at Toneyama National Hospital (Toyonaka, Japan). Of these patients, the 242 who were diagnosed with pathologic Stage IA disease were included in the current study. Smoking behavior, gender, age, tumor diameter, disease histology, and preoperative and postoperative serum CEA levels were chosen as study variables, with the cutoff level between subnormal and normal serum CEA levels set at 2.5 ng/mL and the cutoff level between normal and high serum CEA levels set at 5.0 ng/mL. Prognostic indicators were evaluated using a Cox hazard model. In addition, survival probabilities were calculated using the Kaplan-Meier method, and differences in survival were assessed by log-lank analysis. RESULTS: Subnormal postoperative serum CEA levels were found to be an independent prognostic indicator (hazard ratio, 2.3; 95% confidence interval, 1.1-4.7; P = 0.03 for comparison with patients who had normal CEA levels) on multivariate analysis. Furthermore, the 5-year survival rate was 87% for patients with subnormal postoperative CEA levels (n = 146), compared with 75% for patients with normal postoperative CEA levels (n = 80) and 53% for patients with high postoperative CEA levels (n = 16) (P < 0.0001). CONCLUSIONS: Among patients with pathologic Stage IA NSCLC, those who had an extremely favorable prognosis were distinguished by their subnormal postoperative serum CEA levels.