Influence of Obesity on the Serum Carcinoembryonic Antigen Value in Patients with Colorectal Cancer

Background: Prior studies suggest that obesity is inversely associated with tumor marker concentration and may reduce diagnostic precision. This study was undertaken to evaluate the association between body mass index (BMI) and serum carcinoembryonic antigen (CEA) concentrations in colorectal cancer patients. Methods: We analyzed the association between BMI and CEA concentration in a group of 2,845 patients who underwent surgical treatment for colorectal adenocarcinoma from 1995 to 2009. Multivariate linear regression analysis was applied to adjust for clinicopathologic confounding factors to analyze main outcome measures. The association of BMI with plasma volume, CEA concentration, and total circulating CEA mass was assessed by determining P values for trends. We also developed a regression formula to calculate the effect of obesity on the serum CEA levels. Results: Increased BMI was linearly correlated with higher plasma volume (P < 0.001 for trend) and lower adjusted CEA concentrations after controlling for potentially confounding factors (P <= 0.005 for trend in stage II and III tumors). Our theoretical model suggests that a CEA value of 7.0 ng/mL in patients of normal weight corresponds to 6.1 ng/mL in obese patients. Conclusions: The hemodilution effect from increased plasma volume may account for the decreased CEA concentrations observed in patients with higher BMI. Impact: Obesity might be one of the factors that affect CEAvalue, leading to loss of sensitivity and diagnostic accuracy in the CEA test. The BMI status of patients should be taken into account during assessment of serum CEA during the surveillance of colorectal cancer. Cancer Epidemiol Biomarkers Prev; 19(10); 2461-8. (C) 2010 AACR.