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Session:: ePosters-Mon330-M6: Colon & Colorectal Cancer

EP1069 - Predictors of Survival in Patients with Stage I Early-Onset Colorectal Cancer with Elevated CEA Levels

Monday, May 11, 2026
4:19 PM - 4:24 PM ET

    ePoster Presenter(s)

  • Anjelli Wignakumar, MBBS, BSc (Hons) (she/her/hers)

    Clinical Research Fellow
    Cleveland Clinic Florida
    Cleveland Clinic Florida
    Weston, FL, United States

    Disclosure information not submitted.

    • Author(s)

  • Sameh H. Emile, MBBCh, MSc, MD, FACS

    Project Scientist
    Cleveland Clinic Florida
    Cleveland Clinic Florida
    Weston, FL, United States

    Disclosure information not submitted.

  • VL

    Vishnu Linkeshwaran, n/a

    2nd year Medical Student
    City St George's, University of London, School of Medicine
    Hertfordshire, England, United Kingdom

    Disclosure information not submitted.

  • AH

    Ahmed Hussein, MD

    Clinical Research fellow
    Cleveland Clinic foundation
    Sunrise, Florida, United States

    Disclosure information not submitted.

  • MB

    Matthew Bilotti, n/a

    Medical Student Researcher and Coauthor
    FAU Charles E. Schmidt College of Medicine
    West Palm Beach, Florida, United States

    Disclosure information not submitted.

  • HF

    Haslett D. Fernandes, n/a

    Research Assistant
    Cleveland Clinic Florida
    Davie, Florida, United States

    Disclosure information not submitted.

  • NK

    Noam Kahana, MD

    Colorectal Fellow
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA; and the Department of General surgery Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
    Faculty of Medicine, Hebrew University of Jerusalem, Israel
    Hollywood, FL, United States

    Disclosure information not submitted.

  • Dana Sands, MD

    Staff Surgeon

    Disclosure information not submitted.

  • GD

    Giovanna Dasilva, MD

    Staff Colorectal Surgeon
    Cleveland Clinic Florida
    Cleveland Clinic Florida
    Weston, Florida, United States

    Disclosure information not submitted.

  • Marylise Boutros, MD, FRCSC, FACS, FACRS (she/her/hers)

    Colorectal Surgeon
    Cleveland Clinic Florida
    McGill University
    Weston, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

    • Senior Author(s)

  • Steven D. Wexner, MD, PhD (Hon)

    Surgeon
    Cleveland Clinic Florida
    Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
    Weston, Florida, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Marylise Boutros, MD, FRCSC, FACS, FACRS: This individual has no relevant relationships with ineligible companies.
Purpose/Background: The incidence of early-onset colorectal cancer (EOCRC) is steadily rising in high-income countries. Compared with later-onset CRC, EOCRC displays distinct molecular and clinical features, including relapse patterns that may not be fully captured by traditional TNM staging. Carcinoembryonic antigen (CEA) remains a widely used biomarker for prognosis and surveillance in CRC. Multiple recent studies show that elevated preoperative CEA is associated with poorer overall and disease-free survival, even in stage I-II disease; however, its specific prognostic role in stage I EOCRC remains uncertain. Clarifying survival predictors in patients with stage I EOCRC with elevated CEA could refine surveillance intensity and guide adjuvant decision-making, aligning with guideline recommendations that emphasize risk-adapted follow-up strategies.

Methods/Interventions: We conducted a retrospective cohort study on patients < 50 years with stage I colorectal adenocarcinoma and elevated preoperative CEA who underwent surgery, Data were obtained from the SEER population-based registry from 2000-2020. The primary outcome was cancer-specific survival (CSS), whereas overall survival (OS) was the secondary outcome.

Results/Outcomes: From 3702 patients with stage I EOCRC who underwent surgery, 511 (13.8%) had an elevated CEA level and were included (mean age 45 years, 53.6% male). Most patients were White (73.8%) and married (54.5%). Tumors were more commonly colonic (54%) and low grade (91.9%), with a median size of 35 mm. 55.8% of cancers were T2, and 2.3% were associated with perineural invasion. Five-year CSS and OS rates were 89.7% (95% CI: 85.9-92.6) and, 85.0% (95% CI: 80.8-88.3), respectively. On multivariable Cox regression, widowed patients (HR 11.95; 95% CI: 2.59-55.06; p=0.001) and perineural invasion (HR 7.71; 95% CI: 1.73-34.33; p=0.007) were independently associated with reduced CSS.

Conclusion/Discussion: Stage I EOCRC with elevated CEA demonstrated lower-than-expected cancer-specific survival. Widowed status and perineural invasion identified high-risk patients with poor outcomes. Risk-adapted management, including consideration of adjuvant chemotherapy in these high-risk patients, may improve prognosis.