Abstract: Objective To evaluate the prognostic value of preoperative serum carcinoembryonic antigen (CEA) level in patients with stage I-III colorectal cancer. Methods The clinicopathological data and prognosis were retrospectively analyzed for 393 patients with colorectal cancer treated in our hospital from January, 2003 to December, 2013. Of these patients, 136 had elevated serum CEA level (≥5 ng/mL) and 257 did not show serum CEA elevation (<5 ng/mL). Results The two groups of patients showed significant differences in the tumor size, degree of tumor differentiation and lymph node metastasis (P<0.05). Cox proportional hazards model suggested that an elevated preoperative CEA level was a risk factor for survival and tumor recurrence, and increased the risks of death and tumor recurrence by 1.59 and 1.89 folds, respectively. Compared with the patients without CEA elevation, those with elevated CEA level had a significantly higher mortality rate (28.7% vs 19.8%, P< 0.05) and tumor recurrence rate (32.4% vs 19.1% , P<0.05) with a significantly lower cumulative total survival rate and cumulative disease-free survival rate (P<0.05); the same results were also found in stage-Ⅲ patients (P<0.05). Conclusions New survival and recurrence data can be generated by incorporating serum CEA level in TNM staging system for more accurate prognostic assessment of the patients.