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Serum Carcinoembryonic Antigen Monitoring After Curative Resection for Colorectal Cancer: Clinical Significance of the Preoperative Level

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Aim

We evaluated preoperative serum carcinoembryonic antigen (CEA) as a prognostic factor for colorectal cancer and determined when surveillance of this marker was useful.

Methods

Serum CEA was measured preoperatively in 1,263 patients who underwent curative resection for colorectal cancer at 3-month intervals for the first 2 postoperative years and at 6-month intervals thereafter. Mean follow-up was 48 months (range 1–156 months).

Results

The 5-year disease-free survival was less in patients with a high preoperative serum CEA level (P < 0.0001). Among patients with a tumor recurrence, 38.5% had high follow-up serum CEA levels. The number of patients with high postoperative serum CEA levels exceeded the number of patients with high preoperative levels. High preoperative and follow-up serum CEA levels were independent prognostic factors for tumor recurrence (P = 0.003 and P < 0.001, respectively). In patients with high preoperative serum CEA levels, CEA surveillance had a 92.3% positive predictive value (PPV) and a 96.1% negative predictive value (NPV). The mean interval between postoperative serum CEA elevation and the diagnosis of a tumor recurrence [diagnostic interval (DI)] was 2.5 months (range 5–17 months). The DI was 0 in 18.8% of patients with a tumor recurrence.

Conclusion

High serum CEA levels preoperatively and at follow-up are prognostic factors for colorectal cancer. Postoperative serum CEA surveillance is used most effectively when patients have high preoperative serum CEA levels. Considering the DI of 0 in 18.8% of the patients, the current CEA surveillance schedule might be changed.

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References

  1. Chapman MA, Buckley D, Henson DB, Armitage NC. Preoperative carcinoembryonic antigen is related to tumour stage and long-term survival in colorectal cancer. Br J Cancer. 1998;78:1346–9.

    CAS  PubMed  Google Scholar 

  2. Morales-Gutierrez C, Vegh I, Colina F, Gomez-Camara A, Ignacio Landa J, Ballesteros D, et al. Survival of patients with colorectal carcinoma: possible prognostic value of tissular carbohydrate antigen 19.9 determination. Cancer. 1999;86:1675–81.

    Article  CAS  PubMed  Google Scholar 

  3. Reiter W, Stieber P, Reuter C, Nagel D, Lau-Werner U, Lamerz R. Multivariate analysis of the prognostic value of CEA and CA 19-9 serum levels in colorectal cancer. Anticancer Res. 2000;20:5195–8.

    CAS  PubMed  Google Scholar 

  4. Stelzner S, Hellmich G, Koch R, Ludwig K. Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: a multivariate analysis. J Surg Oncol. 2005;89:211–7.

    Article  PubMed  Google Scholar 

  5. Takahashi Y, Mai M, Nakazato H. Preoperative CEA and PPD values as prognostic factors for immunochemotherapy using PSK and 5-FU. Anticancer Res. 2005;25:1377–84.

    PubMed  Google Scholar 

  6. Chen CC, Yang SH, Lin JK, Lin TC, Chen WS, Jiang JK, et al. Is it reasonable to add preoperative serum level of CEA and CA19-9 to staging for colorectal cancer? J Surg Res. 2005;124:169–74.

    Article  CAS  PubMed  Google Scholar 

  7. Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA, Tangen C. An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA. 1993;270:943–7.

    Article  CAS  PubMed  Google Scholar 

  8. Wang JY, Tang R, Chiang JM. Value of carcinoembryonic antigen in the management of colorectal cancer. Dis Colon Rectum. 1994;37:272–7.

    Article  CAS  PubMed  Google Scholar 

  9. Wichmann MW, Lau-Werner U, Muller C, Hornung HM, Stieber P, Schildberg FW. Colorectal Cancer Study Group. Carcinoembryonic antigen for the detection of recurrent disease following curative resection of colorectal cancer. Anticancer Res. 2000;20:4953–5.

    Google Scholar 

  10. Zeng Z, Cohen AM, Urmacher C. Usefulness of carcinoembryonic antigen monitoring despite normal preoperative values in node-positive colon cancer patients. Dis Colon Rectum. 1993;36:1063–8.

    Article  CAS  PubMed  Google Scholar 

  11. Barillari P, Ramacciato G, Manetti G, Bovino A, Sammartino P, Stipa V. Surveillance of colorectal cancer: effectiveness of early detection of intraluminal recurrences on prognosis and survival of patients treated for cure. Dis Colon Rectum. 1996;39:388–93.

    Article  CAS  PubMed  Google Scholar 

  12. Rockall TA, McDonald PJ. Carcinoembryonic antigen: its value in the follow-up of patients with colorectal cancer. Int J Colorectal Dis. 1999;14:73–7.

    Article  CAS  PubMed  Google Scholar 

  13. Mariani G, Carmellini M, Bonaguidi F, Benelli MA, Toni MG. Serum CEA monitoring in the follow-up of colorectal cancer patients with negative preoperative serum CEA. Eur J Cancer. 1980;16:1099–103.

    CAS  PubMed  Google Scholar 

  14. Kievit J, van de Velde CJ. Utility and cost of carcinoembryonic antigen monitoring in colon cancer follow-up evaluation. A Markov analysis. Cancer. 1990;65:2580–7.

    Article  CAS  PubMed  Google Scholar 

  15. Flamini E, Mercatali L, Nanni O, Calistri D, Nunziatini R, Zoli W, et al. Free DNA and carcinoembryonic antigen serum levels: an important combination for diagnosis of colorectal cancer. Clin Cancer Res. 2006;12:6985–8.

    Article  CAS  PubMed  Google Scholar 

  16. Park YJ, Park KJ, Park JG, Lee KU, Choe KJ, Kim JP. Prognostic factors in 2230 Korean colorectal cancer patients: Analysis of consecutively operated cases. World J Surg. 1999;23:721–6.

    Article  CAS  PubMed  Google Scholar 

  17. Duffy MJ, van Dalen A, Haglund C, Hansson L, Klapdor R, Lamerz R, et al. Clinical utility of biochemical markers in colorectal cancer: European Group on Tumour Markers (EGTM) guidelines. Eur J Cancer. 2003;39:718–27.

    Article  CAS  PubMed  Google Scholar 

  18. Louhimo J, Carpelan-Holmstrom M, Alfthan H, Stenman UH, Jarvinen HJ, Haglund C. Serum HCG beta, CA 72-4 and CEA are independent prognostic factors in colorectal cancer. Int J Cancer. 2002;101:545–8.

    Article  PubMed  CAS  Google Scholar 

  19. Lindmark G, Bergstrom R, Pahlman L, Glimelius B. The association of preoperative serum tumour markers with Dukes’ stage and survival in colorectal cancer. Br J Cancer. 1995;71:1090–4.

    CAS  PubMed  Google Scholar 

  20. Carpelan-Holmstrom M, Haglund C, Lundin J, Jarvinen H, Roberts P. Pre-operative serum levels of CA 242 and CEA predict outcome in colorectal cancer. Eur J Cancer. 1996;32A:1156–61.

    Article  CAS  PubMed  Google Scholar 

  21. Forones NM, Tanaka M. CEA and CA 19-9 as prognostic indexes in colorectal cancer. Hepatogastroenterology. 1999;46:905–8.

    CAS  PubMed  Google Scholar 

  22. Ueno H, Mochizuki H, Hatsuse K, Hase K, Yamamoto T. Indicators for treatment strategies of colorectal liver metastases. Ann Surg. 2000;231:59–66.

    Article  CAS  PubMed  Google Scholar 

  23. Sorbye H, Dahl O. Carcinoembryonic antigen surge in metastatic colorectal cancer patients responding to oxaliplatin combination chemotherapy: implications for tumor marker monitoring and guidelines. J Clin Oncol. 2003;21:4466–7.

    Article  PubMed  Google Scholar 

  24. Staab HJ, Anderer FA, Stumpf E, Hornung A, Fischer R, Kieninger G. Eighty-four potential second-look operations based on sequential carcinoembryonic antigen determinations and clinical investigations in patients with recurrent gastrointestinal cancer. Am J Surg. 1985;149:198–204.

    Article  CAS  PubMed  Google Scholar 

  25. McCall JL, Black RB, Rich CA, Harvey JR, Baker RA, Watts JM, et al. The value of serum carcinoembryonic antigen in predicting recurrent disease following curative resection of colorectal cancer. Dis Colon Rectum. 1994;37:875–1.

    Article  CAS  PubMed  Google Scholar 

  26. Martin EW, Minton JP, Carey LC. CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann Surg. 1983;202:310–7.

    Article  Google Scholar 

  27. Allen-Mersh TG. Aspects of treatment. Serum CEA in the follow-up of colorectal carcinoma. Experience in a District General Hospital. Ann L Coll Surg Eng. 1984;66:751–5.

    Google Scholar 

  28. Chau I, Allen MJ, Cunningham D, Norman AR, Brown G, Ford HE, et al. The value of routine serum carcino-embryonic antigen measurement and computed tomography in the surveillance of patients after adjuvant chemotherapyfor colorectal cancer. J Clin Oncol. 2004;22:1420–9.

    Article  CAS  PubMed  Google Scholar 

  29. Borie F, Combescure C, Daurès JP, et al. Cost-effectiveness of two follow-up strategies for curative resection of colorectal cancer: comparative study using a Markov model. World J Surg. 2004;28:563–9.

    PubMed  Google Scholar 

  30. Borie F, Daures JP, Millat B, et al. Cost and effectiveness of follow-up examinations in patients with colorectal cancer resected for cure in a French population-based study. J Gastrointest Surg. 2004;8:552–8.

    Article  PubMed  Google Scholar 

  31. Sugarbaker, PH, Gianola FJ, Dwyer A. A simplified plan for follow up of patients with colon and rectal cancer supported by prospective studies of laboratory and radiologic test results. Surgery. 1987;102:79–87.

    CAS  PubMed  Google Scholar 

  32. Makela JT, Laitinen SO, Kairaluoma MI. Five year followup after radical surgery for colorectal cancer—results of a prospective randomized trial. Arch Surg. 1995;130:1062–7.

    CAS  PubMed  Google Scholar 

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Correspondence to Gyu-Seog Choi MD.

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Park, I.J., Choi, GS., Lim, K.H. et al. Serum Carcinoembryonic Antigen Monitoring After Curative Resection for Colorectal Cancer: Clinical Significance of the Preoperative Level. Ann Surg Oncol 16, 3087–3093 (2009). https://doi.org/10.1245/s10434-009-0625-z

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  • DOI: https://doi.org/10.1245/s10434-009-0625-z

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