Advanced Colon Cancer: Staging and Prognosis by CEA Test

Abstract

The carcinoembryonic antigen (CEA) test was studied in 54 patients with advanced stages of colon cancer which was treated with high doses of folinic acid + fluorouracil. The CEA test correlates evaluated included: prognostic value, performance status, metastatic pattern, histologic grading, predictive value for response to chemotherapy, and value differences in cases with partial response to therapy. CEA levels <5 ng/ml corresponded to a greater survival time than did levels >5 ng/ml. A correlation of CEA with performance status and with metastatic pattern was demonstrated. A progressive increase in average CEA values corresponded to increases in neoplastic mass. Although CEA levels were not found to be an index for predicting the response to chemotherapy, there was a significant difference between pre- and posttreatment levels for partial response. The results suggest that CEA offers an additional criterion for evaluating the response of colon cancer to chemotherapy and it also has a role in the staging of advanced disease.

Serum tumor markers in colorectal cancer staging, grading, and follow-up

“…The cutoff values were chosen according to Barone et al [3] for CEA, Ohuchi et al [4] for CA 72-4, Huber et al 181 for CA 19-9, and according to Plebani et al [28] for CA 242. The limits of TPA, TPS, and TPM were calculated by means of mean + 2 SD of values from a control population of blood donors (n = 100 cases).…”

The prognostic role of baseline CEA and CA 19-9 values and their time-dependent variations in advanced colorectal cancer patients submitted to first-line therapy

“…CEA has been extensively studied in metastatic colorectal cancer patients since the '70s and a considerable amount of literature has been published. In summary, CEA has been demonstrated to predict response to chemotherapy and overall survival 3,4,5 . All these studies, however, have a series of limitations: they enrolled a relatively low number of patients; the results of those studies reporting data from clinical trials comparing different chemotherapies can be hardly referred to the daily oncological routine as marker evaluation is a secondary aim and enrolled patients are selected by strict including and excluding criteria; patients with CEA levels below the upper normality threshold have never been studied as marker levels were considered as false negative.…”

The Carcinoembryonic Antigen (CEA): Past, Present, and Future

“…Despite disagreement among various investigations of the relationship between preoperative CEA and prognosis, most report that a high preoperative CEA level is indicative of a poor prognosis. This association is often as predictive of prognosis as are pathological staging and grading (91,155,156,165,(168)(169)(170)(171)(172)(173). On the basis of these observations, the National Institutes of Health suggested in their 1981 Consensus Statement (62) that CEA determination should be used as an adjunct to staging.…”

“…As for lung cancer, the use of serial serum CEA determinations in the monitoring of patients with surgicallytreated non-small cell lung cancer revealed a sensitivity of 58% in the detection of recurrence; this figure increased to 88% with concomitant analysis of serum CA 125 and squamous cell carcinoma antigen (218). Serial CEA assay may also be useful in a number of other tumors that have been less well studied to date (89,117,137,138,185,172,184,187,188,195,(219)(220)(221)(222)(223)(224)(225)(226)(227)(228)(229). In patients with gastric or esophageal carcinoma, for example, an elevated CEA level during serial follow-up after preoperative chemotherapy has been shown to be predictive of relapse, and has demonstrated the potential for diagnosis of recurrent disease in advance of its clinical presentation (140).…”