CEA Monitoring Among Patients in Multi-institutional Adjuvant G.I. Therapy Protocols

Abstract

The Gastrointestinal Tumor Study Group (GITSG) has since 1975 included protocols for monitoring carcinoembryonic antigen (CEA) levels in its colorectal cancer adjuvant trials. Among the 563 patients on the colon cancer study (GI 6175) and the 207 patients on the rectal cancer study (GI 7175), one third had preoperative CEA determinations and more than 90% had some postoperative CEA monitoring. Colon cancer patients whose preoperative CEA was greater than 5 ng/ml had a greater probability of recurring than those whose values were lower (33% versus 18% recurrence with 21 months minimum follow-up; p < 0.05). The prognostic value of preoperative CEA was apparent only in patients with Dukes' C1 colon tumors. Preoperative CEA values were not of prognostic significance among the rectal adenocarcinoma patients. Although elevated levels of CEA after resection of either colon or rectum cancers were strongly associated with subsequent tumor recurrence, no single CEA value, arbitrarily defined as "elevated", provided an adequate screening test with both high sensitivity and high specificity. Postoperative CEA elevations were more strongly predictive of recurrence when part of a steadily rising trend. In the colon cancer study, the median monthly increase in CEA for disease-free patients was estimated to be zero, and for the relapsed patients 5.8%. The corresponding estimates for patients on the rectal cancer protocol were zero and 7.8%. Only 36 of the 344 disease-free patients on the colon protocol and 14 of the 94 disease-free patients on the rectal protocol (15%) exhibited a rate of increase of CEA as high as 3% per month over the entire period of observation. Two thirds of the relapsed patients on both studies showed a rate of increase this high or higher. The patterns of CEA rise in individual patients were quite varied, however, and monthly rates of increase as established in our study are not to be used as guidelines in patient management.

Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer

“…The majority of studies evaluating preoperative CEA levels reveal it to be an independent prognostic factor after surgical resection for colorectal cancer [1][2][3][4][5][6][7][8]10], although some contradictory studies reported that the CEA level is a predictor for survival [12][13][14][15][16]. We concur with this and confirmed a preoperative elevation in serum CEA as an independent prognostic factor for both 5-year overall and disease-free survival in this analysis.…”

“…Many studies have demonstrated the prognostic value of the preoperative CEA level after surgical resection of colon and rectal cancer, but whether the preoperative CEA level is an independent prognostic variable in colon cancer has remained controversial [12][13][14][15][16]. Therefore, the aim of this study was to assess the prognostic value of the preoperative serum CEA level in patients with colon cancer.…”

Multivariate analyses as aids to diagnosis and assessment of prognosis in gastrointestinal cancer

“…A more critical examination restricted to 563 patients with Dukes stage B or C tumours undergoing curative resection found that a raised pre-operative CEA only had a significant effect on prognosis in Dukes C lesions of the colon but not of the rectum (Steel et al, 1982 (Bradwell et al, 1979), and cancer of the cervix (Te Velde et al, 1979).…”

“…However, the prognostic significance of slightly raised levels of CEA is still debatable (Goslin et al, 1980;Blake et al, 1982;Steel et al, 1982). A combination of CEA and acute phase reactant proteins (APRPs) have been used in the pre-operative assessment of stomach cancer (Rashid et al, 1982) and colorectal cancer (Ward et al, 1977) and their value assessed by multivariate analysis.…”

Clinical factors in prediction of prognosis after anterior resection with total mesorectal excision for carcinoma of the rectum

“…Moertel et al reported its independent prognostic value only in patients with involvement of four or more lymph nodes (34). Different results were observed in the trial of Gastrointestinal Tumor Study Group: s-CEA affected survival of patients with one to four positive nodes (35). Moreover, Wang et al in another study concluded that prediction of significant outcomes persisted for patients analysed separately at Astler-Coller stage C1 (lack of tumor penetration beyond the bowel wall) and C2 (presence of penetration) (36).…”