Serum CEA testing in the post-operative surveillance of colorectal carcinoma

Abstract

Summary Six hundred and sixty-three patients were followed with serial serum CEA measurements in addition to routine clinical surveillance after radical resection of colorectal carcinoma. Of 626 available for analysis, 366 (58.4%) remained clinically free of recurrence and had a normal CEA (<20ngml-1) throughout and 89 (14.2%) had a temporary non-progressive rise in CEA with no evidence of secondary disease. Of 171 patients who developed proven or suggestive recurrence, 114 had a preceding rise in the serum CEA and in further 21 the CEA rose simultaneously with recurrence. In 36 patients secondary disease was detected while the CEA was still within normal limits. CEA was more effective as an early index of distant metastasis, thus in 76% of those patients with a preceding rise in CEA, the secondary disease was disseminated, whereas only 20% had localised recurrence. The pattern of rise in CEA was of no practical value in distinguishing localised from distant recurrence.

The role of CA-242 and CEA in surveillance following curative resection for colorectal cancer

“…For single measurements (e.g. preoperative levels) it is possible to compare the specificity and sensitivity of two tests independently of the cut-off level used to define the abnormality by using receiver operating characteristic (ROC) curve analysis (Pasanen et al, 1993;Zweig & Campbell, 1993 (Beart & O'Connell, 1983;Hine & Dykes, 1984), some on a trend (Staab et al, 1985;Sugarbaker et al, 1987), and others using more complicated analytical methods (Martin et al, 1977). This issue was addressed specifically by Denstman et al (1986), but although some form of slope analysis was recommended in preference to an absolute cut-off value no firm guidein could be offered.…”

“…Many clinicians will include the measurement of CEA as an essential investigation in the detection of asymptomatic recurre of colorectal cancer. Those surgeons who advocate the use of second-look surgery advise that CEA should be measured every 6-8 weeks so that a suspicious rising level can be identified as early as possible (Staab et al, 1985;Minton & Chevinsky, 1989); for others 3 monthly CEA testing during the high-risk period of the first 2 years after resection tends to be the rule with a reduction in frequency of testing thereafter (Hine & Dykes, 1984).…”

Correlation of CEA but not CA 19-9 as serum biomarkers of disease activity in a case of metastatic rectal adenocarcinoma

“…19,22 This tumor marker is often the earliest indicator of recurrence, preceding clinical and radiographic evidence in 3-quarters of cases. [9][10][11][12] As a result, current ASCO guidelines recommend that CEA measurements be routinely obtained at 3 month intervals during postoperative surveillance and at 1-3 month intervals during systemic treatment for metastatic CRC. 23 The value of monitoring CA 19-9, on the other hand, is more controversial.…”

“…Persistent elevation of CEA after surgery suggests the presence of residual disease and portends a poor prognosis. 8,9 Similarly, repeat elevation of CEA in a patient with an initially positive serologic response to treatment is highly suggestive of recurrent disease [9][10][11][12] and often warrants further investigation if verified to be significantly elevated and/or consistently rising.…”

A prospective study comparing multi-gene biomarker chip and serum carcinoembryonic antigen in the postoperative surveillance for patients with stage I–III colorectal cancer

“…In the literature, the estimated sensitivity of serum CEA for detecting relapsed disease in patients with completely resected CRC is 58%-89%, with a 1.5-6.0-month lead time between serum CEA level elevation and recurrence detection [26][27][28][29]. In the present study, the sensitivity and specificity of elevated serum CEA level detection were 60.4% and 83.2%, with a median lead time of 2.8 months between serum CEA level and relapse detection, consistent with the previous reports.…”