The prognostic significant of percentage drop in serum CEA post curative resection for colon cancer

Preoperative Carcinoembryonic Antigen and Prognosis of Colorectal Cancer. An Independent Prognostic Factor Still Reliable

“…11 These observations, which were made as recently as 2013 and which still seem surprising after 30 years, are certainly not due to the lack of testing new molecular, genetic, or humoral markers, but to the fact that these are not reliable, simple, nor cost effective as the CEA could be. In recent years, we are not the only ones 1,3,4,6,7,10,11,16,18,19,[27][28][29] who believe that the determination of the p-CEA has a prognostic value in identifying, preoperatively, the group of patients who most likely will show recurrences. In fact, p-CEA is able to identify both patients whose understaging results from occult metastasis and those who are carriers of histologically advanced or more aggressive neoplasms.…”

“…Many authors 4,5,9,19,22,32 have reported that the lack of return of the CEA to normal range after radical surgical resection, given the short half-life marker, is an index of both inadequate resection leading to early recurrence or presence of mostly hepatic occult metastases. In our study, we recorded that in 13.5% of the cases, a percentage noticeably lower than that reported by other authors, 32 the p-CEA did not fall within normal range after 3 months after a surgery judged as radical.…”

“…In fact, the prognosis of patients with the same staging is often various and that the need to continually implement ever-changing variables in an already excessively fragmented staging is still present. 2,4,[7][8][9] Recently, in light of these needs, great attention has been paid to the study of molecular and genetic markers. At present, these markers still have not found a regular application due to the complexity of their determination, the difficulty of standardization and, last but not least, the low cost-benefit ratio.…”

“…At present, these markers still have not found a regular application due to the complexity of their determination, the difficulty of standardization and, last but not least, the low cost-benefit ratio. 1,3,4,9,10 With this in mind, in our opinion, the carcinoembryonic antigen (CEA) maintains its position, as for over 30 years it has continued to be the most widely used marker 11 and whose validity, with regard to colorectal follow-up, has been sanctioned by leading organizations such as the American Society of Clinical Oncology (ASCO) 12 and the European Group on Tumor Markers. 13 Moreover, as Herrera 14 and Wanebo 15 had already reported by the end of the '70s, the preoperative determination of the CEA (p-CEA) seems to be related both to the staging of colorectal neoplasia and to the patient's prognosis.…”

“…13 Moreover, as Herrera 14 and Wanebo 15 had already reported by the end of the '70s, the preoperative determination of the CEA (p-CEA) seems to be related both to the staging of colorectal neoplasia and to the patient's prognosis. However, to date, none of this has been conclusively demonstrated and is still a matter of intense debate both in prestigious scientific journals 4,7,11,[16][17][18][19][20][21] as well as in different guidelines. 22 The American Society of Clinical Oncology itself, if on the one hand suggests using the determination of the CEA in the preoperative staging thus justifying a worse prognosis when increased, 12 on the other, does not validate using the p-CEA in the determination of an adjuvant or neo-adjuvant therapeutic strategy.…”