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The role of periodic serum CA19-9 test in surveillance after colorectal cancer surgery

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Abstract

Background

The serum carcinoembryonic antigen (CEA) test is mainly used for postoperative surveillance of colorectal cancer patients in Western and Japanese guidelines, but evidence to support the use of CA19-9 is scarce.

Methods

We analyzed the cohort data from 22 institutions of the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer. Patients who had undergone curative surgery for primary colorectal cancer (pathological stage I–III) between 1997 and 2006 were eligible for analysis. Sensitivities of CEA and CA19-9 at the time of recurrence and the contribution of CA19-9 to detecting recurrences were assessed.

Results

A total of 17,833 patients were eligible, and the overall recurrence rate was 18 %. The sensitivity of CA19-9 in detecting recurrence was lower than that of CEA (29 vs. 57 %). Among patients with recurrence, recurrences were first suspected in 96 % using standard surveillance modalities (CEA elevation, CT scan, clinic visit, and colonoscopy), whereas recurrences were suspected because of CA19-9 elevation in an estimated 1.3 % of patients. With regard to prognosis after recurrences, the sensitivity of CA19-9 was lower than that of CEA in the detection of surgically treatable recurrences (22 vs. 49 %). In terms of overall survival after recurrences, CA19-9 and CEA had almost comparable hazard ratios (1.66 and 1.48, respectively).

Conclusions

Our data suggested that the sensitivity of serum CA19-9 test is low, and that adding it to the current standard surveillance strategies is not beneficial.

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Acknowledgments

The authors thank all members of the institutions belonging to the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer who participated in this study: Ichiro Takemasa (Sapporo Medical University); Kenichi Hakamada (Hirosaki University); Hitoshi Kameyama (Niigata University); Yasumasa Takii (Niigata Cancer Center Hospital); Yoshiki Kajiwara and Kazuo Hase (National Defense Medical College); Kenjiro Kotake (Tochigi Cancer Center); Toshiaki Watanabe (Tokyo University); Keiichi Takahashi (Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital); Yukihide Kanemitsu (National Cancer Center Hospital); Michio Itabashi (Tokyo Women’s Medical University); Hidero Yano (National Center for Global Health and Medicine); Shinichi Yamauchi and Masamichi Yasuno (Tokyo Medical and Dental University); Hirotoshi Hasegawa (Keio University); Yoichiro Hashiguchi (Teikyo University); Tadahiko Masaki (Kyorin University); Masahiko Watanabe (Kitasato University); Kotaro Maeda (Fujita Health University); Kouji Komori (Aichi Cancer Center Hospital); Masayuki Ohue (Osaka Medical Center for Cancer and Cardiovascular Diseases); Naohiro Tomita (Hyogo College of Medicine); and Yoshito Akagi (Kurume University).

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Authors and Affiliations

  1. Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-ku, Kyoto, Japan

    Ryosuke Okamura, Suguru Hasegawa, Koya Hida, Nobuaki Hoshino, Kenji Kawada & Yoshiharu Sakai

  2. Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Ryosuke Okamura
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  2. Suguru Hasegawa
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  3. Koya Hida
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  4. Nobuaki Hoshino
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  5. Kenji Kawada
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  6. Kenichi Sugihara
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  7. Yoshiharu Sakai
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Consortia

The Japanese Study Group for Postoperative Follow-up of Colorectal Cancer

Corresponding author

Correspondence to Ryosuke Okamura.

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The authors declare that they have no conflict of interest.

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Okamura, R., Hasegawa, S., Hida, K. et al. The role of periodic serum CA19-9 test in surveillance after colorectal cancer surgery. Int J Clin Oncol 22, 96–101 (2017). https://doi.org/10.1007/s10147-016-1027-4

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  • DOI: https://doi.org/10.1007/s10147-016-1027-4

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