International Journal of Clinical Oncology

, Volume 23, Issue 5, pp 924–929 | Cite as

Analysis of unexplained carcinoembryonic antigen elevation after curative treatment of locally advanced rectal cancer

  • Sung Uk Lee
  • Eunjin Jwa
  • Dae Yong KimEmail author
  • Tae Hyun Kim
  • Ji Yeon Baek
  • Yongjun Cha
  • Hee Jin Chang
  • Jae Hwan Oh
Original Article



To analyze the causes and patterns of unexplained carcinoembryonic antigen (CEA) elevation after curative treatment in locally advanced rectal cancer patients.


Among the 1309 locally advanced rectal cancer patients treated with curative resection and radiotherapy between January 2001 and June 2011, 325 patients who postoperatively developed abnormal CEA elevation were reviewed. The unexplained CEA elevation was defined as a CEA level higher than 5 ng/mL with no evidence of cancer recurrence at the time of elevation.


Of the 325 patients, 143 (44%) had unexplained CEA elevations. The causes were categorized as delayed recurrence (n = 29, 20%), non-colorectal malignancy (n = 10, 7%), and non-malignancy-related conditions (n = 104, 73%). Shorter intervals between treatment and the first CEA elevation, and a higher peak CEA level, were observed in the delayed recurrence group compared with the non-colorectal malignancy or non-malignancy-related group (intervals of 6.8 vs. 44.9 vs. 23.2 months, respectively, p = 0.002; and peak CEA levels of 9.9 vs. 7.1 vs. 6.2 ng/mL, respectively, p = 0.034). In patients who showed delayed recurrence, the interval between the first CEA elevation and diagnosis of recurrence was a median of 13.0 months (range 3.8–60.6 months). Smoking was the most common cause for non-malignancy-related conditions. The patterns of unexplained CEA elevations were defined as sporadic (n = 78, 55%), stationary (n = 37, 26%), and increasing (n = 28, 20%). The patterns were significantly different depending on the cause (p < 0.001).


Analysis of the patterns of unexplained CEA elevations is a reasonable approach to predict the cause of the cancer.


Rectal cancer Carcinoembryonic antigen Surveillance Smoking 



This work was supported by a National Cancer Center Grant (NCC-1510160 & NCC-1610440).

Author contributions

SUL: Data curation, methodology, project administration, formal analysis, writing—original draft, and writing—review and editing. EJ: Data curation, methodology, project administration, formal analysis, writing—original draft, and writing. SUL and EJ contributed equally to this study. DYK: Responsible for overall content, conceptualization, formal analysis, funding acquisition, software, and writing—review and editing. THK: Writing, reading, supervision and approval of article. JYB: Writing, investigation, reading, and approval of article. YC: Writing, investigation, reading, and approval of article. HJC: Writing, investigation, reading, and approval of article. JHO: Writing, investigation, reading, and approval of article.

Compliance with ethical standards

Conflict of interest

All authors state that there are no conflicts of interest

Ethical approval

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and the International Conference on Harmonization guideline E6: Good Clinical Practice.


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Copyright information

© Japan Society of Clinical Oncology 2018

Authors and Affiliations

  • Sung Uk Lee
    • 1
  • Eunjin Jwa
    • 1
  • Dae Yong Kim
    • 1
    Email author
  • Tae Hyun Kim
    • 1
  • Ji Yeon Baek
    • 1
  • Yongjun Cha
    • 1
  • Hee Jin Chang
    • 1
  • Jae Hwan Oh
    • 1
  1. 1.Center for Colorectal Cancer, National Cancer CenterGoyangRepublic of Korea

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