Abstract
PURPOSE: The practical value of carcinoembryonic antigen (CEA) assay in the management of colorectal cancer after surgery is controversial. The value of CEA in the management of colorectal cancer was reviewed and discussed to justify the use of CEA assay in the management of colorectal cancer. METHODS: A retrospective study was performed on 318 patients who underwent resection by one surgeon (JYW) between 1981 and 1986 and who were followed for a minimum of 5 years or until death. RESULTS: The incidence of preoperative CEA levels >5 ng/ml in Dukes Stages A, B, C, and D were 0, 32, 48, and 79 percent, respectively. Five-year survival rates for groups with CEA levels ≤5 ng/ml and >5 ng/ml were 85 percent and 55 percent (P < 0.05), respectively, in Dukes Stage B patients and 64 percent and 37 percent (P < 0.05) in Stage C patients. The sensitivity and specificity of postoperative CEA monitoring in detecting recurrent diseases were 66 percent and 94 percent, respectively, for patients with a preoperative CEA value ≤5 ng/ml and 97 percent and 88 percent for patients with a higher preoperative CEA value. CONCLUSION: CEA is still the best tumor marker available to be used as an independent prognostic factor and as a monitor for recurrence of disease after primary tumor resection.
Similar content being viewed by others
References
Gold P, Freedman SO. Demonstration of tumor-specific antigens in human colonic carcinomata by immunological tolerance and absorption techniques. J Exp Med 1965;121:439–62.
National Institutes of Health Consensus Development Conference. Carcinoembryonic antigen: its role as a marker in the management of cancer. Cancer Res 1981;41:2017–8.
Fletcher RH. Carcinoembryonic antigen. Ann Intern Med 1986;104:66–73.
Wanebo HJ, Rao B, Pinsky CM,et al. Preoperative carcinoembryonic antigen level as a prognostic indicator in colorectal cancer. N Engl J Med 1978;299:448–51.
Staab HJ, Anderer FA, Brummendorf T, Stumpf E, Fischer R. Prognostic value of preoperative serum CEA level compared to clinical staging. Br J Cancer 1981;44:652–62.
Wolmark N, Fisher B, Wieand HS,et al. The prognostic significance of preoperative carcinoembryonic antigen levels in colorectal cancer—results from NSABP clinical trials. Ann Surg 1984;199: 375–81.
Lewi H, Blumgart LH, Carter DC,et al. Preoperative carcinoembryonic antigen and survival in patients with colorectal cancer. Br J Surg 1984;71:206–8.
Moertel CG, O'Fallon JR, Go VL, O'Connell MJ, Thynne GS. The preoperative carcinoembryonic antigen test in the diagnosis, staging and prognosis of colorectal cancer. Cancer 1986;58:603–10.
LoGerfo P, Herter FP. Carcinoembryonic antigen and prognosis in patients with colon cancer. Ann Surg 1975;181:81–4.
Goslin R, O'Brien MJ, Steele G,et al. Correlation of plasma CEA and CEA attaining in poorly differentiated colorectal cancer. Am J Med 1981;71:246–53.
Chu DZ, Erickson CA, Russell MP,et al. Prognostic significance of carcinoembryonic antigen in colorectal carcinoma. Arch Surg 1991;126:3:314–6.
Goslin R, Steele G Jr, MacIntyre J,et al. The use of preoperative plasma CEA levels for stratification of patients after curative resection of colorectal cancers. Ann Surg 1980;192:747–51.
Steele G Jr, Ellenberg S, Ramming K,et al. (Gastrointestinal Tumor Study Group). Carcinoembryonic antigen monitoring among patients in multiinstitutional adjuvant G.I. therapy protocols. Ann Surg 1982;196:162–9.
Scott NA, Wieand HS, Moertel CG,et al. Colorectal cancer: Dukes' stage, tumor site, preoperative plasma CEA level, and patient prognosis related to tumor DNA ploidy pattern. Arch Surg 1987;122:1375–9.
Arnaud JP, Koehl C, Adloff M. Carcinoembryonic antigen (CEA) in diagnosis and prognosis of colorectal carcinoma. Dis Colon Rectum 1980;23:141–4.
Mach JP, Vienny H, Jaeger P,et al. Long-term follow-up of colorectal carcinoma patients by repeated CEA radioimmunoassay. Cancer 1978;42:1439–47.
Hine KR, Dykes PW. Serum CEA testing in the post-operative surveillance of colorectal carcinoma. Br J Cancer 1984;49:689–93.
Staab HJ, Anderer FA, Stumpf E, Fischer R. Carcinoembryonic antigen follow-up and selection of patients for second-look operation in management of gastrointestinal carcinoma. J Surg Oncol 1978;10:273–82.
Wood CB, Ratcliffe JG, Burt RW, Malcolm AJ, Blumgart LH. The clinical significance of the pattern of elevated serum carcinoembryonic antigen (CEA) levels in recurrent colorectal cancer. Br J Surg 1980;67:46–8.
Staab HJ, Anderer FA, Stumpf E, Fischer R. Slope analysis of the postoperative CEA time course and its possible application as an aid in diagnosis of disease progression in gastrointestinal cancer. Am J Surg 1978;136:322–7.
Boey J, Cheung HC, Lai CK, Wong J. A prospective evaluation of serum carcinoembryonic antigen (CEA) levels in the management of colorectal carcinoma. World J Surg 1984;8:279–86.
Tate H. Plasma CEA in the post-surgical monitoring of colorectal carcinoma. Br J Cancer 1982;46: 323–30.
Minton JP, Hoehn JL, Gerber DM,et al. Results of a 400 patient carcinoembryonic antigen second-look colorectal cancer study. Cancer 1985;55:1284–90.
Author information
Authors and Affiliations
About this article
Cite this article
Wang, J.Y., Tang, R. & Chiang, J.M. Value of carcinoembryonic antigen in the management of colorectal cancer. Dis Colon Rectum 37, 272–277 (1994). https://doi.org/10.1007/BF02048166
Issue Date:
DOI: https://doi.org/10.1007/BF02048166