Serum Carcinoembryonic Antigen Monitoring After Curative Resection for Colorectal Cancer: Clinical Significance of the Preoperative Level
Serum Carcinoembryonic Antigen Monitoring After Curative Resection for Colorectal Cancer: Clinical Significance of the Preoperative Level
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DOI：
10.1245/s10434-009-0625-z
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发表时间：
2009-11-01
影响因子：
3.7
通讯作者：
Jun, Soo Han
中科院分区：
文献类型：
--
作者：
Park, In Ja;Choi, Gyu-Seog;Jun, Soo Han
我们评估了术前血清癌胚抗原（CEA）作为结直肠癌的预后因素，并确定了何时监测该标志物是有用的。在1，263例结直肠癌根治性切除术患者中，术前测定了血清CEA，术后前2年每隔3个月测定一次，此后每隔6个月测定一次。平均随访48个月（1-156个月），术前血清CEA水平高者5年无瘤生存率低（P < 0.0001）。在肿瘤复发的患者中，38.5%的患者随访时血清CEA水平较高。术后血清CEA水平高的患者数量超过术前水平高的患者数量。术前和随访时高CEA水平是肿瘤复发的独立预后因素（分别为P = 0.003和P < 0.001）。在术前血清CEA水平高的患者中，CEA监测的阳性预测值（PPV）为92.3%，阴性预测值（NPV）为96.1%。术后血清CEA升高与肿瘤复发诊断之间的平均间隔[诊断间隔（DI）]为2.5个月（范围5-17个月）。18.8%的肿瘤复发患者DI为0。术前和随访时血清CEA水平高是结直肠癌的预后因素。当患者术前血清CEA水平较高时，术后血清CEA监测最为有效。考虑到18.8%的患者DI为0，可能会改变当前CEA监测计划。
We evaluated preoperative serum carcinoembryonic antigen (CEA) as a prognostic factor for colorectal cancer and determined when surveillance of this marker was useful.Serum CEA was measured preoperatively in 1,263 patients who underwent curative resection for colorectal cancer at 3-month intervals for the first 2 postoperative years and at 6-month intervals thereafter. Mean follow-up was 48 months (range 1-156 months).The 5-year disease-free survival was less in patients with a high preoperative serum CEA level (P < 0.0001). Among patients with a tumor recurrence, 38.5% had high follow-up serum CEA levels. The number of patients with high postoperative serum CEA levels exceeded the number of patients with high preoperative levels. High preoperative and follow-up serum CEA levels were independent prognostic factors for tumor recurrence (P = 0.003 and P < 0.001, respectively). In patients with high preoperative serum CEA levels, CEA surveillance had a 92.3% positive predictive value (PPV) and a 96.1% negative predictive value (NPV). The mean interval between postoperative serum CEA elevation and the diagnosis of a tumor recurrence [diagnostic interval (DI)] was 2.5 months (range 5-17 months). The DI was 0 in 18.8% of patients with a tumor recurrence.High serum CEA levels preoperatively and at follow-up are prognostic factors for colorectal cancer. Postoperative serum CEA surveillance is used most effectively when patients have high preoperative serum CEA levels. Considering the DI of 0 in 18.8% of the patients, the current CEA surveillance schedule might be changed.