The value of routine serum carcino-embryonic antigen measurement and computed tomography in the surveillance of patients after adjuvant chemotherapy for colorectal cancer
The value of routine serum carcino-embryonic antigen measurement and computed tomography in the surveillance of patients after adjuvant chemotherapy for colorectal cancer
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DOI：
10.1200/jco.2004.05.041
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发表时间：
2004-04-15
影响因子：
45.3
通讯作者：
Oates, J
中科院分区：
文献类型：
--
作者：
Chau, I;Allen, MJ;Oates, J
目的评价常规癌胚抗原(CEA)和胸部、腹部、盆腔CT检查作为结直肠癌(CRC)随访策略的可行性。化疗结束后，定期就诊5年。分别于化疗后12个月、24个月行胸部、腹部、盆腔CT检查。结果1993~1999年间，共纳入530例患者。中位随访期为5.6年。154例患者观察到疾病复发。根据症状(n=65)、癌胚抗原(n=45)、CT(n=49)和其他(n=9)发现复发。14名经CT检查复发的患者同时伴有CEA升高，这两组患者都包括在内。从复发时间来看，CT检测组的存活率高于有症状组(P=0.0046)。33名患者(21%)对复发进行了潜在的根治手术，并且比那些没有进行手术的患者有更好的生存(P<；0.00001)。在接受肝、肺转移切除的患者中，CT组13例(26.5%)，CEA组8例(17.8%)，症状组仅2例(3.1%)(CT v症状性，P=.001；CEA v症状性，P=.015)。结论CT和CEA是II、III期结直肠癌术后随访的重要组成部分。(C)2004年，由美国临床肿瘤学会提供。
Purpose This analysis aims to evaluate routine carcino-embryonic antigen (CEA) and computed tomography (CT) of thorax, abdomen, and pelvis as part of protocol-specified follow-up policy for colorectal cancer (CRC).Patients and Methods Patients with resected stage II and III CRC were randomly assigned to bolus fluorouracil/leucovorin or protracted venous infusion fluorouracil. Following completion of chemotherapy, patients were seen in clinic at regular intervals for 5 years. CEA was measured at each clinic visit, and CT of thorax, abdomen, and pelvis was performed at 12 and 24 months after commencement of chemotherapy.Results Between 1993 and 1999, 530 patients were recruited. The median follow-up was 5.6 years. Disease relapses were observed in 154 patients. Relapses were detected by symptoms (n = 65), CEA (n = 45), CT (n = 49), and others (n = 9). Fourteen patients, whose relapses were detected by CT, had a concomitant elevation of CEA and were included in both groups. The CT-detected group had a better survival compared with the symptomatic group from the time of relapse (P = .0046). Thirty-three patients (21%) proceeded to potentially curative surgery for relapse and enjoyed a better survival than those who did not (P < .00001). For patients who underwent hepatic or pulmonary metastatic resection, 13 (26.5%) were in the CT group, eight (17.8%) in the CEA group, and only two (3.1%) in the symptomatic group (CT v symptomatic, P < .001; CEA v symptomatic, P = .015).Conclusion Surveillance CT and CEA are valuable components of postoperative follow-up in stage II and III colorectal cancer. (C) 2004 by American Society of Clinical Oncology.