An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer.
An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer.
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DOI：
10.1001/jama.1993.03510080047030
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发表时间：
1993-08
期刊：
影响因子：
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通讯作者：
C. Moertel;T. Fleming;J. Macdonald;D. Haller;J. Laurie;C. Tangen
中科院分区：
文献类型：
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作者：
C. Moertel;T. Fleming;J. Macdonald;D. Haller;J. Laurie;C. Tangen
目的探讨癌胚抗原（CEA）监测对结肠癌术后复发的预测价值。设计：临床数据收集自国家外科辅助试验，其中CEA监测是可选的。设置癌症中心、大学和社区诊所。共1216例结肠癌切除患者，其中1017例（84%）进行了CEA监测。主要观察指标：CEA检测对癌症复发的敏感性和特异性，CEA激发的诊断和手术干预及其最终结果。结果在417例监测的复发患者中，59%的患者先前CEA浓度升高。在600名没有复发的患者中，有16%的患者出现了假阳性检测结果。癌胚抗原检测对肝或腹膜后转移最敏感，对局部、肺或腹膜受累相对不敏感。在115例CEA升高的患者中进行了手术探查，47例复发，通常是肝脏，切除了根治性目的。另一方面，38例CEA浓度正常的患者和23例未监测的患者也接受了这种切除术-通常是为了肺部或局部复发。在所有CEA监测的患者中，2.3%的患者在挽救手术后存活且无疾病超过1年（2.9%的CEA升高患者和1.9%的CEA未升高患者）。在未进行CEA监测的患者中，2.0%的患者在挽救手术后存活且无病超过1年。结论：CEA监测导致的癌症治愈充其量是罕见的。值得怀疑的是，这一小小的收益是否证明了这种干预可能给患者带来的大量美元成本和身体和情绪压力是合理的。
OBJECTIVE To determine the effectiveness of carcinoembryonic antigen (CEA) monitoring in detecting surgically curable recurrence of colon cancer. DESIGN Clinical data were collected from a national surgical adjuvant trial in which CEA monitoring was elective. SETTING Cancer centers, universities, and community clinics. PATIENTS A total of 1216 patients with resected colon cancer, 1017 (84%) of whom had CEA monitoring. MAIN OUTCOME MEASURES Sensitivity and specificity of CEA testing for cancer recurrence and CEA-motivated diagnostic and surgical interventions and their end results. RESULTS Among 417 monitored patients with recurrence, 59% had a preceding elevation of CEA concentration. Sixteen percent of 600 patients without recurrence showed a false-positive test result. Carcinoembryonic antigen testing was most sensitive for hepatic or retroperitoneal metastasis and relatively insensitive for local, pulmonary, or peritoneal involvement. Surgical explorations were performed in 115 patients with CEA elevations, and 47 recurrences, usually hepatic, were resected with curative intent. On the other hand, 38 patients with normal CEA concentrations and 23 patients not monitored also underwent such resections--usually for pulmonary or local recurrence. Of all CEA-monitored patients, 2.3% are alive and disease free more than 1 year after salvage surgery (2.9% of those with CEA elevations and 1.9% of those with no elevations). Of patients with no CEA monitoring, 2.0% are also alive and disease free more than 1 year after salvage surgery. CONCLUSIONS Cancer cures attributable to CEA monitoring are, at best, infrequent. It is questionable whether this small gain justifies the substantial cost in dollars and physical and emotional stress that this intervention may cause for patients.