Intensive Risk-Adjusted Follow-up With the CEA, TPA, CA19.9, and CA72.4 Tumor Marker Panel and Abdominal Ultrasonography to Diagnose Operable Colorectal Cancer Recurrences Effect on Survival
Intensive Risk-Adjusted Follow-up With the CEA, TPA, CA19.9, and CA72.4 Tumor Marker Panel and Abdominal Ultrasonography to Diagnose Operable Colorectal Cancer Recurrences Effect on Survival
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DOI：
10.1001/archsurg.2010.251
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发表时间：
2010-12-01
影响因子：
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通讯作者：
Miccoli, Paolo
中科院分区：
文献类型：
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作者：
Nicolini, Andrea;Ferrari, Paola;Miccoli, Paolo
假设：密集的风险调整后的随访可改善接受结直肠癌手术的患者肿瘤复发的可切除性和更好的总体生存。设计：长期观察性单中心研究。地点：意大利比萨大学。患者：108名接受结直肠癌手术的无病患者接受了血清CEA、TPA、CA19.9和CA72.4肿瘤标记物(TM)面板和腹部超声的长期随访。主要观察指标：TMS、腹部超声以及腹部和胸部计算机断层扫描(CT)的敏感性和特异性；结果：22例无症状性结直肠癌患者共复发32次。CEA、TPA、CA19.9、CA72.4和TM的敏感度分别为46.9%、34.4%、9.4%、9.4%和81.0%，复发前平均(SD)时间分别为4.3(4.8)、4.1(4.7)、8.3(10.9)、5.0(7.0)和5.3(5.8)个月。腹部和胸部CT敏感性为100.0%。在86例无复发患者中，TM组和所有组标志物的特异度为100.0%，腹部B超、腹部CT和骨骼CT的特异度分别为99.9%、99.0%和100.0%。8例未行二线手术的复发患者首次复发后的中位生存期为16个月(3~48个月)。在14例接受转移切除术的患者中，首次复发后的中位生存期为37个月(范围为12-187个月；P=0.03)。在108名患者中，累积的5年总生存率为88.7%。结论：使用CEA、TPA、CA19.9和CA72.4TM面板和腹部超声进行长期密集的风险调整监测可以早期发现大多数复发。然后，患者可以接受根治性转移瘤切除术，潜在地提高总存活率。
Hypothesis: Intensive risk-adjusted follow-up leads to improved resectability of tumor recurrences and better overall survival among patients who have undergone surgery for colorectal cancer.Design: Long-term observational single-center study.Setting: University of Pisa, Pisa, Italy.Patients: One hundred eight disease-free patients who had undergone surgery for colorectal cancer were submitted to long-term follow-up with the serum CEA, TPA, CA19.9, and CA72.4 tumor marker (TM) panel and abdominal ultrasonography.Main Outcome Measures: Sensitivities and specificities of TMs, abdominal ultrasonography, and abdominal and chest computed tomography (CT); the median survival among patients operated on and those not operated on and the cumulative 5-year overall survival among the entire group.Results: Twenty-two patients with asymptomatic colorectal cancer recurred 32 times. The CEA, TPA, CA19.9, CA72.4, and TM panel sensitivities were 46.9%, 34.4%, 9.4%, 9.4%, and 81.0%, respectively, and the mean (SD) lead times before confirmation of recurrence were 4.3 (4.8), 4.1 (4.7), 8.3 (10.9), 5.0 (7.0), and 5.3 (5.8) months, respectively. Abdominal and chest CT sensitivities were 100.0%. Among 86 patients without recurrence, specificities of the TM panel and all panel markers were 100.0%, while specificities of abdominal ultrasonography, abdominal CT, and skeletal CT were 99.9%, 99.0%, and 100.0%, respectively. The median survival after first recurrence was 16 months (range, 3-48 months) for 8 patients with recurrence who did not undergo second-line surgery. Among 14 remaining patients who underwent metastasectomy, the median survival after first recurrence was 37 months (range, 12-187 months; P = .03). Among the entire group of 108 patients, the cumulative 5-year overall survival was 88.7%.Conclusions: Long-term intensive risk-adjusted monitoring using the CEA, TPA, CA19.9, and CA72.4 TM panel and abdominal ultrasonography allows early detection of most recurrences. Patients can then undergo radical metastasectomy, with potentially improved overall survival.