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.270.8.943
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发表时间：
1993-08-25
影响因子：
120.7
通讯作者：
TANGEN, C
中科院分区：
文献类型：
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作者：
MOERTEL, CG;FLEMING, TR;TANGEN, C
目标。目的探讨癌胚抗原（CEA）监测在检测手术可治愈的结肠癌复发中的作用。临床数据收集自一项国家外科辅助试验，其中CEA监测是选择性的。-癌症中心、大学和社区诊所。-共1216例结肠癌切除术患者，其中1017例（84%）有CEA监测。主要结果测量。- CEA检测对癌症复发的敏感性和特异性，以及CEA驱动的诊断和手术干预及其最终结果。在417例复发患者中，59%的患者既往CEA浓度升高。在600名没有复发的患者中，有16%的人出现了假阳性的检测结果。癌胚抗原检测对肝脏或腹膜后转移最敏感，对局部、肺或腹膜转移相对不敏感。115例CEA升高的患者进行了外科探查，47例复发，通常是肝脏，被切除以达到治愈目的。另一方面，38名CEA浓度正常的患者和23名未监测的患者也进行了这种切除，通常是肺部或局部复发。在所有CEA监测的患者中，2.3%的患者在挽救性手术后1年以上存活且无疾病（2.9%的CEA升高患者和1.9%的CEA无升高患者）。在没有CEA监测的患者中，2.0%的患者在抢救手术后1年以上仍然存活且无疾病。-由于CEA监测而治愈的癌症最多是很少的。值得怀疑的是，这一点小小的收获是否证明了这种干预可能给患者带来的巨大的美元成本和身体和精神压力是合理的。
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.