Abnormal CEA Level Research Articles

Long-term outcomes of intraoperative chemotherapy with 5-FU for colorectal cancer patients receiving curative resection (IOCCRC): a randomized, multicenter, prospective, phase III trial.

We aimed to compare combined intraoperative chemotherapy and surgical resection with curative surgical resection alone in colorectal cancer patients. We performed a multicenter, open-label, randomized, phase III trial. All eligible patients were randomized and assigned to intraoperative chemotherapy and curative surgical resection or curative surgical resection alone (1:1). Survival actualization after long-term follow-up was performed in patients analyzed on an intention-to-treat basis. From January 2011 to January 2016, 696 colorectal cancer patients were enrolled and randomly assigned to intraoperative chemotherapy and radical surgical resection (n=341) or curative surgical resection alone (n=344). Intraoperative chemotherapy with surgical resection showed no significant survival benefit over surgical resection alone in colorectal cancer patients (3-year DFS: 91.1% vs. 90.0%, P=0.328; 3-year OS: 94.4% vs. 95.9%, P=0.756). However, colon cancer patients benefitted from intraoperative chemotherapy, with a relative 4% reduction in liver and peritoneal metastasis (HR=0.336, 95% CI: 0.148-0.759, P=0.015) and a 6.5% improvement in 3-year DFS (HR=0.579, 95% CI: 0.353-0.949, P=0.032). Meanwhile, patients with colon cancer and abnormal pretreatment CEA levels achieved significant survival benefits from intraoperative chemotherapy (DFS: HR=0.464, 95% CI: 0.233-0.921, P=0.029 and OS: (HR=0.476, 95% CI: 0.223-1.017, P=0.049). Intraoperative chemotherapy showed no significant extra prognostic benefit in total colorectal cancer patients who underwent radical surgical resection; however, in colon cancer patients with abnormal pretreatment serum CEA levels (> 5ng/ml), intraoperative chemotherapy could improve long-term survival.

Development of novel models for predicting mismatch repair protein deficiency and relevant disease-free survival in colorectal cancer patients.

DNA mismatch repair (MMR) protein deficiency has attached more attention for its potential to be a biomarker of immunotherapy for colorectal cancer (CRC) patients. However, clinical models involving the expression status of MMR protein are rare. Herein, we sought to develop two clinical models (a diagnostic model for the prediction of MMR status and a prognostic model for the prediction of disease-free survival) for CRC patients. A total of 582 CRC patients were finally included. There were 53 patients with deficient expression of MMR protein. The differences between the deficient MMR (dMMR) group and the proficient MMR (pMMR) group were analyzed. Compared to pMMR patients, those with dMMR status were younger and had better pathological features (depth of invasion, lymph node metastasis, distant metastasis, pathological stage, perineuronal invasion, and PLT level) and disease-free survival (DFS). The tumor location of the left colon, adenocarcinoma, and abnormal PLT level were identified as the independent predictors for pMMR. Based on these data, we developed the diagnostic model using Logistic regression analysis. It showed a satisfactory accuracy (AUC = 82.3% in the derivate set; AUC = 73.6% in the validation set). Furthermore, pMMR, poorer differentiation, perineuronal invasion, distant metastasis, lower hemoglobin level, and abnormal CEA level were established as the independent prognostic factors of poorer DFS. Based on them, a prognostic model with valuable performance (1-year AUC = 75.5%/3-year AUC = 76.9% in the derivate set; 1-year AUC = 72.3%/3-year AUC = 73.8% in the validation set) was developed. Our diagnostic and prognostic models could identify CRC patients at risk for pMMR protein expression and disease recurrence. It may contribute to improving the diagnosis and treatment of CRC patients at an individual level.

Abstract P1-08-06: Development of an aritifical neural network model and comparison with nomogram for prediction of pathological complete response after neoadjuvant chemotherapy in breast cancer

Abstract Purpose: Identifying patients who may benefit from neoadjuvant chemotherapy will facilitate personalized treatment regarding chemotherapy and surgery. This study compares the predictive performance of an artificial neural network algorithm with nomogram to predict pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in patients with advanced breast cancer.. Methods: Medical records of 359 patients with advanced breast cancer who received NAC prior to surgical resection between January 2017 and December 2019 were retrospectively reviewed. Random over sampling method was used to overcome data imbalance and random sampling method to divide patients into training and test sets at a split ratio of 7:3. Univariate and multivariate regression analyses were used to develop a nomogram and a machine learning model based on artificial neural network. Performance of the two models were evaluated using the validation sets in terms of area under the receiver operating characteristic curve (AUC).. Results: Multivariate logistic regression analysis showed that high level of estrogen receptor (ER) (OR 0.84, p < 0.001), positive human epidermal growth factor receptor 2 (HER2) status (OR 1.25, p < 0.001), complete response on magnetic resonance imaging (MRI) (OR 1.62, p < 0.001), abnormal CEA level after NAC (OR 0.86, p = 0.051), and abnormal CA15-3 level after NAC (OR 0.87, p = 0.074) were independent predictors of pCR. A nomogram and a neural network model to predict pCR were developed using the five predictors. Validation test showed AUCs of 0.789 [95 % confidence interval (CI), 0.707-0.871] for the nomogram and 0.876 [95 % CI, 0.808-0.943] for the neural network model.. Conclusion: We developed a nomogram and an artificial neural network (ANN)-based machine learning model to predict pCR after NAC. Both models showed excellent performance, but the ANN model performed better in terms of accuracy and discrimination. Machine-learning algorithms hold promise in medical application and provide better prediction than nomogram. Citation Format: Hee-Chul Shin, Ji-Jung Jung, Eun-Kyu Kim, Eunyoung Kang. Development of an aritifical neural network model and comparison with nomogram for prediction of pathological complete response after neoadjuvant chemotherapy in breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-08-06.

Correlation Between the Glasgow Prognostic Score and the Serum Cytokine Profile in Taiwanese Patients with Colorectal Cancer.

The Glasgow Prognostic Score and circulating cytokine levels are related to the prognosis of colorectal cancer and the severity of chronic inflammation. The association between the Glasgow Prognostic Score and circulating cytokines in colorectal cancer remains unclear. The levels of 10 circulating cytokines (TNF-α, TGF-β, IFN-γ, IL-1β, IL-4, IL-6, IL-10, IL-12, IL-13, and IL-23) were measured in 128 patients with colorectal cancer. The relationship between the Glasgow Prognostic Score, clinicopathologic variables, and cytokine levels was assessed by univariate and multivariate logistic regression analyses. The correlation among cytokines was also examined. Patients with advanced stage colorectal cancer had lower levels of albumin (P = 0.003), higher levels of C-reactive protein (CRP; P < 0.001), carcinoembryonic antigen (CEA; P < 0.001), interferon (IFN)-γ (P < 0.001), and interleukin (IL)-10 (P = 0.006), and shorter survival outcomes (P < 0.001). Patients with a high Glasgow Prognostic Score (1 or 2) had lower 5-year progression-free survival and poor overall survival (log-rank P < 0.001). A high Glasgow Prognostic Score was significantly correlated with abnormal CEA levels (CEA > 5 ng/mL, P = 0.033), and higher levels of tumor necrosis factor (TNF)-α (TNF-α ⩾ 53.9 pg/mL, P = 0.035) and IL-10 (IL-10 ⩾ 75.95 pg/mL, P = 0.008). TNF-α, IFN-γ, IL-1β, IL-4, IL-6, IL-10, IL-13, and IL-23 were significantly correlated with each other (all P < 0.05). Only IL-10 was correlated with abnormal CEA levels (P < 0.001). The Glasgow Prognostic Score and level of circulating cytokines have an intergroup correlation, and there is a close association among cytokines in colorectal cancer.

577P - Intraoperative chemotherapy with 5-FU for colorectal cancer patients receiving curative resection (IOCCRC): A randomized, multicenter, prospective, phase III trial

BackgroundWhether colorectal cancer patients who undergo radical resection can benefit from intraoperative chemotherapy is still under debate. Therefore, we aimed to compare the results of intraoperative chemotherapy combined with radical surgical resection with surgical resection alone in colorectal cancer patients. MethodsThis is a multicenter, open-label, randomized, non-inferiority, phase 3 trial. All patients who had been histologically confirmed and could receive radical resection with no sign of distance metastasis, were enrolled. The patients were randomized to receive intraoperative chemotherapy with radical surgical resection, or radical surgery resection alone (1:1). Intraoperative chemotherapy included portal vein chemotherapy (200mg/m2 5-FU), intraluminal chemotherapy (1000mg/m2 5-FU), and intraperitoneal chemotherapy (300mg/m2 5-FU). The primary endpoint was 3-year disease-free survival (DFS) analyzed on an intention-to-treat basis with an α of 0.05 and a power of 80%. ResultsFrom January 2011 to January 2016, 685 colorectal cancer patients were enrolled and randomly assigned to intraoperative chemotherapy with radical surgical resection (n=341), or surgical resection alone (control group, n=344). After a median follow-up of 65.1 months, 21 patients in the intraoperative chemotherapy group and 26 patients in the control group had died. 39 patients in the intraoperative chemotherapy group and 47 patients in the control group experienced distance metastasis or local recurrence. Intraoperative chemotherapy showed no significant benefit for colorectal cancer patients who underwent radical resection (p=0.334). Subgroup analyses showed that patients with pre-treatment abnormal CEA level (> 5ng/ml) could benefit from intraoperative chemotherapy (p=0.026, HR:0.516). The patients with pre-treatment normal CEA level (< 5ng/ml) still did not benefit from intraoperative chemotherapy (p=0.298). ConclusionsIntraoperative chemotherapy could improve 3-years DFS of colorectal cancer patients whose pre-treatment serum CEA level was higher than 5ng/ml. Clinical trial identificationNCT01465451. Legal entity responsible for the studyZhizhong Pan. FundingSun Yat-sen University 5010 funding. DisclosureAll authors have declared no conflicts of interest.

Associations between epidermal growth factor receptor gene mutation and serum tumor markers in advanced lung adenocarcinomas: a retrospective study.

To investigate the associations between epidermal growth factor receptor (EGFR) gene mutations and serum tumor markers in advanced lung adenocarcinomas. We investigated the association between EGFR gene mutations and clinical features, including serum tumor marker levels, in 97 advanced lung adenocarcinomas patients who did not undergo the treatment of EGFR tyrosine kinase inhibitors. EGFR gene mutation was detected by real-time PCR at exons 18, 19, 20, and 21. Serum tumor marker concentrations were analyzed by chemiluminescence assay kit at the same time. EGFR gene mutations were detected in 42 (43%) advanced lung adenocarcinoma patients. Gender (P=0.003), smoking status (P=0.001), and abnormal serum status of carcinoembryonic antigen (CEA, P=0.028) were significantly associated with EGFR gene mutation incidence. Multivariate analysis showed the abnormal CEA level in serum was independently associated with the incidence of EGFR gene mutation (P=0.046) with an odds ratio of 2.613 (95% CI: 1.018-6.710). However, receiver operating characteristic (ROC) curve analysis revealed CEA was not an ideal predictive marker for EGFR gene mutation status in advanced lung adenocarcinoma (the area under the ROC curve was 0.608, P=0.069). EGFR gene mutation status is significantly associated with serum CEA status in advanced lung adenocarcinmoas. However, serum CEA is not an ideal predictor for EGFR mutation.

Abstract 3000: New epigenetic biomarker for colorectal cancer.

Abstract DNA is released and circulate in the blood of cancer patients. Epigenetic changes in the levels of circulating DNA has been associated with tumor burden and malignant progression. Public physical examination recommends occult fecal blood test for colorectal cancer (CRC) screening but its false positive rate is too high. As for serum marker for CRC including CEA and CA19-9, their sensitivity are nor satisfactory especially in early stage CRC patients and therefore, the potential use of circulating DNA for CRC screening has emerged. The aim of this study is the clinical utility of cell-free DNA as blood biomarkers. Based on our previous report about the new methylation markers for CRC on a genome-wide scale, we selected 4 methylation markers positive for CRC and established CRC screening panel. First, we collected plasma DNA from blood samples of 100 CRC patients preoperatively and 50 age-matched healthy volunteers. Then, we performed pyrosequence about plasma DNA after bisulfite treatment. Using this cancer screening panel, 82 CRC patients were positive for at least 1 marker. On the other hand, no control samples were positive for any markers and therefore, sensitivity and specificity using this cancer screening panel for CRC were 82.0% and 100%, respectively. According to TNM classification, positive rate for earlier stage including 1 and 2 patients were lower than advanced CRC patients. Similarly, the patients with abnormal serum CEA level harbored higher positive rate for the cancer panel, but serum CA19-9 level which is another CRC marker was not associated with positive rate. Two markers of the panel were relatively high in old age although they were negative for control samples. Considering that no hypermethylation was detected in control samples, this cancer panel is superior to preexisting blood tumor markers for CRC and available for cancer screening. Citation Format: Kiyoko Takane, Yutaka Midorikawa, Koichi Yagi, Ayako Sakai, Hiroyuki Aburatani, Tadatoshi Takayama, Atsuhi Kaneda. New epigenetic biomarker for colorectal cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3000. doi:10.1158/1538-7445.AM2013-3000

Impact of the type and modalities of preoperative chemotherapy on the outcome of liver resection for colorectal metastases.

3519 Background: Prognostic factors of survival have been extensively reported after resection of colorectal liver metastases. However, a specific analysis of patients (pts) submitted to preoperative chemotherapy (PCT), with the real impact of type and modalities of treatment on patient outcome is lacking. Methods: From Jan 1995 to June 2010, 10,436 pts from 151 centers and 39 countries were entered into LiverMetSurvey an international, prospective registry designed to assess the efficacy of multimodality treatment for colorectal liver metastases (CLM). Among this cohort, 4,444 pts (49.9%) received PCT. There were 38% of men and mean age was 61. Prognostic factors of overall (OS) and disease-free (DFS) survivals were determined including characteristics of primary tumor, of metastasis, initial resectability, type and duration of PCT, using multivariate analyses. Results: Metastases were initially resectable in 63%, originated in the rectum in 33% and were synchronous in 69% of pts. 33% pts had ≥ 3 CLM, bilateral in 49% and with a size > 5cm in 30%. PCT was oxaliplatin-based in 36%, irinotecan-based in 12% and both drug-based in 3% of pts. Targeted therapy was used in combination with oxaliplatin (11%), irinotecan (9%) or both (1%). Median, 5-year and 10-year OS were 43 months, 39%, and 23%, respectively. Median, 5-year and 10-year DFS were 17 months, 21%, and 15%, respectively. Variables independently associated with poor OS included metastatic primary lymph nodes (p=0.005), abnormal CEA levels (p<0.001), metastases >3 (p=0.006), concomitant extrahepatic metastases (p<0.001), tumoral progression while on PCT (p=0.03), the use of >1 line of PCT (p<0.001) and R2 resection (p<0.001). The use of > 6 cycles of PCT was additionally associated to a poor DFS (p=0.004). Neither the type of conventional PCT nor the combined use of targeted agents independently influenced outcome following resection. Conclusions: PCT is used in half of pts overall, 63% of whom with initially resectable CLM. The type of PCT does not influence the outcome provided that resection is achieved. However, the shorter is the PCT and the more limited is the number of lines, the best is the survival after surgery.

Low preoperative serum albumin in colon cancer: a risk factor for poor outcome

The number of colon cancer patients is increasing worldwide. Malnutrition and comorbidities are frequently associated with these patients. The relationships between the preoperative malnutrition and the outcomes of colon cancer patients are unclear; this study aimed to clarify these issues. A total of 3,849 consecutive colon cancer patients were enrolled in an analysis of short-term outcomes and 2,529 patients were included in an analysis of the long-term outcomes. These patients were divided into the hypoalbuminemic and normal groups according to the definition of hypoalbuminemia (serum albumin < 35 g/L). Advanced age, female gender, abnormal CEA levels, right colon or large tumors, mucinous adenocarcinoma, poor differentiation, stage II cancer, TNM advancing T stage, old cardiovascular accident, diabetes, and liver cirrhosis were more likely to be associated with hypoalbuminemia. Hypoalbuminemic patients had a higher rate of postoperative mortality and morbidity, including complications related to wounds, lungs, the urinary system, and anastomosis. The 5-year overall survival rates of patients with normal albumin and hypoalbuminemia were 78.0% and 60.0%, respectively (P < 0.0001), and the 5-year relapse-free survival rates were 78.9% and 73.5%, respectively (P = 0.0042). In a multivariate analysis, the albumin level was also significantly correlated with 5-year overall survival (<35 vs. ≥ 35, HR 1.75; 95% CI 1.49-2.08) and 5-year relapse-free survival (<35 vs. ≥ 35, HR 1.28; 95% CI 1.04-1.56). Hypoalbuminemia is a predictor of poor surgical outcomes of colon cancer and is a poor prognosis factor for long-term survival of colon cancer after curative operation.

Persistent High Postoperative Carcinoembryonic Antigen in Colorectal Cancer Patients- Is it Important?

INTRODUCTION:Evaluation of pre- and postoperative serum CEA levels together has seldom been assessed for the prognosis of colorectal cancer (CRC). OBJECTIVE: To concurrently evaluate pre- and postoperative CEA as factors of relapse and survival.METHODS:The study consisted of 114 patients who had undergone surgery from February 2002 to June 2006 for CRC. All patients were classified into four groups according to their pre- and postoperative CEA levels. Data obtained for clinicopathologic parameters, lymph node metastasis, stage, recurrence, and CEA levels were analyzed to determine their association with survival. Multivariate analysis by the Cox proportional hazard regression model was performed to identify the independent prognostic factors associated with survival.RESULTS:Postoperative serum CEA levels remained high in Group 3 (n = 32). Nineteen patients (59.3%) demonstrated a detectable cause for persistent high CEA levels, while the reasons for those in the other thirteen patients (40.6%) remained obscure. Abnormal preoperative CEA levels significantly correlated with the depth of tumor invasion, lymph node metastasis, TNM stage, and recurrence (p < 0.05). Abnormal postoperative CEA levels were significantly related to the depth of tumor invasion, TNM stage, and postoperative relapse (p<0.05). Patients in Group 3 demonstrated the worst survival rate. Abnormal postoperative CEA levels, lymph node metastasis, and location of the tumor were independent prognostic factors for survival.CONCLUSION:The survival of patients with high postoperative CEA levels due to unknown reasons may be extended if they are exhaustively tested with sensitive diagnostic methods and treated at an early stage.

Clinicopathologic Characteristics of Left-Sided Colon Cancers with High Microsatellite Instability

Background : High microsatellite instability (MSI-H) colorectal carcinomas (CRCs) with numerous mutations in the microsatellite sequence are characterized by a right-sided preponderance, frequent peritumoral and intratumoral lymphocytic infiltration, and frequent mucin production. However, no study has correlated anatomic site and type of genetic changes with clinicopathologic changes. Methods : We analyzed the histopathologic features of 135 MSI-H CRCs and compared them to 140 microsatellite stable (MSS) CRCs. Histopathologic changes in MSI-H were further analyzed according to anatomic sites and genetic changes. Results : MSI-H CRCs showed previously reported clinicopathologic findings; a right-sided preponderance, an increased number of mucinous carcinomas, and peritumoral lymphoid reactions (p<0.001 for each variable). Increased serum CEA levels showed an MSS CRC preponderance (p=0.013). We further analyzed the histologic differences between right- and left-sided MSI-H tumors. We found that MSI-H CRCs on both sides had similar clinicopathologic findings, except for higher tumor stage (p=0.048) and less frequent abnormal CEA levels in left-sided MSI-H tumors (p=0.027). We found that not all clinicopathologic features were different between hereditary nonpolyposis colorectal cancers (HNPCCs) and sporadic MSI-H CRCs. Conclusions : These findings indicate that MSI-H CRCs of the left colon have similar clinicopathologic characteristics as right-sided MSI-H CRCs. We did not find any significant clinicopathological difference between HNPCCs and sporadic MSI-H CRCs.

Role of early serial change in serum carcinoembryonic antigen levels as a predictive marker for gefitinib sensitivity in Japanese patients with non-small cell lung cancer

17029 Background: The aim was to evaluate the utility of an early change in CEA levels for predicting subsequent gefitinib sensitivity in NSCLC patients. Methods: CEA level was measured before and after the beginning of gefitinib treatment (day1) in 110 (91%) of consecutive 121 patients. Daily decline rate of CEA was simply defined for each patient as follows: (M0−Mx)/Dx/M0*100(%), with the baseline level (M0), the level on days × (Mx), and days from day 1 to day X (Dx). Results: Patient characteristics were as follows; median age: 62, M/F: 61/39%, Ad/others: 84/16% and smoker: 66%. Objective response rate and disease control rate were 28.2% and 74.5%, respectively. Median baseline CEA level was 12.6 ng/mL. Daily decline rate of CEA level from day 1 to the date on which confirmation of objective response was performed significantly differed among the response categories; median decreases in percentages were 0.86, 0.06, and −1.52%/day in CR/PR, SD, and PD patients, respectively (p &lt; 0.0001). This association was more evident in the 70 patients with abnormal baseline CEA level (≥5.0 ng/mL). A cutoff level of −0.58% decrease per day most accurately reflected tumor shrinkage in the 70 patients, with sensitivity, specificity, and positive and negative predictive values for disease control (CR/PR/SD) of 89.1, 73.3, 92.5 and 64.7%, respectively. Among 49 (41%) patients reassessed CEA levels within the first 2 weeks since day 1, 41 could continue the treatment without any disease progression during this period. The daily decline rate in this early phase tended to differ between the responses (median; 1.57 and −0.50% in CR/PR/SD and PD, respectively; p = 0.0975), and less exactly reflected disease control with sensitivity, specificity, and positive and negative predictive values of 82.1, 40.0, 88.5, and 28.6%, respectively when a cutoff of −0.58% was applied. Conclusion: Degree of change in CEA level from the start of gefitinib treatment to confirmation of objective response significantly correlated with tumor shrinkage. As a predictor for obtaining disease control, monitoring early change in CEA level might be useful due to high sensitivity and positive predictive value, in spite of low specificity for detection of PD patients. No significant financial relationships to disclose.

16. FDG-PET in the Detection of Recurrence in Colorectal Cancer Based on Rising CEA Level. Experience in 72 Patients

Purpose: A rising CEA level after the resection of colorectal cancer is an early indicator of tumour recurrence. However, conventional imaging techniques have limited sensitivity for detecting recurrent disease in such patients. Our group has evaluated the role of Positron Emission Tomography with 18F-Fluorodeoxiglucose (FDG-PET) in this clinical situation.Material and Methods: Seventy-two patients with abnormal CEA levels and normal results of conventional methods of tumour detection were studied with FDG-PET. The PET results were compared with pathologic findings (n = 25) long-term radiological (n = 9) and clinical follow-up (n = 38). Influence of PET findings in therapeutic management was also considered in this study.Results: PET detected lesions in 63/72 patients (87.1%). Metabolic imaging showed metastases in the liver (44.1%), ganglionar nodes (27.5%), local recurrence (20.4%) and lung metastases (8%). Overall, the sensitivity of PET was 94.4%, specificity was 83.3%, the positive-predictive value was 97.1%, the negative-predictive value was 71.4% and the diagnostic accuracy was 92.8%. FDG-PET findings change therapeutic decision in 68/72 patients (94.1%)Conclusion: When conventional examinations are normal, FDG-PET is a valuable imaging tool in patients who have rising CEA level after colorectal surgery. Metabolic imaging represents a very cost-effectiveness diagnostic procedure in this clinical situation, avoiding unnecessary invasive techniques.

Evaluation of the behavior of carcinoembryonic antigen in cirrhotic patients.

Benign liver diseases are a cause of increased serum levels of CEA. We studied the behavior of CEA in 86 patients with liver cirrhosis who underwent extensive clinical and laboratory evaluation. We found abnormal CEA levels in 38.4% of the patients (28.6% Child's grade A, 40.6% Child's B, and 42.4% Child's C) with a mean of 4.75 ng/ml. Significant differences were found between patients and controls. There was a trend towards higher levels of CEA in more severe cirrhosis according to Child's classification, although this was not significant. We found significant correlations between CEA and some liver tests, including glycocholic acid (r = 0.264., p = 0.012), a marker of severity in liver diseases. The increase of CEA in these patients is probably due to alterations in its metabolic processing caused by hepatocellular dysfunction. Moderate elevations of serum CEA can be expected in cirrhotic patients independently of malignancy.

CEA Carcinoma Monitoring by Two RIA

A comparison was made of the accuracy of two CEA assays by RIA in diagnosis of different cancers. The basis of the study was a consecutive series of 76 patients thought to have bladder, colon, stomach or pancreas pathology, or a space occupying lesion; cancer was the final diagnosis in 46. The RIA assay method of Hoffman‐La Roche and the CIS (Sorin) direct double antibody RIA assay were used for CEA detection. Results were correlated with the clinical and follow up evaluation. Samples were taken before operation, immediately after, and 1,2, 3 and 6 months after. Ninety eight per cent of the patients with a negative diagnosis for cancer had no detectable CEA, or levels below 2.5 ng/ml with Roche assay, and below 8 ng/ml with CIS assay. Abnormal CEA levels were found in the different groups as follows: with the Roche assay bladder—22%, colon—45%, stomach—23%, and pancreas—40%, with the CIS assay bladder—66%, colon—61%, stomach—38% and pancreas—60%. We conclude that neither test is ideal for clinical purposes although the CIS assay is probably more sensitive than the Roche assay. Both assays are useful in the monitoring and detection of recurrent tumors.