Carcinoembryonic Antigen Titers Research Articles

Prognostic impact of perioperative change in serum p53 antibody titers in esophageal squamous cell carcinoma.

The clinical effectiveness of tumor markers for estimating prognosis in esophageal squamous cell carcinoma (ESCC) remains unclear. We assessed the clinical impact of changes in perioperative serum p53 antibodies (s-p53-Abs) titers in ESCC. From January 2011 to March 2021, 249 patients were enrolled in this study. Titers of s-p53-Abs were measured before the initial treatment and 3months after esophagectomy. Patients were divided into a s-p53-Abs decreased or unchanged group (Group D, n = 217) and an increased group (Group I, n = 32). Short- and long-term outcomes were compared between the groups. There was no correlation between the changes in squamous cell carcinoma antigen and carcinoembryonic antigen titers and recurrence site, number of recurrent lesions, and prognosis. However, the recurrence rate was significantly higher in Group I than in Group D (53.1% vs. 28.6%, p = 0.008), especially for distant organ recurrence (37.5% vs. 18.4%, p = 0.019). Furthermore, the rate of polyrecurrence was higher in Group I than in Group D (34.4% vs. 14.3%, p = 0.009). Recurrence-free survival (RFS) was significantly worse in Group I than in Group D (median survival time, 21.2months vs. 36.7months, p = 0.015). Multivariate analysis revealed that lymphatic vessel infiltration (hazard ratio [HR], 1.721; 95% CI 1.069-2.772; p = 0.026), blood vessel infiltration (HR, 2.348; 95% CI 1.385-3.982; p = 0.002), advanced pathological stage (≥ III) (HR, 3.937; 95% CI 2.295-6.754; p < 0.001), and increased s-p53-Abs titers (HR, 2.635; 95% CI 1.488-4.667; p = 0.001) were independent predictors of poor RFS. Elevation of s-p53-Abs titers after esophagectomy can predict polyrecurrence in distant organs and poor prognosis.

Evaluation of Peritoneal Lavage for Gastric Cancer Staging in Patients Without Ascites Based on Cytology and Carcinoembryonic Antigen

Background: Imaging, cytological examination of ascites (if present), laparosco- py, and peritoneal lavage are performed before surgery for gastric cancer staging. Peritoneal lavage aims to diagnose the microscopic presence of tumor cells on the peritoneal surface. Positive cytology may have a prognostic value that classifies the disorder as stage IV, in which the patient is no longer an elective surgical candidate. Thus, our study was designed to assess the ability of peritoneal lavage to stage gastric cancer in non-ascitic patients based on cytological evaluation and carcinoembryonic antigen (CEA) level measurement.&#x0D; Methods: In our prospective study, we examined gastric cancer patients who were candidates for elective surgery. Upon entering the abdominal cavity and before tu- mor manipulation, normal saline (500 ml) was applied, and the abdominal cavity was thoroughly dispersed. After three minutes, the fluid was drained and addressed to cytological analysis and CEA measurement by radioimmunoassay (RIA). Study var- iables including age, sex, family history, tumor position, pathology, staging, grading, the original tumor size, regional lymph node involvement, and distant metastases were recorded during the pre- and postoperative staging. The association between positive peritoneal lavage cytology and various patients’ characteristics was investigated.&#x0D; Results: In this study, 94 patients were screened. Due to lymphoma and gastrointes- tinal stromal tumor (GIST), two patients were excluded. We examined 92 patients, including 63 males (68.5 %) and 29 females (31.5 %). The mean age of patients was 58.52 ± 11.87 years. The most common tumor location was the esophagogastric junction. Moderately differentiated adenocarcinoma was the most frequent micro- scopic diagnosis. T3 was the most prevalent primary tumor size in 51 patients. Sev- enty-two patients (78.26%) were operable, of whom 18 (19.6 %) were positive for peritoneal lavage cytology. Positive cytology of peritoneal lavage was significantly related to tumor size, tumor grade, serosa/adjacent organ invasion (T4), laparoscopic staging findings, locally advanced disease (R0), and stage of the disease (P &lt; 0.05). In the peritoneal lavage fluid, elevated CEA titers were significantly related to the high-grade tumor (P = 0.012). &#x0D; Conclusion: Our study demonstrated that positive cytology and high CEA titers in peritoneal lavage fluid of gastric cancer patients without ascites are significantly correlated to the advanced stages.&#x0D;

MiRNA biogenesis-associated RNase III nucleases Drosha and Dicer are upregulated in colorectal adenocarcinoma.

Drosha and Dicer are important regulators of microRNA (miRNA) biogenesis, and it has been suggested that their aberrant regulation may cause colorectal cancer (CRC). The aim of the present study was to evaluate the mRNA expression levels of these two important RNase III nucleases and their association with clinical features in CRC specimens from South Korean patients. The expression levels of Drosha and Dicer mRNA were investigated in 77 CRC tissues and adjacent histologically non-neoplastic tissues using the quantitative polymerase chain reaction. The expression levels of Drosha and Dicer mRNA were identified to be upregulated in CRC. Neither the Drosha nor the Dicer mRNA expression level was associated with any clinical parameter, including sex, age, TNM stage, body mass index and carcinoembryonic antigen titer in patients with CRC. Furthermore, the expression levels of Drosha and Dicer mRNA were not associated with each other. The miRNA biogenesis-associated RNase III nucleases Drosha and Dicer are significantly upregulated in CRC, suggesting their importance in the pathobiology of colorectal carcinogenesis.

Diagnosis and monitoring of colorectal cancer by L6 blood serum polymerase chain reaction is superior to carcinoembryonic antigen-enzyme-linked immunosorbent assay.

The aim of this study was to compare carcinoembryonic antigen levels with detection of messenger ribonucleic acid coding for the tumor-associated antigen L6 in patients with colorectal cancer. Not only are carcinoembryonic antigens expressed by the corresponding tumor cell, but the messenger ribonucleic acid of tumor-associated antigens, in contrast, is produced exclusively by viable tumor cells. L6 messenger ribonucleic acid was determined by reverse-transcription polymerase chain reaction. Carcinoembryonic antigen was measured by the enzyme-linked immunosorbent assay technique, with a cutoff value of 40 microg/l. Blood serum was sampled from 187 patients with colorectal cancer. Statistical significance was calculated with the McNemar chi-squared test. Preoperatively, 79 percent of patients in all stages were positive for L6 messenger ribonucleic acid, whereas only 35 percent had elevated carcinoembryonic antigen titers (P < 0.001). In Dukes A tumors, 84.9 percent of patients were positive for L6 messenger ribonucleic acid, whereas carcinoembryonic antigen was elevated in only 16.9 percent of patients. Only in Dukes D tumors did the enzyme-linked immunosorbent assay for carcinoembryonic antigen exhibit the same sensitivity as reverse-transcription polymerase chain reaction for L6 messenger ribonucleic acid. Recurrence was detected significantly earlier by reverse-transcription polymerase chain reaction for L6 messenger ribonucleic acid than by enzyme-linked immunosorbent assay for carcinoembryonic antigen. L6 is more sensitive and precise than carcinoembryonic antigen in diagnosing and monitoring colorectal cancer.

Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 59

A wide range of axonal peripheral neuropathies, especially subacute sensory and motor neuronopathies have been reported as remote effect of cancer. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) most often occurs isolated but it may accompany several autoimmune diseases. The association of CIDP and carcinoma is rare and its relevance is still debated. Few cases have been associated with gastrointestinal cancers. This 53‐year old man was admitted in December 1989 because of severe extremity weakness after EBV infection. Neurologic examination showed facial paresis, proximal and distal limb weakness, areflexia, distal loss for touch and deep sensibilities. Patient recovered with PE but mild symptoms and signs persisted in the limbs. In June 1997, patient developed acute relapse of his neuropathy after an episode of pneumonia. Electrophysiology, CSF and nerve biopsy were consistent with CIDP. Search for anti‐nerve antibodies was negative except for anti‐neurofilament IgM. IVIG had partial benefit. During the following four years, patient received IVIG 1 g/Kg monthly; however he continued to experience relapses of the neuropathy often occurring after trivial infections. Laboratory tests (monoclonal IgG; elevated SR and WB count, serum electrophoresis, carcinoembryonic antigen titer) suggested a systemic disease. In September 2001 a rectosigmoidal adenocarcinoma with bladder and liver metastases was discovered on abdominal CT scan and surgically treated. Patient's general and neurologic conditions rapidly deteriorated despite of chemotherapy with fluorouracil and leucovorin. He died on late summer 2002. We outline the unusual association of CIDP and intestinal cancer and the long interval elapsed between neuropathy onset and cancer detection.

Expression of carcinoembryonic antigen in peripheral- or central-located small cell lung cancer: its clinical significance.

Small cell lung cancer (SCLC) has a higher percentage of hilar masses than other histological types of lung cancer. The primary site is usually adjacent to the hilum, but we often observe primary sites in the peripheral lung field. In this study, our objectives were to elucidate whether peripheral-located small cell lung cancer (PSCLC) is an independent entity and whether it differs clinically from central-located small cell lung cancer (CSCLC). We reviewed the clinical and pathological features of 52 patients treated at Kagawa Medical University Hospital between 1987 and 1996 with a diagnosis of SCLC. We defined CSCLC as a tumor whose primary site is located in the segmental bronchi or more proximally and PSCLC as a tumor located distal to the subsegmental bronchi. Twenty-one PSCLC patients and 31 CSCLC patients were identified. Kaplan-Meier survival curves were constructed and comparisons were made between PSCLC and CSCLC by the log-rank test. The carcinoembryonic antigen (CEA) level was also evaluated in each group. Although the percentage of limited disease (LD) in the patients with PSCLC was higher than that in the patients with CSCLC, the 3-year survival rate of PSCLC tended to be worse than that of CSCLC (9% for patients with PSCLC and 29% for those with CSCLC). Survival curves of patients with PSCLC also tended to be worse than those of patients with CSCLC, not only in the limited disease group but also in the extensive disease (ED) group. In addition, the mean CEA value in patients with PSCLC was higher than that in patients with CSCLC (p < 0.001), whereas the neuron specific enolase (NSE) level was not significantly different between PSCLC and CSCLC. The median survival of patients with pretherapeutic CEA titers of > or =5 ng/ml was significantly shorter than that in patients with CEA levels <5 ng/ml. These findings suggest that the survival of SCLC patients with a high CEA level was significantly shorter than that of patients with a low CEA level. In addition, CEA levels in PSCLC patients were significantly higher than those in CSCLC patients. However, the survivals of LD or ED patients with PSCLC and CSCLC were not statistically different.

Can postoperative surveillance with serial CEA immunoscintigraphy detect resectable rectal cancer recurrence and potentially improve tumor-free survival?

Background: This study was performed to determine if postoperative serial monitoring of rectal cancer patients can be performed with an immunoscintigraphic imaging test for carcinoembryonic antigen (CEA). It was also of interest to assess whether this test, in combination with standard monitoring procedures used in an intensive surveillance plan, can result in the identification of surgically salvageable patients. Study Design: Forty consecutive resected Dukes’ B and C rectal cancer patients underwent a prospective, single-institution, surveillance trial of physical examination (including digital rectal examination), endoscopy, CT of the abdomen and pelvis, liver ultrasound, chest x-ray, blood CEA, and CEA immunoscintigraphy with arcitumomab (CEA-Scan, Immunomedics, Morris Plains, NJ) every 6 months for the first 2 years and every 12 months for the next 3 years after initial operation. Outcomes were compared with those from a similar group of 69 patients treated previously at the same institution but without CEA imaging. Results: A total of 219 CEA imaging studies were performed without any significant adverse effects or immune responses, and resulted in lesion sensitivity, specificity, accuracy, and positive and negative predictive values of 94.1%, 97.5%, 97.3%, 76.2%, and 99.5%, respectively. Of the 40 patients, 16 developed 22 surgically confirmed local or distant recurrences, and CEA imaging correctly disclosed 82% of these lesions preoperatively. All of the patients found to have recurrences had at least one tumor site by CEA imaging; only 6 of 16 had elevated blood CEA titers. On a patient-basis, there was a sensitivity of 100%, a specificity of 79.2%, an accuracy of 87.5%, and positive and negative predictive values of 76.2% and 100%, respectively. The potential therapeutic benefit of serial arcitumomab imaging is suggested by the fact that 6 of 16 patients (37.5%) with recurrence underwent potentially curative second-look operations, compared with 6 of 69 (8.7%) of a comparable population studied at this institution during an earlier 6-year period, using all of the same tests except CEA imaging. None of the patients in this historic control group survived more than 21 months, although the mean survival of the six patients resected for cure in the study population was 35 months (range 11 to 69 months). During 6 years of followup, three of the six re-resected patients eventually died of cancer recurrence, two died from other causes (and were confirmed by necropsy to be tumor-free), and one patient is still free of disease in the sixth year. CEA scanning appeared to be more predictive of recurrence than blood CEA testing or other diagnostic modalities. Conclusions: Arcitumomab inclusion in intensive surveillance of patients with resected rectal cancer can disclose tumor recurrence at a stage that allowed surgical salvage therapy in 37.5% of the 16 patients with recurrence who had second-look surgery, and in 19% the patients were free of disease during longterm followup. This pilot study suggests that a randomized prospective trial comparing standard surveillance procedures to the use of CEA imaging added thereto should be undertaken.

Initial clinical study of indium-111-labeled clone 110 anticarcinoembryonic antigen antibody in patients with colorectal cancer.

A murine monoclonal antibody directed against carcinoembryonic antigen (CEA) was labeled with indium-111 (111In) by means of a benzylisothiocyanate derivative of diethylenetriamine penta-acetic acid (DTPA) and used for clinical radioimmunodetection studies. Twenty-one patients having a history of surgically resected colorectal cancer and rising serum CEA levels suggestive of tumor recurrence were studied. Patients were infused over 20 minutes with 5, 10, or 20 mg of the monoclonal antibody labeled with 5 mCi of 111In. The mean radiochemical purity was greater than 96%. No toxicity was seen. The stability of the radiolabel on antibody in patient serum was demonstrated by high-performance liquid chromatography (HPLC), sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) with autoradiography, and immunoprecipitation for up to 96 hours after infusion. Tumor sites were identified in 20 of 21 patients. Sites of antibody accumulation in 20 patients were confirmed as tumor either by resection at laparotomy (16 patients) or fine-needle biopsy (four patients). Nine patients who had the identified lesion resected or irradiated showed return of the serum CEA antigen level to normal or near normal values. In the absence of high levels of circulating CEA (greater than 500 ng/mL), the disappearance of radioactivity from patient serum demonstrated first order elimination kinetics, with a mean half-life of 38 hours. The serum half-life was not affected by the dose of antibody administered or by serum CEA titers below 500 ng/mL. Despite a mean liver uptake of 18% injected dose (ID) 24 hours after administration, hepatic metastases were easily visualized as areas of increased uptake of radioactivity. Radioimmunodetection of recurrent colorectal cancer, not detected by computed tomographic (CT) scans, appears achievable with this agent. This may allow successful clinical intervention in selected patients.

Immunohistochemical and histologic study of cervical lymphoepithelial cysts

Four cases of lateral cervical cysts were reported. All cyst walls were lined with keratinized stratified squamous epithelium, and contained lymph follicles with well-defined germinal centers. Ectopic salivary gland tissue was found in one case. Histochemical examination by the immunoperoxidase method revealed the existence of carcinoembryonic antigen (CEA). However, alpha-feto protein (AFP) and amylase were not detected in any of the cysts. The cyst fluid contained high levels of CEA and high titers of salivary type amylase, but AFP was negative. These results do not support any one of the theories concerning the etiology of cervical lymphoepithelial cysts. It seems likely that cysts derive from both epithelial remnants of the branchial apparatus and from salivary gland inclusions in lymph nodes.

Measuring of Immunoreactivity of Carcinoembryonic Antigen (CEA) in Colorectal Cancer by Microdensitometry

In 32 patients with colorectal carcinomas, the immunoreactivity of carcinoembryonic antigen (CEA) was measured on section preparations of the tumours by means of a computer controlled microdensitometric method. By measuring numerous single points, the intensity of the immunohistochemical staining reaction of CEA was evaluated. This method is superior to the commonly used semiquantitative method (+, ++, ) for the assessment of various degrees of staining intensity whenever the antigen to be measured is not homogeneously dispersed in the tissue. The results show that highly differentiated colorectal carcinomas of stage A according to Dukes classification have a lower CEA immunoreactivity than highly differentiated carcinomas of stage B. A correlation between CEA immunoreactivity and degree of malignancy could only be found in patients in stage B. Stage C carcinomas of all degrees of differentiation appeared with a very low CEA immunoreactivity. CEA follow-up controls in our study were of little value for detecting local recurrences; metastases, however, almost always caused an increase in serum CEA titers. Prognostically, a preoperatively increased serum CEA level seems to be as unfavourable as a low CEA immunoreactivity in the tumour.

Solving the problem of antibody interference in commercial "sandwich"-type immunoassays of carcinoembryonic antigen.

We evaluated the effect of human anti-murine antibodies (HAMA) on apparent concentrations of carcinoembryonic antigen (CEA) as measured in serum with commercial enzyme immunoassay (EIA) kits manufactured by Abbot ("two-step" double monoclonal antibody assay), Roche, and Hybritech (room-temperature protocol). In sera from patients given parenteral murine monoclonal antibody for experimental diagnostic and immunotherapy studies, HAMA titers were determined with Immunomedics' "ImmuSTRIP HAMA-EIA" kit reagents. "True" CEA titers were established by using the ImmuCEA/MA-EIA and heat-extraction to destroy HAMA before assay for CEA. The concordance of the ImmuCEA/MA assay with the Abbott and Roche CEA EIAs was established with sera from normal individuals and from patients who had not received parenteral injections of murine monoclonal antibody. At high (100 mg/L) concentrations of HAMA, false-positive results were observed with all three kits. The Hybritech and Roche assays were more sensitive to interference by HAMA than was the Abbott CEA-EIA, false-positive results being observed at HAMA concentrations between 1 and 10 mg/L. Similar sensitivity of the three kits to interference by primate anti-MAb sera was demonstrated. Use of primate anti-MAb sera to create controls with HAMA activity and of analyte is recommended to evaluate MAb assays for potential HAMA interference and for use to devise methods to eliminate HAMA interference.

Is there any clinical relevance of serial determinations of serum carcinoembryonic antigen in small cell lung cancer patients?

Carcinoembryonic antigen (CEA) serum concentrations were serially determined by an enzyme immunoassay before, during, and after chemotherapy and radiotherapy in 129 male patients with small cell lung cancer (SCLC). Pretherapeutic CEA concentrations were as follows: 2.5 ng/ml or less for 37% of the patients; greater than 2.5 but less than or equal to 5 for 27%; and greater than 5 for 36%. Before therapy, CEA levels in patients with extensive disease (median value, 5.8 ng/ml) were higher than those in patients with limited disease (3.0 ng/ml; P less than 0.01). Median survival in patients with pretherapeutic CEA titers of 5 ng/ml or less (median survival, 14.3 months) was significantly longer than in patients with CEA levels greater than 5 but less than or equal to 10 and CEA levels greater than 10, respectively (8.3 and 9.7 months; P less than 0.01). Patients with pretherapeutic CEA levels greater than 10 ng/ml showed a significant decrease (P less than 0.01) of CEA while reaching partial remission (PR) or complete remission (CR). In five of 16 evaluable patients, a continuous increase of CEA titers was seen starting at least 3 months before relapse could be defined by clinical, radiologic, or endoscopic means. However, the number of patients for whom CEA serum determinations reliably indicate stage of disease and outcome of therapy is small (at best, 10% of all SCLC patients), and pretherapeutic CEA level cannot be used for individual prognosis. Moreover, it is still uncertain whether earlier detection of relapse in SCLC can improve the therapeutic results. So far, the clinical relevance of serial CEA serum determinations in SCLC patients is rather low.

"Sandwich"-type immunoassay of carcinoembryonic antigen in patients receiving murine monoclonal antibodies for diagnosis and therapy.

Measurements of carcinoembryonic antigen (CEA) in blood increased dramatically in some patients who were receiving injections of monoclonal antibody. CEA titers were measured with a monoclonal antibody-based double-determinant enzyme immunoassay in which untreated plasma specimens were diluted with an equal volume of buffer containing mouse serum. Increasing CEA titers were accompanied by the appearance and coincident increase in titers of human antibody against mouse Ig (HAMA). Adsorption of these sera with solid-phase anti-human IgG or Protein A restored antigen titers to pretreatment values; evidently the serum factor eliciting false-positive CEA titers was most probably HAMA. Neither addition of undiluted mouse serum to the assay mixture nor pretreatment by heating plasma specimens to 70 degrees C effectively abolished HAMA interference. By contrast, protein precipitation with polyethylene glycol (130 g/L) or heating plasma samples to 90 degrees C eliminated false-positive titers caused by HAMA, but did not reduce authentic CEA titers.

CORRELATION BETWEEN SERUM CARCINOEMBRYONIC ANTIGEN LEVEL IN PATIENTS WITH COLORECTAL CANCER AND TUMOR HISTOPATHOLOGY

Serum carcinoembryonic antigen (CEA) values were determined in 123 patients with colorectal carcinoma preoperatively. Serum CEA titers above 5.1 ng/ml were considered to indicate positive cases. Preoperatively 50.8% of all patietns had a positive test result. According to stage classification, the assay was positive in 9.1% of patients with stage I tumors, 50.9% with stage II, 38.9% with stage III, 33.3% with stage IV and 88.9% with stage V. Among cases of small cancers less than 2 cm in size, there were no positive results.Histopathological evaluation of the tumor included evidence of lymphatic vessel and venous invasion and degree of wall penetration. A low serum CEA level in colonic cancer cases suggested that the tumor was localized within the bowel wall and the patient underwent curative resection. The higherst values were found in patients with liver metastasis. Serum CEA levels tended to be elevated when hepatic metastasis, peritoneal dissemenation, serous invasion and wall penetration were present. However, CEA value was not directly correlated with either lymphatic vessel or venous invasion.

Efficacy of liver scanning in malignant diseases

The use of radiocolloid liver scanning as a routine diagnostic procedure to detect liver metastases has been declining as the most effective uses of this test have become better appreciated. Liver scanning to detect hepatic metastases appears to have the greatest efficacy in two circumstances. The first is as a staging procedure in malignancies that metastasize to the liver early, before being suspected clinically or liver function parameters alter. Such malignancies include gastric carcinoma, Wilms' tumor, small cell carcinoma of the lung, and rhabdomyosarcoma. The second effective use of liver scanning is as a confirmatory test in patients with known malignancy who develop abnormal levels of serum liver enzymes, carcinoembryonic antigen titer, hepatomegaly, ascites, or jaundice.

Carcinoembryonic antigen radioimmunodetection in the evaluation of colorectal cancer and in the detection of occult neoplasms

Radioimmunodetection of colorectal cancer was evaluated in 51 patients by injecting 131I-labeled goat antibody immunoglobulin G against carcinoembryonic antigen and performing total-body photoscans with a gamma scintillation camera 24 and 48 h later. The scintigrams were then processed by computer to subtract the images of the 99m-Tc-serum albumin and pertechnetate administered, which reject background and nontarget radioactivity, from the 131I-antibody scans. The results indicate that radioimmunodetection is a safe and a potentially clinically useful cancer detection method, which in this study demonstrated primary colorectal carcinomas in 10 of 12 (83%) of the patients evaluated preoperatively and between 87% (46 of 53) and 92% (49 of 53) of known metastatic tumor sites. Thus, the method's overall sensitivity (true-positive rate) was 86%–91% on a tumor-site basis. A false-negative rate of between 9% and 14% and a false-positive rate of < 4% were found. In 11 of the 51 patients evaluated, tumor sites were detected that were not found by other clinical methods of cancer detection. These sites of tumor were then confirmed later, as much as 40 wk after radioimmunodetection was performed. It is concluded that in colorectal cancer patients, the current method of carcinoembryonic antigen radioimmunodetection can (a) contribute to the preoperative clinical staging of the patients, (b) assist in the postoperative evaluation of tumor recurrence or spread, (c) complement other methods used to assess tumor response to therapy, (d) support the indication of a rising carcinoembryonic antigen titer (when other methods cannot detect tumor) for second-look surgery, and (e) confirm the findings of other detection measures that are less tumor-specific.

Serum CEA monitoring in the follow-up of colorectal cancer patients with negative preoperative serum CEA

Thirty-nine patients with colorectal cancer and normal preoperative levels of carcino-embryonic antigen (CEA) were followed up with serial CEA determinations and with complete clinical and laboratory work-ups for the detection of tumor recurrence, for at least 1 yr after surgery. The same schedule for serum CEA assay and other clinical and laboratory tests was followed, for comparison, in 32 colorectal cancer patients with elevated preoperative serum CEA titers, and in whom surgery had been followed by a return to normal of the CEA values. In the follow-up group with negative preoperative serum CEA values, 66.7% of the patients had normal serum CEA titers, and 60% were free from symptoms of tumor recurrence after 1 yr from surgery. Whereas, 28.2% of the patients of this group showed a steady rise of their serum CEA levels after periods ranging from 3–12 months from surgery; this serum CEA elevation preceded in nine of these patients other evidence of tumor recurrence by 3–5 months in the average. The above pattern was superimposable to that observed in the patients with positive preoperative serum CEA, about one third of whom exhibited a steady rise of serum CEA to abnormal values (as an early indicator of tumor recurrence) in the first year after surgery. The present results point out the relevant value of monitoring the serum CEA titers also in the postoperative follow-up of patients with normal preoperative serum CEA, since about one third of these patients may develop steadily rising serum CEA levels as an early indicator of tumor recurrence in the first year after surgical treatment.

The value of serial carcinoembryonic antigen (CEA) in predicting response rate and survival of patients with gastrointestinal cancer treated with chemotherapy.

Elevated serum levels of carcinoembryonic antigen (CEA) were found in 70% of 141 patients with advanced gastrointestinal (GI) cancers. Serial CEA measurements were performed on 70 patients before and during chemotherapy. The majority were treated with 5-FU and Methyl-CCNU (33 patients), 5-FU (19 patients), or 5-FU and mitomycin-C (8 patients). In 49 patients with colorectal carcinoma who had elevated serum CEA prior to chemotherapy, 18 had objective partial tumor remission, 16/18 (89%) showed definite decrease in CEA level, one had no change, and one had an increase CEA titer. Thirty-one patients had either stable disease (10 patients) or increasing disease (21 patients) while on chemotherapy. Of these patients four showed decrease in CEA, eight had no change, and 19 had increase in CEA levels as compared to pretreatment value. The survival of patients with a decrease in CEA during chemotherapy was statistically significant (p = .03) as compared to survival of those with no change or increasing CEA levels. In 21 patients with other GI cancers, the correlation between the clinical response and change in CEA level observed was not as definite as in patients with colorectal carcinoma.

Carcinoembryonic antigen (CEA): its role as a monitor of radiation therapy for colorectal cancer.

Serial CEA radioimmunoassays have been performed on patients receiving radiation therapy preoperatively or as treatment of recurrent or metastatic colorectal cancer. Pretreatment circulating CEA titers which were elevated showed a significant decrease with accumulating doses of irradiation, indicating that the bulk of CEA-producing tumor was within the radiation therapy portal. The decrease of circulating CEA with preoperative radiation therapy was short-lived and suggested that surgical resection should be performed within 8 weeks of irradiation. Serial CEA titers are useful as an adjunct to other clinical, laboratory and radiologic data in formulating patient management decisions.

Das Verhalten des carcinoembryonalen Antigens beim Retinoblastom

In 47 patients (46 children and 1 adult) with unilateral and bilateral retinoblastoma, the titer of the carcinoembryonic antigen (CEA) was determined. The CEA titer of children with active retinoblastomas was 1.44 +/- 0.26 ng/ml (x +/- SEM). Those patients whose retinoblastoma was inactivated by therapy did not show a significantly lower CEA titer. In the group of children with one eye removed because of a unilateral retinoblastoma, the CEA titer was significantly (P less than 0.1) lower. The globes of 25 children were examined histologically. In those cases with invasion of the optic nerve or choroid, the CEA titer was significantly higher (P less than 0.1) as compared with those where the tumor was limited to the retina alone.