Elevated Preoperative Carcinoembryonic Antigen Research Articles

Immunoperoxidase staining of carcinoembryonic antigen as a prognostic indicator in colorectal carcinoma.

Immunoperoxidase staining for carcinoembryonic antigen (CEA) was performed on 192 colorectal carcinomas to determine: whether tissue staining can be substituted for preoperative serum CEA levels, and whether patient survival can be predicted by these parameters. The overall incidence of positive tissue staining was 75 percent, which was similar to the elevated serum level percentage of 73 percent. Both the serum CEA level and the CEA tissue stain correlated with patient survival in Dukes' stage C patients. There was no correlation between tissue CEA stain and tumor differentiation. Positive tissue stain and elevated preoperative serum CEA identified patients with poor prognosis in Dukes' stage D only. This study shows that tissue staining with immunoperoxidase may be substituted for preoperative serum levels for CEA. The combination of these two parameters, however, does not identify patients at greater risk for recurrence than either procedure alone.

The use of preoperative plasma CEA levels for the Stratification of patients after curative resection of colorectal cancers.

One hundred forty-five patients with colorectal cancer were analyzed in order to correlate the preoperative plasma carcinoembryonic antigen (CEA) levels with the sites and times of disease recurrence. The median follow-up periods of these patients was 50 months (range 36-72 months). Twenty-one patients were found to have metastases at the time of their operation. None of the seven patients whose primary tumors were classified as Dukes/Kirklin A have had tumor recurrence. Seventeen per cent of the patients with Dukes/Kirklin B tumors have had tumor recurrences, and 63% of the patients with Dukes/Kirklin C colorectal primary tumors have had tumor recurrence. No correlation was found between preoperative CEA values and subsequent risk of tumor recurrence or times to recurrence among the patients with Dukes/Kirklin B colorectal primary cancers. In Dukes/Kirklin C patients, however, elevated preoperative CEA values predicted a higher risk of tumor recurrence. Ninety per cent of the patients (19/21) with preoperative CEA levels greater than 5.0 ng/ml have had relapses, with a median time of 17 months before disease recurrence. Only 39% (9/23) of the patients with Dukes/Kirklin C lesions and CEA levels less than 5 ng/ml have had relapses and there is insufficient follow-up data as yet to determine the median survival time. If those patients whose Dukes/Kirklin C primary tumors were poorly differentiated on histologic examination are excluded, the contrast between patients having CEA levels greater than 5.0 ng/ml and those having CEA levels less than 5 ng/ml is even more marked. Sixteen of the 18 remaining patients whose CEA levels were greater than 5.0 ng/ml prior to curative resection have had relapses as compared with only three of 15 patients whose preoperative CEA values were less than 5. We conclude, therefore, that CEA is an important factor in stratifying patients after curative resection of their Dukes/Kirklin C colorectal tumors.

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.

CEA levels in head and neck cancer.

Serum carcinoembryonic antigen (CEA) levels were determined for 439 patients with squamous carcinoma of the head and neck region, 154 healthy smokers, and 122 nonsmokers. Among nonsmokers 95% of the CEA levels did not exceed 5 ng/ml, but among smokers this discriminatory level was 7 ng/ml. Among tumor-bearing patients 36% of the CEA levels exceeded 5 ng/ml but only 17% exceeded 7 ng/ml. Both the incidence and magnitude of CEA elevations correlated with clinical stage of tumor; however, excluding patients with clinically apparent advanced malignancies, the incidence and magnitude of elevations were similar among tumor-bearing patients, tumor-free treated patients, and smokers. Although not predictive of ultimate survival, elevated preoperative CEA levels declined to the range of normals after resection. Similarly, during palliative irradiation for incurable tumors, CEA levels declined with regression of tumor. Irradiation did not nonspecifically elevate CEA levels. The data indicate that in patients with head and neck squamous carcinomas CEA level is not likely to contribute to a determination of prognosis after therapy; however, serial determinations may have adjunctive value in monitoring tumor response.