Increase In Carcinoembryonic Antigen Levels Research Articles

The dynamic monitoring of CEA in response to chemotherapy and prognosis of mCRC patients

BackgroundThe role of carcinoembryonic antigen (CEA) change patterns in tumor response and long-term outcome is unclear. This study aimed to investigate the correlation between changes in CEA levels and tumor response as a potential prognostic model.MethodsCEA levels were determined from baseline to progression. A χ2 test was used to assess the correlation between CEA changes and tumor response. Univariate and multivariate COX models were used to explore the correlation of CEA changes to progression-free survival (PFS) and overall survival (OS).ResultsAll 114 patients were divided into five groups according to CEA change pattern (A: patients had an initial fast CEA decrease that then turned into a slow increase; B: patients had an initial slow CEA decrease that then turned to a slow increase; C: patients had a continually slow CEA increase; D: patients had a continually fast CEA increase; E: patients had an initial fast CEA decrease that then turned into a fast increase). Patients in Group A had the longest OS and PFS while Group E patients had the shortest OS. Baseline to week 12 and week 12 to week 18 change rates were consistent with tumor response and progression, respectively. An increase in CEA level by ≥2.7% from week 12 to 18 was an independent negative prognostic factor of OS.ConclusionsCEA changes mirror the tumor response to first-line chemotherapy and are associated with prognosis. CEA monitoring may be a substitute for computed tomography during the CEA stable period of treatment.

Clinical significance of changes in systemic inflammatory markers and carcinoembryonic antigen levels in predicting metastatic colorectal cancer prognosis and chemotherapy response.

Metastatic colorectal cancer (mCRC) is associated with poor prognosis, and biomarkers are required for predicting survival and chemotherapy response. This study aimed to evaluate the significance of changes in systemic inflammatory markers and carcinoembryonic antigen (CEA) levels in predicting mCRC prognosis and chemotherapy response. In this retrospective study, 503 patients who received first-line palliative chemotherapy for mCRC between 2008 and 2014 at a tertiary hospital in Korea were evaluated. Changes in neutrophil-to-lymphocyte ratio (NLR) and modified Glasgow prognostic score (mGPS) were divided into low-to-low, high-to-low, low-to-high and high-to-high groups. The CEA response was defined as CEA-complete response (CEA normalization), CEA-partial response (≥50% decrease in CEA levels), CEA-progressive disease (≥50% increase in CEA levels) and CEA-stable disease. Overall survival (OS) and progression-free survival (PFS) were evaluated according to NLR, mGPS and CEA levels. High prechemotherapy NLR, mGPS and CEA levels independently predicted poor survival and chemotherapy response. Continuously high NLR or change to high NLR was also associated with poor OS and PFS; however, continuously low NLR or reduced NLR showed good prognosis. CEA response was also an independent prognostic marker for OS and PFS. High NLR and mGPS were correlated with elevated CEA levels. Inflammatory marker levels were significantly associated with CEA levels. The prechemotherapy levels of systemic inflammatory markers and CEA were associated with OS or PFS. The change patterns in NLR and CEA levels can be utilized as prognostic and predictive markers for chemotherapy response.

Clinical Significance of Discordance between Carcinoembryonic Antigen Levels and RECIST in Metastatic Colorectal Cancer.

PurposeThe purpose of this study was to investigate the prognostic implications of carcinoembryonic antigen (CEA) levels that are inconsistent with Response Evaluation Criteria in Solid Tumor (RECIST) responses in metastatic colorectal cancer patients.Materials and MethodsWe retrospectively evaluated 360 patients with at least one measurable lesion who received first-line palliative chemotherapy. CEA-response was defined as CEA-complete response (CR; CEA normalization), CEA-partial response (PR; ≥ 50% decrease in CEA levels), CEA-progressive disease (PD; ≥ 50% increase in CEA levels), and CEA-stable disease (SD; non-CR/PR/PD). Overall survival (OS) and progression-free survival (PFS) were evaluated according to CEA-response.ResultsIn RECIST-PR patients, poorer CEA-response was associated with disease progression at the subsequent evaluation. In RECIST-SD patients, CEA-CR and -PR were associated with lower disease progression rates than CEA-PD at the subsequent evaluation. Correlations between survival outcome and CEA-response in same-category RECIST patients were assessed. In RECIST-PR patients, discordant CEA-response (CEA-PD/SD) was associated with poorer survival than CEA-CR/PR (median OS and PFS, 44.0 and 15.4 [CEA-CR], 28.9 and 12.5 [CEA-PR], 21.0 and 9.8 [CEA-SD], and 13.0 and 7.0 [CEA-PD] months, respectively; all p < 0.001). In RECIST-SD patients, favorable CEA-response produced better survival (median OS and PFS, 26.8 and 21.0 [CEA-CR], 21.0 and 11.0 [CEA-PR], 16.1 and 8.2 [CEA-SD], and 12.2 and 6.0 [CEA-PD] months, respectively; all p < 0.001). RECIST-PD patients with CEA-CR showed longer OS than those with CEA-PD. Multivariate analysis demonstrated that discordant CEA-response is a powerful prognostic factor for RECIST-PR and RECIST-SD patients.ConclusionAmong patients of the same RECIST-response categories, CEA-response patterns are significantly prognostic and strongly predictive of subsequent evaluation outcomes.

Change in systemic inflammation markers and CEA levels as predictive marker for chemotherapy response and prognosis in metastatic colorectal cancer.

e15053Background: This study aimed to evaluate the value of systemic inflammation markers and carcinoembryonic antigen (CEA) levels as predicting chemotherapy response and prognosis in metastatic colorectal cancer (mCRC). Methods: We retrospectively evaluated 503 patients who received first-line palliative chemotherapy for mCRC between Jan, 2008 and Dec, 2014. We evaluated the changes in neutrophil-to-lymphocyte ratio (NLR) and modified Glasgow Prognostic Score (mGPS) before and after chemotherapy. These were categorized into group A (low to low), group B (high to low), group C (low to high), and group D (high to high). The CEA-response was defined as CEA-CR (CEA normalization), CEA-PR (≥50% decrease in CEA levels), CEA-PD (≥50% increase in CEA levels), and CEA-SD (non-CR/PR/PD). Overall and progression-free survivals were evaluated according to NLR, mGPS and CEA levels. Results: High NLR (P = 0.001) and mGPS (P = 0.002) were correlated with elevated CEA levels. In multivariate analysis, high pre-chemothe...

A 79-Year-Old Man With Interstitial Lung Disease and Cryptic Area of High 18Fluorodeoxyglucose Uptake in Left Upper Lobe

Seven years after left hemicolectomy and radical lymph nodal dissection followed by adjuvant chemotherapy for colorectal cancer (histotype, adenocarcinoma; stage, pT3N2M0; grading, G2), a slight increase in carcinoembryonic antigen levels (6.2 ng/mL; range, 0-5 ng/mL) was detected in a 79-year-old man. He was a heavy smoker with history of an interstitial fibrotic lung disease with associated areas of emphysema.

False-positive elevations of carcinoembryonic antigen in patients with a history of resected colorectal cancer.

Routine monitoring of carcinoembryonic antigen (CEA) levels is standard in patients with resected colorectal cancer (CRC). The incidence of false-positives and the upper limits of false-positive elevations have not been previously well characterized. A search of medical records at Memorial Sloan-Kettering Cancer Center identified 728 patients who underwent an R0 resection of locoregional CRC between January 2003 and December 2012 and who had an increase in CEA level above the normal range after a normal perioperative CEA level. Of these, 358 had a false-positive elevation of CEA level, 335 had a true-positive elevation indicative of recurrent CRC, and 35 had a true-positive elevation indicative of the development of a new, non-CRC malignancy. Of those with false elevations, 111 had a single isolated CEA level elevation (median highest CEA level of 5.5 ng/mL) with no further abnormal measurements, whereas 247 had elevations on 2 or more readings, with a median highest level of 6.7 ng/mL. Of these 247 patients with confirmed false-positive CEA level elevations, only 5 (2%) had measurements greater than 15 ng/mL, and no confirmed elevation greater than 35 ng/mL was a false-positive. False-positive CEA test results in the range of 5 to 15 ng/mL are common. Confirmation of CEA elevation in this range before initiating imaging studies may be appropriate. False-positive results greater than 15 ng/mL are rare, and all confirmed CEA levels greater than 35 ng/mL were associated with cancer recurrence.

The Relation Between Serum CEA Response and the CTscan Finding After Neoadjuvant Therapy in Rectal Cancer Patients

Serum Carcinoembryonic Antigen (CEA) levels are the most widely used tumor marker for colorectal cancer. Elevated serum CEA has been reported to be associated with an increased risk of relapse and poor patient outcome. Whether this marker would be altered with preoperative adjuvant treatment of rectal cancer prior to resection and can this alteration reflect any changes in the tumor have not been yet investigated. If so, this might guide us to predict curative from palliative resection and to correlate between the marker level and future tumor response to the adjuvant therapy. Aim: This review was undertaken to assess the effect of preoperative neoadjuvant therapy on serum CEA level and the re- lationship between these effect on CEA and changes of the tumor in CT scan in advanced rectal cancer patient before de- finitive surgery. Methods: Between January 2002 and October 2007, a retrospective review using the colorectal database for all rectal can- cer patients treated in King Faisal Specialist Hospital and Research Center was performed. All patients received preopera- tive long course radiotherapy alone, or combined with 5- fluorouracil. Serum CEA and CT scan was done for the patients before starting the neoadjuvant therapy, and repeated again prior to surgery. Surgical resection was planned 6 - 8 weeks following the completion of treatment. We determined the criteria of the tumor response in the CT scan findings and compared the results with the CEA level after the neoadjuvant therapy. Results: Out-off the 77 patients, 38 received radiotherapy alone, while 39 patients received chemoradiotherapy, CT scan was done for all patients in both groups (pre and post neoajuvent therapy). Patients divided into 2 groups based on the CT scan findings to: CT responder and CT non-responder patients. In the radiation only group, 21 (55 %) patients had raised CEA levels before the treatment, 18 (86%) of them showed a decrease in CEA with CT response, while 3(14%) patients' demonstrated further increase and CT non-response. 17(45%) patients with normal CEA. 15 (89%) of them showed normal CEA post treatment 12 (80%) of them showed CT response and 3 of them shows CT non-response. 2/17 (11%) patients showed further increase in CEA level and CT non-response as well. In the chemoradiotherapy group, 17 (43%) patients had high CEA level before the treatment. 16 (95%) of them showed a decrease in CEA and CT response while 1(5%) patient showed increase in CEA level and CT non-response post treat- ment. 22/39(57%) showed normal CEA where all of them remained in normal level post treatment and only 1 patient (5%) showed CT non-response. All patients with CEA and CT scan response are operable patients and we can consider them for curative resection, while all patients with CEA and CT scan non response are non operable or can get a palliative treatment due to ( metastasis or carcinomatosis). 4 patients of normal CEA post treatment CT scan shows ( increase in thickening and single new lesion in the liver with suspicious of metastasis ) but still operable patients with intension to cure. Conclusions: There is an obvious relation between serum CEA level and CT scan findings during neoadjuvant therapy. CEA level post neoadjuvent therapy can differentiate between operable and non operable patients. CT scan can be used for patients with increase CEA level as further investigation before surgery and can be eliminated for those with CEA normal or dropped level. Further studies are needed to correlate this finding with post operative histopathological finding and patient outcome

Serum levels of IGF-I and IGFBP-III and their relation with carcinoembryonic antigen and carbohydrate antigen 19-9 in cases of esophageal cancer

Tumour markers are used for diagnosis, staging, evaluation of response to treatment, prognosis and detection of recurrences in clinical oncology. In this study, we aim to investigate the levels of insulin-like growth factor (IGF)-I and IGF-binding protein (IGFBP)-III in cases with oesophageal carcinoma. We investigated their possible use as tumour markers and their relation to other tumour markers. Forty patients who were diagnosed as having oesophageal carcinoma by histopathological evaluation of endoscopic biopsies between January 2003 and July 2004 and 40 healthy people as the control group were included in the study. The serum levels of tumour markers including IGF-I, IGFBP-III, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 were measured in both groups. Data were compared statistically, and the importance of IGF-I and IGFBP-III levels were investigated in cases with oesophageal carcinoma. IGF-I levels were significantly higher in patients with oesophageal carcinoma when compared with the control group (p < 0.05), whereas IGFBP-III levels were significantly lower (p < 0.05). The increase in CEA levels was not statistically significant when compared with the control group. The increase in CA 19-9 levels was statistically significant when compared with the control group (p < 0.05). No correlation was detected between levels of IGF-I and IGFBP-III and levels of CEA and CA 19-9. We suggest that the serum IGF-I level may be used as a tumour marker in oesophageal carcinoma. A low level of serum IGFBP-III is also significant in cases with oesophageal carcinoma. We believe that drugs which inhibit IGF-I function or which stimulate the function of IGFBP-III may open new horizons in extra-surgical modalities for the treatment of oesophageal cancer.

Transient CEA increase at start of oxaliplatin combination therapy for metastatic colorectal cancer

In general a rising carcinoembryonic antigen (CEA) level means tumor progression. We observed a transient increase in CEA level despite objective response among patients receiving chemotherapy for metastatic colorectal cancer. This surge phenomenon has not previously been described for patients with metastatic colorectal disease. CEA was measured every second week in 27 patients receiving oxaliplatin, 5-fluororuracil, and folinic acid as first-line therapy against metastatic colorectal cancer. Four patients (15%, 95% CI 5–31%) met the criteria for therapy-induced CEA surge. The time of reaching maximum CEA level varied from 13 to 56 days. Median rise in CEA from baseline was 263% (range 24–632%). An initial rise of CEA during chemotherapy in colorectal cancer patients may therefore not always indicate progression of disease but may be a transient CEA surge in patients responding to chemotherapy.

Effects of recombinant human gamma-interferon on carcinoembryonic antigen expression of human colon cancer cells.

The effects of human recombinant gamma-interferon (gamma-IFN) on the levels of carcinoembryonic antigen (CEA) expression were investigated in vitro in three human colon adenocarcinoma cell lines (WiDr, HT29, and SW403). Subconfluent cultures were exposed continuously to IFN at concentrations of 1-1,000 antiviral units/ml for up to 6 consecutive days. IFN resulted in a significant increase in CEA levels when assayed by cellular enzyme-linked immunosorbent assay (ELISA), with higher concentrations and longer exposure times resulting in greater CEA enhancement. A three to five-fold enhancement of CEA was observed after 5-6 days of continuous exposures at concentrations of 100-1,000 antiviral units/ml. CEA levels returned to baseline over a 4-day period after discontinuation of IFN. Levels of IFN that resulted in CEA enhancement also resulted in cell growth inhibition, with a direct correlation observed. Flow cytometric studies, which evaluated changes in CEA membrane expression of only the viable cells remaining after IFN exposure, gave similar results to cellular ELISA. Quantitative CEA ELISA, which quantitated changes in total cellular CEA content, demonstrated greater increase in CEA than predicted by cellular ELISA. Continuous IFN exposures for 5-6 days at 1,000 U/ml led to a 96-, 26-, and 5-fold increase in total CEA for the WiDr, HT29, and SW403 cell lines, respectively. WiDr cells exposed to daily 6-h IFN pulses demonstrated intermediate increases in CEA compared with cells exposed continuously to IFN.(ABSTRACT TRUNCATED AT 250 WORDS)

Tumor markers in mammary carcinoma. An evaluation of carcinoembryonic antigen, placental alkaline phosphatase, pseudouridine and CA-50.

In 104 patients with breast cancer, carcinoembryonic antigen (CEA), placental alkaline phosphatase (PLAP) and the carbohydrate antigen CA-50 were analysed in serum. Excretion of the modified nucleoside, pseudouridine, was analysed in urine. The patients were subdivided in three different clinical stages according to disease manifestations. Levels of CEA and pseudouridine correlated to clinical stage and 58 per cent of the patients with distant metastases had elevated levels of CEA, compared with 36 per cent for pseudouridine. For PLAP and CA-50, the levels did not show any clear correlation to clinical stage. Increased activity of PLAP correlated strongly to tobacco smoking. A decrease in the level of CEA was observed following radical mastectomy. Increase in CEA levels predicted relapse in 5 out of 14 patients within about 3 to 6 months. In patients with tumor manifestations, elevated CEA levels predicted an inferior prognosis compared to those with ordinary levels.

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.