Serial Serum Carcinoembryonic Antigen Research Articles

583P - Pre-Op Cea Influences Interpretation of Cea Dynamics for Surveillance of Recurrent Colorectal Cancer

ABSTRACT Background Serial serum carcinoembryonic antigen (CEA) assays are routinely performed following curative resection of colorectal cancer. The interpretation of post-op CEA dynamics in relation to pre-operative CEA values remains unclear. The aim of our study was to determine the value of pre-op CEA levels in interpreting subsequent rises in CEA for detection of recurrent disease. Methods We identified 699 patients who developed recurrent disease following curative resection of colorectal cancer. Patient's demographics, clinical and histopathologic characteristics, time to recurrence were evaluated in relation to pre-op CEA levels and CEA dynamics. Median time to recurrence was 20 months (95%CI: 27.3-35.0). Results Prior to curative surgery, 49.5% of patients had a Pre-op CEA > 5 Ug/L (primary tumor is a “secretor”) whilst 50.5% did not have elevated pre-op CEA (“non-secretor”). The pre-op CEA value is prognostic (continuous variable, p 5 Ug/L prior to relapse was observed in 51% of all patients. This new rise was more likely to be observed among patients whose initial primary was secretory (p Conclusions Pre-operative CEA levels prior to initial surgery influence CEA dynamics post curative resection in patients with recurrent colorectal cancer. Among secretors, fall to baseline CEA is associated with longer time to recurrence. Among all patients, a new rise in CEA is more likely to occur in patients whose initial primary is secretory. Once this new rise occurs, median time to recurrence is 2.4 months and this duration is not dependent on initial secretory status. Disclosure All authors have declared no conflicts of interest.

Clinical Significance of Serial Serum Carcinoembryonic Antigen Values for Treating Rectal Cancer with Preoperative Chemoradiotherapy

PurposePreoperative chemoradiotherapy is now widely accepted to treat rectal cancer; however, the prognosis for rectal cancer patients during and after chemoradiotherapy must be determined. The aim of this study was to evaluate the serial serum carcinoembryonic antigen (s-CEA) samples in patients with rectal cancer who underwent radical surgery after concurrent chemoradiotherapy (CRT).MethodsThis study evaluated 236 patients with rectal cancer who received preoperative CRT followed by curative surgery between June 2005 and June 2010. We measured the patient's s-CEA levels pre-CRT, post-CRT and post-surgery. Patients were classified into four groups according to their s-CEA concentrations (group 1, high, high, high; group 2, high, high, normal; group 3, high, normal, normal; group 4, normal, normal, normal). We analyzed the clinicopathologic factors and the outcomes among these groups.ResultsOf the 236 patients, 12 were in group 1, 31 were in group 2, 67 were in group 3, and 126 were in group 4. The 3-year disease-free survival rate in group 1 was poorer than those in group 3 (P = 0.007) and group 4 (P < 0.001). In a univariate analysis, type of surgery, clinical N stage, pathologic T or N stage, lymphovascular invasion, perineural invasion, and CEA group were prognostic factors. A multivariate analysis revealed that type of surgery, pathologic T stage, and lymphovascular invasion were independent prognostic factors; however, no statistical significance was associated with the CEA group.ConclusionHigh pre-CRT, post-CRT, and post-surgery s-CEA levels in patients with rectal cancer were associated with high rates of systemic recurrence and poor survival. Therefore, patients with sustained high s-CEA levels during CRT require careful monitoring after surgery.

The predictive values of carcinoembryonic antigen (CEA) in patients with metastatic non-small cell lung cancer (NSCLC) treated with gefitinib

22145 Background: Gefitinib inhibits the signaling of the EGFR tyrosine kinase and has shown activity in the treatment of advanced NSCLC, especially in Asian patients. Mutation in EGFR exon 19 and 21 have been shown to be the strongest predictor of response to gefitinib. Other clinical factors which also predict for response include female gender, adenocarcinoma, never smoker and Asian ethnicity. Recently, CEA was reported as a predictive factor of the efficacy of gefitinib and its level was associated with the frequency of EGFR mutation. Methods: We retrospectively reviewed records of 125 patients with metastatic NSCLC who received gefitinib as the only treatment and identified 24 cases that had at least one CEA serum level determined before starting gefitinib and response could be evaluated. 9 cases had serial serum CEA determined during the gefitinib therapy. Response was evaluated every 2 months by CT scans and using the RECIST criteria. Pre-treatment CEA>5 ug/L was defined as abnormal. Results: See T...

Usefulness of analytical CEA doubling time and half-life time for overlooked synchronous metastases in colorectal carcinoma.

Measurement of carcinoembryonic antigen (CEA) has been widely applied to detect recurrence, especially of colorectal carcinoma. The validity however, is still controversial. We investigated serial changes in CEA values to calculate whether the CEA doubling time and half-life time could predict metastatic progression or prognosis in colorectal carcinoma. Pre- and post-operative serial serum CEA contents were determined in 22 cases of colorectal cancer with or without metastasis. CEA values were determined by enzyme immunoassay (EIA). Patients were assigned depending upon survival time (within vs. more than 18 months after primary resection) for assessment of CEA doubling time. From the gradient of the semi-logarithmic CEA graph, the preoperative doubling time was calculated and the postoperative half-life time was estimated according to the diagnosis of metastases within 2 years after primary resection [metastasis (+) or (-)]. In spite of the effect of curative re-operation of metastatic lesions or of postoperative adjuvant chemotherapy, the CEA doubling time of the groups showed a relation with prognosis (p = 0.045, Student's t-test) when the patients were divided into >18 and < or =18 months survival time. The CEA half-life time of the groups without overlooked metastases was statistically longer than those with (mean +/- SD 8.01 +/- 2.07 and 4.33 +/- 1.11, respectively, p < 0.01, one-factor ANOVA test). Clearance (k) showed a significant difference between the groups (p < 0.001, Student's t-test). The CEA doubling time appeared to be a less independent prognostic factor, whereas prolongation of the CEA half-life time might potentially suggest the existence of overlooked synchronous metastases from colorectal carcinoma.

Patterns of serum CEA fall after hepatic arterial chemotherapy as sole therapy and combined with cryotherapy for colorectal metastases.

Hepatic artery chemotherapy (HAC) and cryoablation are treatments for unresectable liver metastases from colorectal carcinomas. Our centre has previously published data that describe survival statistics of patients after each of these treatments. It has also been established that serial serum carcinoembryonic antigen (CEA) concentrations may be used to monitor disease progress, and that the magnitude of fall is prognostic for both treatments. The pattern of fall of CEA following cryotherapy and regional chemotherapy has not previously been compared. In this study, we examined 26 HAC patients and 24 cryotherapy patients. The mean percentage of the pre-treatment CEA concentration for the HAC group was 60.5% at 50 days and 29.4% at 150 days, and for the cryotherapy group 24.9% at 50 days and 24.3% at 150 days. Calculating the difference between means revealed a significantly different mean fall in the cryotherapy group at 50 days (P < 0.001) and a difference in mean fall at 150 days (P > 0.1) which was not significant. In patients who responded to hepatic artery chemotherapy, the eventual CEA fall was very similar in magnitude. The pattern of fall of CEA differs in these two treatments.

Evaluation of Serum Carcinoembryonic Antigen Monitoring in the follow-up of Colorectal Cancer Patients with Metastatic Lymph Nodes and a Normal Preoperative Serum Level

The value of serial serum carcinoembryonic antigen (CEA) assay in the follow-up of colorectal cancer patients with metastatic lymph nodes and normal (< or = 5 ng/ml) preoperative CEA levels, was examined in this study. Thirty-eight patients were studied and compared with 22 patients with elevated CEA levels. The overall sensitivity of CEA for the diagnosis of recurrence was 36%. Postoperative CEA was strongly influenced by the site of recurrence. CEA monitoring showed the best results in patients who developed hepatic metastases (sensitivity 60%, specificity 94%, positive predictive value 60%, and negative predictive value 94%), and was ineffective for the detection of locoregional or pulmonary metastases. The results indicate that elevation of CEA in the postoperative course of these patients is an indicator of the presence of hepatic metastases. Postoperative CEA monitoring should not be omitted in Dukes C patients with normal preoperative levels, and is more reliable for the detection of liver metastases.

Comparison of doubling times of serum carcinoembryonic antigen produced by various metastatic lesions in recurrent gastric and colorectal carcinomas

The authors measured the serial serum carcinoembryonic antigen (CEA) levels in patients with recurrent gastric or colorectal carcinoma. Among the 45 patients with recurrent gastric carcinomas, those with lung metastases showed the most prolonged CEA doubling time (CEA-DT), followed by those with liver and peritoneal metastases, respectively. Of the 31 patients with recurrent colorectal carcinomas, those with local recurrence showed the most prolonged CEA-DT, followed by those with lung, liver, and peritoneal metastases, respectively. A positive correlation was observed for gastric and colorectal carcinomas between CEA-DT in patients with metastatic lesions and outcome (R = 0.84 and 0.93, respectively). The results of the current study suggest that postoperative measurement of CEA-DT is useful in the determination of region of recurrence of carcinoma, which would permit early surgery and chemotherapy. Measurement of CEA-DT also may be helpful for the accurate determination of prognosis.

Carcinoma of the ampulla of Vater.

A consecutive series of 36 Japanese patients with ampullary carcinoma who underwent a pancreatoduodenectomy at the Department of Surgery I, Kyushu University Hospital during the past 20 years were reviewed clinicopathologically to study prognostic factors. A univariate generalized Wilcoxon test showed that preoperative serum carcino-embryonic antigen (CEA) concentration, venous invasion, lymphatic permeation and perineural invasion were significant parameters. A multivariate Cox regression analysis showed that venous invasion was the only significant variable. In a sequential serum CEA follow up of 10 patients, an elevation of serum CEA levels was seen to correspond to the clinical development of a recurrence in six, while a high concentration of serum CEA was not evident despite the clinical manifestation of a recurrence in two, and serum CEA levels remained within the normal limits with no evidence of a recurrence in two others. According to the death certificates of 15 patients, where an exact site of metastasis was available, 11 died from liver metastasis, three from lung metastasis and one from peritoneal dissemination. These findings support the theory that a histologic invasion of the venous space is an independent prognostic factor and close attention should be paid to any signs of haematogenous metastasis, such as to the liver and lung, as well as to a serial serum CEA follow up.

CEA tissue staining in colorectal cancer patients. A way to improve the usefulness of serial serum CEA evaluation.

The evaluation of serial plasma carcinoembryonic antigen (CEA) levels is one of the most important parameter used to establish the prognosis of surgically cured colorectal cancer patients. Carcinoembryonic antigen is particularly useful in the identification of recurrences and metastasis. However, to improve the usefulness of this assay, it would be helpful to accurately determine, if possible, those patients whose cancers produce CEA. The evaluation of the presence of CEA in these cancer specimens by means of immunoperoxidase staining technique does seem to improve the sensitivity of the CEA test. Fifty-seven patients with colorectal cancer who underwent surgical treatment were studied. Tissue CEA evaluation was correlated with the plasma CEA levels, the pathologic stage and grade, and histologic type of the cancers. Results demonstrate that 66.6% of Dukes' B cancers, 78.9% of Dukes' C, and 77.7% of Dukes' D cancers stained positively for CEA by immunoperoxidase. Thirty of 57 patients with preoperative pathologic plasma CEA levels had positive tissue CEA, whereas 8/57 patients did not. Of patients with a well-differentiated cancer (G1), 81.4% had positive tissue CEA versus the 64% of G2 and 60% of G3 cancers. The authors conclude that the use of the immunoperoxidase stain to measure CEA in tissue, so that the CEA serum assay may be used in those patients known to produce CEA, results in a major increase in the sensitivity of the test.

The Value of the Serial Serum Carcinoembryonic Antigen (CEA) Measurements in Patients with the Bronchogenic Carcinoma Before and After Non-surgical (radio-and chemotherapy) Therapies

The Value of the Serial Serum Carcinoembryonic Antigen (CEA) Measurements in Patients with the Bronchogenic Carcinoma Before and After Non-surgical (radio-and chemotherapy) Therapies

Usefulness of serial serum carcinoembryonic antigen (CEA) determinations during anticancer therapy or long-term follow-up of gastrointestinal carcinoma.

Repeated determinations of serum CEA levels in untreated advanced gastrointestinal cancer patients with initially elevated values showed day to day variations of ±35%. If there was no intervening chemotherapy, all such patients who were followed over long term showed progressively increasing CEA levels. With chemotherapy there was a general correlation between changes in serum CEA levels and clinically measured changes in tumor mass. Among patients who showed objective improvement, 75% had reduction in serum CEA levels (> 35%) and 87% had either reduced or unchanged levels. Among those who showed objective progression, 65% had increases in serum CEA levels (> 35%) and 80% had either increased or unchanged levels. Paradoxical reductions in CEA levels were observed in some patients approaching terminal status. Among 80 patients being followed with serial CEA determinations after potentially curative resections of large bowel cancer and normal postoperative CEA levels, 6 have again showed clinical evidence of malignant disease and in 5 of these there was concurrent elevation of serum CEA. Serial serum CEA determinations appear to have some value for following the course of gastrointestinal cancer patients after surgery or chemotherapy, but these determinations must be interpreted in the context of the over-all clinical picture.