Serum Carcinoembryonic Antigen In Patients Research Articles

Meta-analysis of the prognostic value of serum carcinoembryonic antigen in patients with colorectal cancer liver metastases after hepatectomy.

Carcinoembryonic antigen (CEA) is a broad-spectrum tumor marker for differential diagnosis, monitoring, and response assessment of a variety of malignancies. This meta-analysis was aimed at evaluating whether serum CEA could predict the prognosis in patients with colorectal cancer liver metastasis (CRCLM) before and after liver resection (LR). PubMed, Embase, Cochrane, and Web of Science were systematically searched to retrieve literature, with a search cutoff date of 27 February 2023. Articles were strictly screened for inclusion according to pre-specified inclusion and exclusion criteria. Data were pooled and analyzed using Stata 16.0. This meta-analysis included 36 studies involving a total of 11 143 CRCLM patients. The results showed that a high pre-LR serum CEA level was correlated with poor overall survival (OS: HR = 1.61, 95% CI = 1.49-1.75, P < 0.001) and recurrence-free survival (RFS: HR = 1.27, 95% CI = 1.11-1.45, P < 0.001) in CRCLM patients. A high post-LR serum CEA level predicted poor overall survival (OS: HR = 2.66, 95% CI = 2.10-3.38, P < 0.001). High preoperative and postoperative serum CEA levels in patients with CRCLM were significantly associated with poor prognosis, independent of treatment modality, mode of analysis, case origin, and cutoff value classification.

Prognostic role of serum carcinoembryonic antigen in patients receiving liver resection for colorectal cancer liver metastasis: A meta-analysis.

Carcinoembryonic antigen (CEA) is a broad-spectrum tumor marker for differential diagnosis, monitoring, and response assessment of a variety of malignancies. To evaluate whether serum CEA could predict the prognosis in patients with colorectal cancer liver metastasis (CRCLM) before and after liver resection (LR). PubMed, Embase, Cochrane, and Web of Science were systematically searched to retrieve literature, with a search cut-off date of February 27, 2023. Articles were strictly screened for inclusion according to pre-specified inclusion and exclusion criteria. Data were pooled and analyzed using Stata 16.0. This meta-analysis included 36 studies involving a total of 11143 CRCLM patients. The results showed that a high pre-LR serum CEA level was correlated with poor overall survival (OS) [hazard ratio (HR) = 1.61, 95% confidence interval (CI): 1.49-1.75, P < 0.001] and recurrence-free survival (HR = 1.27, 95%CI: 1.11-1.45, P < 0.001) in CRCLM patients. A high post-LR serum CEA level predicted poor OS (HR = 2.66, 95%CI: 2.10-3.38, P < 0.001). A comparison by treatment modality, analysis modality, patient source, and cutoff-value showed that overall, high preoperative and postoperative serum CEA levels remained correlated with a poor prognosis. This study concluded that high pre-LR and post-LR serum CEA levels were significantly correlated with a poor prognosis in CRCLM patients.

Enhanced prognostic value of combined circulating tumor cells and serum carcinoembryonic antigen in patients with colorectal cancer.

Circulating tumor cells (CTCs) have been investigated as a potential biomarker for predicting prognosis and monitoring therapeutic responses in colorectal cancer (CRC). However, the sensitivity of CTCs detection is low, thus limiting the clinical utility of CTCs. We aim to examine the clinicopathological parameters that improve prognosis prediction for CRC using CTCs as a biomarker. We enumerated CTCs in 186 CRC patients and associated the number of CTCs with the clinicopathological features and overall survival (OS) using a univariate and multivariate Cox regression model and Kaplan-Meier survival analysis. The presence of CTCs from 186 CRC patients was significantly associated with stage, preoperational carcinoembryonic antigen (CEA), and CA19-9 levels. Using Kaplan-Meier survival and Cox regression analysis, patients with five or more CTCs exhibited significantly worse OS compared to patients with fewer than five CTCs. The combination of CTCs with tumor marker CEA has a better OS prediction than individual CTCs or CEA and serves as a more effective prediction model in patients with CRC. We identified that patients with more than five CTCs exhibited significantly worse OS. Additionally, patients with the normal level of CEA, but who also had more than five CTCs trended towards a worse OS.

ASO Visual Abstract: Clinical Usefulness of Postoperative Serum Carcinoembryonic Antigen in Patients with Colorectal Cancer with Liver Metastases.

ASO Visual Abstract: Clinical Usefulness of Postoperative Serum Carcinoembryonic Antigen in Patients with Colorectal Cancer with Liver Metastases.

Clinical Usefulness of Postoperative Serum Carcinoembryonic Antigen in Patients with Colorectal Cancer with Liver Metastases.

Colorectal cancer with liver metastasis (CLM) has high postoperative recurrence rates; therefore, optimizing perioperative treatment is imperative. Postoperative carcinoembryonic antigen (CEA) can aid in detecting minimal residual disease in colon cancer following curative resection. This study aimed to identify the potential role of serum CEA following liver resection in patients with CLM. This retrospective study was conducted at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research from 2004 to 2018 and enrolled patients with CLM who underwent complete resection of primary tumors and CLM. Associations between perioperative CEA levels and characteristics of recurrence were investigated. Recurrence was detected during a median follow-up period of 90.1 months in 343 (54.2%) out of 633 analyzed patients. Patients in the postoperative CEA level > 5 ng/ml group had a significantly higher recurrence rate (75.7% versus 50.0%,p < 0.01) and shorter time until recurrence (4.4 versus 36.9 months,p < 0.01) than those in the postoperative CEA level ≤ 5 ng/ml group. Multivariate analysis revealed that postoperative CEA level > 5 ng/ml was an independent predictor, with hazard ratios of 2.77 (p < 0.01) for recurrence-free survival (RFS) and 3.18 (p < 0.01) for overall survival (OS). Additionally, RFS was significantly shorter among patients in the postoperative CEA level > 5 ng/ml group who did not have normalized CEA levels following adjuvant chemotherapy than among those in the normalized CEA group. The postoperative and post-adjuvant chemotherapy CEA levels in the CEA level > 5 ng/ml group may be predictors of RFS and OS.

Elevation of Serum CEA in Patients with Squamous Cell Carcinoma of the Anus

The proportion of anal cancer cases that produce elevated carcinoembryonic antigen (CEA) levels is not well described in the medical literature. In this study, we used electronic health record data from a single urban cancer center to identify patients from 2004–2018 with anal cancer who have also had a pre-initial treatment CEA measurement. We identified 40 patients who met our eligibility criteria. Of those, 11 (27.5%) had an elevated pretreatment CEA. Elevated CEA was not associated with any of the clinical or demographic covariates; however, three out of five patients with a recurrence had an elevated CEA.

Distributions and significance of LAP+ CD4+ Treg cells in the peripheral blood of patients with colorectal cancer

Objective To explore the distributions of LAP+ CD4+ Treg cells in the peripheral blood of patients with colorectal cancer and its relationship with the clinicopathological factors. Methods The retrospective case-control study was adopted. The clinical data of 40 patients undergoing radical resection of colorectal cancer and 20 healthy volunteers who were admitted to the First Affiliated Hospital of Guangxi Medical University between April 2014 and October 2014 were collected. The proportion of LAP+ CD4+ Treg cells in the peripheral blood was detected by flow cytometry. Analysis indicators included: (1) proportion of LAP+ CD4+ Treg cells in the peripheral blood between patients with colorectal cancer and healthy volunteers, (2) relationship between clinicopathological factors and proportion of LAP+ CD4+ Treg cells in the peripheral blood, (3) correlation analysis of quantitative data on the clinicopathological factors related with proportion of LAP+ CD4+ Treg cells in the peripheral blood. Measurement data with normal distribution were presented as ±s, and comparison between groups was analyzed using the t test. Correlation analysis was done using the Pearson test. Results (1)Results of flow cytometry showed that proportion of LAP+ CD4+ Treg cells in the peripheral blood was 9.4%±2.9% in patients with colorectal cancer and 1.5%±0.7% in healthy volunteers, with a statistically significant difference (t=12.275, P<0.05). (2) Relationship between clinicopathological factors and proportion of LAP+ CD4+ Treg cells in the peripheral blood: proportion of LAP+ CD4+ Treg cells in the peripheral blood in patients with colorectal cancer was 8.5%±3.2% with serum carcinoembryonic antigen (CEA)<5.0 μg/L, 12.3%±3.0% with serum CEA≥5.0 μg/L, 8.1%±1.1% in stage A-B of Dukes staging, 10.8%±2.0% in stage C-D of Dukes staging, 11.4%±2.0% with lymph nodes metastasis and 9.3%±2.1% without lymph nodes metastasis, showing statistically significant differences in the different levels of CEA, Dukes staging and lymph node metastasis (t=2.783, -5.376, 3.276, P<0.05). (3) Correlation analysis: there was a positive correlation between serum CEA of patients with colorectal cancer and proportion of LAP+ CD4+ Treg cells in the peripheral blood, with a statistically significant difference (r=0.543, P<0.05). Conclusions The proportion of LAP+ CD4+ Treg cells in the peripheral blood of patients with colorectal cancer is increased, and it is also different among patients with different Dukes staging and lymph node metastasis. There is a positive correlation between serum CEA of patients with colorectal cancer and proportion of LAP+ CD4+ Treg cells in the peripheral blood. Key words: Colorectal neoplasms; LAP+ CD4+ Treg cells; Flow cytometer

Evaluation of the Clinical Significance of Serum Carcinoembryonic Antigen in Patients with Resectable Gastric Adenocarcinoma

Carcinoembryonic antigen (CEA) is the most commonly used tumor marker for gastrointestinal cancers but its value for resectable gastric adenocarcinoma (RGA) patients in areas of high GA incidence is uncertain. We retrospectively studied 400 subjects with RGA from the Fujian Province in China, which has a high incidence of GA. Patients had surgery between January 2010 and December 2013. CEA was measured and correlated to pathology. High pretreatment serum CEA (>5ng/mL) was associated with patient age (p=0.000), tumor size (p=0.008), and T and N stages (p=0.002, p=0.032, respectively), alpha fetoprotein (p=0.014), and CA19-9 (p=0.000). High CEA was significantly associated with poor overall survival. Overall survival in the whole group of patients was 63.8%, whereas it was only 42.9% in the high CEA group (p=0.0001). Mean overall survival for high CEA patients was significantly shorter than patients with low CEA (36.5±2.63months vs. 47.4±0.98months, p=0.000). Multivariate analysis confirmed that pretreatment serum CEA was an independent prognostic factor for increased death risk. Additionally, mean CEA in 45 high CEA patients was reduced after surgery. Pretreatment serum CEA may help to predict survival for patients with RGA in high GA incidence areas.

A Prospective Study of Serum Carcinoembryonic Antigen in Patients with Newly Diagnosed Colorectal Cancer and Healthy Individuals

Aims: Studies have shown that serum levels of tumor markers are influenced by several factors. The present study has assessed the effect of smoking, age, sex and on elevated levels of carcinoembryonic antigen (CEA) among the healthy individuals, and has compared it in patients with newly diagnosed colorectal cancer. Methods: Our experimental study was conducted on 800 cases in Iran. We had two parallel groups including 675 normal cases and 125 patients with colorectal cancer. The quantitative measurement of CEA for the recruited individuals was carried out by RIA method. Results: We observed the distribution of CEA values was significantly higher in colorectal cases than apparently healthy cases (P<0.001). Also the distribution of CEA values was found to be significantly higher in the healthy smokers group when compared to the healthy nonsmokers (P<0.05). Comparison among mean of CEA levels in three age groups including individuals with mean age under 30 years, between 30 and 60 years and upper 60 years old respectively as groups 1, 2 and 3 showed significantly elevated CEA levels in over 60 years individuals (P<0.05). Conclusions: This study indicated that among all disagreements about CEA validity as a beneficial tool for clinicians, they should be aware of the usefulness of the CEA level in serum but even a very high CEA level should not be considered by itself as evidence of cancer.

Clinical value of preoperative serum carcinoembryonic antigen detection in the prediction of esophageal cancer lymph node metastasis

Objective To investigate the clinical value of preoperative serum carcinoembryonic antigen (CEA) detection in the prediction of esophageal cancer lymph node metastasis. Methods The clinical data of 111 patients with esophageal cancer who were admitted to the Chaoyang Hospital of Capital Medical University between December 2010 and January 2014 were retrospectively analyzed. Patients received preoperative serum CEA examination and enhanced CT of the chest. The surgical procedures were selected according to the condition of patients, including radical resection of esophageal cancer via left thoracic approach, transabdominal right thoracic approach (open and laparoscopic surgeries), cervico-thoracic-abdominal triple incision (open and laparoscopic surgeries) and transabdominal incision. The international standard was used for tumor location and TNM stage of esophageal cancer. The count data and comparison of ordinal data in the univariate analysis were analyzed using the chi-square test, Fisher exact probability and rank-sum test, respectively. The multivariate analysis was done using the stepwise logistic regression. The ROC curve was used for evaluating diagnostic value of serum CEA examination and enhanced CT of the chest. All the 111 patients were divided into 4 groups according to the interquartile range results of the CEA examination, and the lymph node metastasis rates of 4 groups were compared by the chi-square test. Results All the 111 patients underwent successful radical resection of esophageal cancer after preoperative serum CEA detection and enhanced CT of the chest, including 40 via left thoracic approach, 56 via transabdominal right thoracic approach, 8 via cervico-thoracic-abdominal triple incision and 7 via transabdominal incision. There were 3 patients with upper thoracic esophageal cancer, 52 with middle thoracic esophageal cancer, 36 with lower thoracic esophageal cancer and 20 with cancer of gastro-esophageal junction. The postoperative pathological type included 84 squamous cell carcinomas, 23 adenocarcinomas and 4 other carcinomas. There were 44 patients with negative lymph node metastases and 67 with positive lymph node metastases. The positive rate of elevated serum CEA in the 111 patients was 36.04%(40/111). Tumor location, pathological type and N stage of tumor were clinical pathological factors affecting the positive rate of serum CEA of patients (Z=6.815, 6.608, 16.928, P 4.21 μg/L by the stratified analysis, respectively, with a significant difference among the 4 groups (χ2=16.026, P<0.05). The areas under the curve of CEA level and enhanced CT of the chest for lymph node metastasis were 0.687 (95% CI: 0.590-0.785) and 0.689 (95% CI: 0.591-0.788) by ROC curve, which were significantly different from the area under the guides (P<0.05). The areas under the curve of CEA level and enhanced CT of the chest for lymph node metastasis were 0.785 (95%CI: 0.697-0.873, P<0.05). Conclusions Serum CEA detection not only has certain predictive value for lymph node metastasis of esophageal cancer, but has a higher predictive value combined with enhanced CT of the chest. There is a risk of lymph node metastasis for patients with deep tumor invasion and elevated CEA level, and the range of lymph node dissection should be expanded. Key words: Esophageal neoplasms; Carcinoembryonic antigen; Lymph node metastasis

Analysis of CEA expression and EGFR mutation status in non-small cell lung cancers.

The serum carcinoembryonic antigen (CEA) level can reflect tumor growth, recurrence and metastasis. It has been reported that epidermal growth factor receptor (EGFR) mutations in exons 19 and 21 may have an important relationship with tumor cell sensitivity to EGFR -TKI therapy. In this study, we investigated the clinical value of EGFR mutations and serum CEA in patients with non-small cell lung cancer (NSCLC). The presence of mutations in EGFR exons 19 and 21 in the tissue samples of 315 patients with NSCLC was detected with real-time fluorescent PCR technology, while the serum CEA level in cases who had not yet undergone surgery, radiotherapy, chemotherapy and targeted therapy were assessed by electrochemical luminescence. The mutation rates in EGFR exons 19 and 21 were 23.2% and 14.9%, respectively, with the two combined in 3.81%. Measured prior to the start of surgery, radiotherapy, chemotherapy and targeted treatment, serum CEA levels were abnormally high in 54.3% of the patients. In those with a serum CEA level <5 ng/mL, the EGFR mutation rate was 18.8%, while with 5~19 ng/mL and ≥ 20 ng/mL, the rates were 36.4% and 62.5%. In addition, in the cohort of patients with the CEA level being 20~49 ng/mL, the EGFR mutation rate was 85.7%, while in those with the CEA level ≥ 50 ng/mL, the EGFR mutation rate was only 20.0%, approximately the same as in cases with the CEA level<5 ng/mL. There is a positive correlation between serum CEA expression level and EGFR mutation status in NSCLC patients, namely the EGFR mutation-positive rate increases as the serum CEA expression level rises within a certain range (≥ 20 ng/mL, especially 20~49 ng/mL). If patient samples are not suitable for EGFR mutation testing, or cannot be obtained at all, testing serum CEA levels might be a simple and easy screening method. Hence, for the NSCLC patients with high serum CEA level (≥ 20 ng/mL, especially 20~49 ng/mL), it is worthy of attempting EGFR-TKI treatment, which may achieve better clinical efficacy and quality of life.

Clinical and prognostic relevance of methylation of circulating HLTF and HPP1 tumor DNA and CEA in serum of patients with colorectal carcinoma (CRC).

3611 Background: Hypermethylation of CpG islands is a frequent epigenetic alteration in CRC. We identified helicase-like transcription factor (HLTF) and hyperplastic polyposis 1 (HPP1)as methylation markers in serum of patients with CRC. So far no data is available on the prognostic relevance of these genes when found in serum of patients with metastasized tumors. The aim of this study was to elucidate the prognostic relevance of methylated HLTFand HPP1DNA compared to carcinoembryonic antigen (CEA) in serum of patients with metastasized CRC. Methods: We examined pretherapeutic sera of 311 patients with CRC (208 UICC I-III, 103 UICC IV). CEA was determined using the AXsym system (Abbott Diagnostics). Circulating free DNA was extracted from the serum samples. After bisulfite treatment of the DNA, quantitative realtime PCR was performed to determine the amount of methylated HTLF and HPP1 DNA. Survival analysis was performed using the Kaplan-Meier method and logrank tests. Hazard ratios were estimated using Cox proportional hazard method. Results: Serum methylation of HLTF and HPP1 was found in 11% (n=23/208) and 5% (n=11/208) of UICC I-III and 24% (n=25/103) and 51% (n=53/103) of UICC IV patients. Methylation of the genes HLTF (p=0.0024) and HPP1 (p<0.0001) occurred significantly more frequently in sera of patients with metastasized CRC than in patients without distant metastases. Overall survival for patients with stage IV disease was shortened when serum methylation of HLTF (19.7 vs. 10.0 months, p=0.0005) or HPP1 (23.2 vs. 10.5 months, p=0.0003) or high levels of CEA (cutoff 27 ng/mlL, median of UICC IV group) (26.8 vs. 12.9 months, p=0.0020) was found. Multivariate analysis showed that methylation of HLTF (HR 1.8, 95% CI 1.0-3.0, p=0.0438) and HPP1 (HR 1.6, 95% CI 1.0-2.7, p=0.0495) as well as CEA (HR 1.7, 95% CI 1.0-2.7, p=0.0317) are independent prognostic factors in UICC IV patients. Conclusions: Detection of methylated HLTF or HPP1 DNA and elevated CEA in serum of patients with metastasized CRC is correlated with worse prognosis. Therefore, HLTF and HPP1 could supplement the current standard CEA as a serum prognostic marker.Prospective studies need to confirm these results.

Selenium in serum and neoplastic tissue in breast cancer: correlation with CEA

Trace element selenium (Se) is regarded to be a breast cancer preventive factor involved in multiple protective pathways. In all, 80 women with breast cancer who underwent a radical mastectomy were enrolled in the study. Serum Se and carcinoembryonic antigen levels were measured using a fluorometric and IRMA assay, respectively. Se tissue concentration was determined by a tissue extracting fluorometric assay. For statistical analysis purposes t-test was used and P-values <0.001 were regarded as statistically significant. Serum Se was 42.5±7.5 μg l−1 in breast cancer patients and 67.6±5.36 μg l−1 in the age-matched control group of healthy individuals. Serum carcinoembryonic antigen in patients was 10±1.7 U ml−1 (normal <2.5 U ml−1 in nonsmokers/<3.5 U ml−1 in smokers). A statistically significant difference was found for both serum Se and CEA between two groups studied (P<0.001). Neoplastic tissue Se concentration was 2660±210 mg g−1 tissue; its concentration in the adjacent non-neoplastic tissue was 680±110 mg g−1 tissue (P<0.001). An inverse relationship between Se and CEA serum levels was found in the two groups studied (r=−0.794). There was no correlation between serum/tissue Se concentration and stage of the disease. The decrease in serum Se concentration as well as its increased concentration in the neoplastic breast tissue is of great significance. These alterations may reflect part of the defence mechanisms against the carcinogenetic process.

Alpha-fetoprotein and carcinoembryonic antigen in pancreatobiliary disease with and without jaundice.

A comparative study of alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) in serum was made by radioimmunoassay in 66 patients with pancreatobiliary disease with and without obstructive jaundice. biliary concentrations of these proteins were assayed in 12 patients with benign and 7 patients with malignant disease. There was no statistical difference in serum AFP between these two groups but there was a difference in serum CEA. Although CEA and AFP in bile in both groups were higher than in serum there was no statistical difference in serum CEA and AFP in patients with and without obstructive jaundice in either benign or malignant disease. In benign disease, patients with inflammation had higher serum CEA than normal. Although there was no statistical difference in serum CEA in patients with a without liver metastases, the serum CEA in liver metastases was significantly higher than in benign disease. We concluded that AFP is unlikely to be important in the assessment or management of patients with cancers other than those derived from the liver or yolk sac, and that the elevation of serum CEA in patients with malignant pancreatobiliary disease either with or without obstructive jaundice occurs mainly in the presence of widespread malignancy, especially in liver metastases.