Wichmann M W, Lau-Werner U, Müller C, Hornung H M, Stieber P, Schildberg F W
Department of Surgery, Ludwig-Maximilians-University, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
Anticancer Res. 2000 Nov-Dec;20(6D):4953-5.
During recent years a discussion about cost-effectiveness and importance of follow-up determination of carcinoembryonic antigen (CEA) after curative resection of large bowel cancer has developed.
Between 1990 and 1998 follow-up CEA levels of 1,321 patients after curative colorectal cancer resection were prospectively collected in cooperation with family physicians, CEA determinations were made with different assays by various laboratories. The reported findings were adjusted for the different methods used.
306 patients developed recurrent disease following curative cancer resection (23.2% of all patients). Regarding the role of follow-up CEA determination, they were divided into: I. no preoperative CEA determination/insufficient follow-up (N = 47); II. no elevation of CEA with primary cancer, a) elevation with recurrent disease (N = 62), b) no elevation at any time point (N = 53), c) role of CEA not completely elucidated (N = 41); III. elevated CEA levels with primary cancer, a) no increase with recurrent disease (N = 21), b) increase with other symptoms of recurrent disease (N = 45), c) increased levels as early symptom of recurrent disease (N = 37). 30 patients (9.8% of all patients with recurrent disease; 2.3% of all patients) with increased CEA levels at the time of recurrent disease underwent surgical resection with curative intention (R0 resection).
Our findings indicate that up to 47% of the patients with recurrent disease and 11% of all patients (N = 144, groups IIa + IIIb + IIIc) could benefit from routine follow-up CEA determinations after curative colorectal cancer resection. Nonetheless, only 2.3% of all patients with elevated CEA levels underwent R0 resection of recurrent disease. Despite these detection and R0 resectability rates, CEA plays a crucial role in the early detection of recurrent disease and remains an important part of routine patient care after curative resection of colorectal cancer.
近年来，关于大肠癌根治性切除术后癌胚抗原（CEA）随访测定的成本效益和重要性展开了讨论。
1990年至1998年间，与家庭医生合作前瞻性收集了1321例大肠癌根治性切除术后患者的CEA随访水平，不同实验室采用不同检测方法进行CEA测定。对所报告的结果针对所使用的不同方法进行了校正。
306例患者在根治性癌症切除术后出现疾病复发（占所有患者的23.2%）。关于随访CEA测定的作用，他们被分为：I.术前未测定CEA/随访不足（N = 47）；II.原发性癌症时CEA未升高，a）复发疾病时升高（N = 62），b）任何时间点均未升高（N = 53），c）CEA的作用未完全阐明（N = 41）；III.原发性癌症时CEA水平升高，a）复发疾病时未升高（N = 21），b）复发疾病的其他症状时升高（N = 45），c）复发疾病的早期症状时水平升高（N = 37）。30例复发疾病时CEA水平升高的患者（占所有复发疾病患者的9.8%；占所有患者的2.3%）接受了根治性手术切除（R0切除）。
我们的研究结果表明，高达47%的复发疾病患者和所有患者的11%（N = 144，IIa + IIIb + IIIc组）可能从大肠癌根治性切除术后的常规随访CEA测定中获益。尽管如此，CEA水平升高的所有患者中只有2.3%接受了复发疾病的R0切除。尽管有这些检测率和R0切除率，但CEA在复发疾病早期检测中起着关键作用，并且仍然是大肠癌根治性切除术后常规患者护理的重要组成部分。
