Trillet-Lenoir V, Chapuis F, Touzet S, Barbier J Y, Freyer G, Gaudin J L, Lombard-Bohas C, Valette P J, Lledo G, Gouttebel M C, Boyer J D, Chassignol L, Hamon H, Claudel-Bonvoisin S, Leprince E, Amoyal P, Glehen O, Darnand P, Heilmann M O, Bleuse J P
Medical Oncology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France.
Clin Oncol (R Coll Radiol). 2004 May;16(3):196-203. doi: 10.1016/j.clon.2003.11.005.
Computed tomography (CT) is the reference technique for evaluating response to chemotherapy. The potential helpfulness of tumour markers is debated.
From March 1997 to January 1999, 91 consecutive patients receiving chemotherapy for metastatic colorectal carcinoma underwent whole-body spiral CT, estimates of anti-carcinoembryonic antigen (CEA) and CA19-9 every 8 weeks.
CEA and CA19-9 levels were above normal in 78 (85.7%) and 61 (67.5%) patients, respectively. Tumour response evaluation according to the RECIST criteria was obtained at 8-week evaluation in 83 (91%) patients. The positive predictive values (PPV) for response of a decrease of the marker levels were 53.8 for CEA and 41.7 for CA19-9 using a 30% decrease threshold, and 60/52.2, respectively, using a 50% decrease threshold. Meaningful PPV values (> 90%) for progression of an increase of the marker levels were only obtained using the 200% increase threshold for CEA alone or a combination of CEA and CA 19-9. A 100% CEA increase between baseline and the 8-week evaluation was correlated to overall survival (P = 0.0023). The need for a radiological confirmation of tumour progression could be avoided by the systematic dosage of tumour markers at baseline and after 8 weeks of treatment only in a sub-population of 13% of the patients with a 200% increase of CEA or CA 19-9 at 8 weeks.
CEA, CA 19-9, or both should be used with caution for tumour response evaluation to chemotherapy in addition to CT in metastatic colorectal carcinoma.
计算机断层扫描（CT）是评估化疗反应的参考技术。肿瘤标志物的潜在作用存在争议。
1997年3月至1999年1月，91例接受转移性结直肠癌化疗的连续患者接受了全身螺旋CT检查，每8周检测抗癌胚抗原（CEA）和CA19-9水平。
CEA和CA19-9水平分别在78例（85.7%）和61例（67.5%）患者中高于正常。83例（91%）患者在8周评估时根据RECIST标准进行了肿瘤反应评估。使用30%降低阈值时，标志物水平下降对反应的阳性预测值（PPV），CEA为53.8，CA19-9为41.7；使用50%降低阈值时，分别为60/52.2。仅使用CEA单独的200%升高阈值或CEA与CA19-9联合使用时，标志物水平升高对进展的有意义PPV值（>90%）才会出现。基线与8周评估之间CEA升高100%与总生存期相关（P = 0.0023）。仅在13%的患者亚组中，即在8周时CEA或CA19-9升高200%的患者中，通过在基线和治疗8周后系统检测肿瘤标志物，可避免对肿瘤进展进行放射学确认的需要。
在转移性结直肠癌中，除CT外，CEA、CA19-9或两者在评估化疗的肿瘤反应时应谨慎使用。
