Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, 199, Tung Hwa North Road, Taipei, Taiwan, Republic of China.
Int J Colorectal Dis. 2010 May;25(5):567-71. doi: 10.1007/s00384-010-0889-6. Epub 2010 Feb 17.
The role of carcinoembryonic antigen (CEA) in the early detection of recurrence during the postoperative follow-up of colorectal cancer remains unclear. We hypothesize that the tumor with longer lead time of CEA elevation to the definite recurrence may have a better prognosis because of its slower growth rate and closer observation.
From 1995 to 2003, 4,841 consecutive patients who received curative resection of localized colorectal adenocarcinoma were enrolled from a prospective database. The patients with persisting CEA elevation after operation had been already excluded. Postoperative follow-up, including physical examination, imaging, and CEA test, were performed according to a surveillance program. A CEA >/=5 ng/mL was defined as elevated. The definition of the CEA lead time was the period between CEA elevation and detection of recurrence. All statistical analyses were performed by SPSS package for Windows (Microsoft, Redmond, WA, USA).
The postoperative median follow-up time for the 4,841 patients was 68 months. A total of 999 patients (20.6%) had CEA elevation and recurrence. Among these patients, recurrence was confirmed in 727 patients (72.8%)before, at the same time, or within 3 months of CEA elevation and thus had a short lead time of CEA elevation (SLT group). In 272 patients (27.2%), recurrence was confirmed after more than 3 months of CEA elevation and thus had a longer lead time of CEA elevation (LLT group). The recurrence pattern showed similarities in these two groups. A total of 193 patients (193/999, 19.3%) received a second radical operation, and 806 patients (80.7%) were inoperable. The re-resection rate between the SLT group (146 patients, 20.1%) and the LLT group (47 patients, 17.3%) was not significantly different. The overall survival rate after recurrence showed no difference between these two groups (P = 0.123).
Most cases of recurrence were detected at nearly the same time when the CEA level was elevated. Therefore, a more sensitive test is needed for early detection. The relationship between the lead time of CEA and the clinical outcome was not statistically significant. A more aggressive approach to the patient who has CEA elevation and is highly suspect of recurrence may be needed.
癌胚抗原（CEA）在结直肠癌术后随访中对早期复发的作用仍不清楚。我们假设，CEA 升高到明确复发的时间较长的肿瘤可能由于其生长速度较慢和更密切的观察而具有更好的预后。
1995 年至 2003 年，从一个前瞻性数据库中纳入了 4841 例接受局部结直肠腺癌根治性切除术的连续患者。已经排除了术后 CEA 持续升高的患者。根据监测计划进行术后随访，包括体格检查、影像学检查和 CEA 检测。CEA >/=5ng/mL 定义为升高。CEA 潜伏期的定义是 CEA 升高与复发之间的时间间隔。所有统计分析均使用 Windows 版 SPSS 软件包（Microsoft，Redmond，WA，USA）进行。
4841 例患者的术后中位随访时间为 68 个月。999 例（20.6%）患者 CEA 升高并复发。在这些患者中，727 例（72.8%）在 CEA 升高之前、同时或 3 个月内确认复发，因此 CEA 升高的潜伏期较短（SLT 组）。在 272 例（27.2%）患者中，CEA 升高后超过 3 个月才确认复发，因此 CEA 升高的潜伏期较长（LLT 组）。这两组的复发模式相似。193 例（193/999，19.3%）患者接受了二次根治性手术，806 例（80.7%）患者无法手术。SLT 组（146 例，20.1%）和 LLT 组（47 例，17.3%）的再切除率无显著差异。复发后总生存率在两组之间无差异（P=0.123）。
大多数复发病例在 CEA 水平升高时几乎同时被发现。因此，需要更敏感的检测方法进行早期检测。CEA 潜伏期与临床结局之间没有统计学意义。对于 CEA 升高且高度怀疑复发的患者，可能需要更积极的治疗方法。
