Litvak Anya, Cercek Andrea, Segal Neil, Reidy-Lagunes Diane, Stadler Zsofia K, Yaeger Rona D, Kemeny Nancy E, Weiser Martin R, Pessin Melissa S, Saltz Leonard
From the Gastrointestinal Oncology Service, Department of Medicine, Department of Surgery, and Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
J Natl Compr Canc Netw. 2014 Jun;12(6):907-13. doi: 10.6004/jnccn.2014.0085.
Routine monitoring of carcinoembryonic antigen (CEA) levels is standard in patients with resected colorectal cancer (CRC). The incidence of false-positives and the upper limits of false-positive elevations have not been previously well characterized. A search of medical records at Memorial Sloan-Kettering Cancer Center identified 728 patients who underwent an R0 resection of locoregional CRC between January 2003 and December 2012 and who had an increase in CEA level above the normal range after a normal perioperative CEA level. Of these, 358 had a false-positive elevation of CEA level, 335 had a true-positive elevation indicative of recurrent CRC, and 35 had a true-positive elevation indicative of the development of a new, non-CRC malignancy. Of those with false elevations, 111 had a single isolated CEA level elevation (median highest CEA level of 5.5 ng/mL) with no further abnormal measurements, whereas 247 had elevations on 2 or more readings, with a median highest level of 6.7 ng/mL. Of these 247 patients with confirmed false-positive CEA level elevations, only 5 (2%) had measurements greater than 15 ng/mL, and no confirmed elevation greater than 35 ng/mL was a false-positive. False-positive CEA test results in the range of 5 to 15 ng/mL are common. Confirmation of CEA elevation in this range before initiating imaging studies may be appropriate. False-positive results greater than 15 ng/mL are rare, and all confirmed CEA levels greater than 35 ng/mL were associated with cancer recurrence.
对接受过结直肠癌（CRC）切除手术的患者进行癌胚抗原（CEA）水平的常规监测是标准做法。此前，假阳性的发生率以及假阳性升高的上限尚未得到充分的界定。检索纪念斯隆凯特琳癌症中心的医疗记录发现，在2003年1月至2012年12月期间，有728例患者接受了局部区域性CRC的R0切除手术，且围手术期CEA水平正常后CEA水平升高至正常范围以上。其中，358例CEA水平出现假阳性升高，335例出现提示CRC复发的真阳性升高，35例出现提示新发非CRC恶性肿瘤的真阳性升高。在假升高的患者中，111例仅有一次孤立的CEA水平升高（CEA最高水平中位数为5.5 ng/mL），且无进一步异常测量结果，而247例在2次或更多次检测中出现升高，最高水平中位数为6.7 ng/mL。在这247例确诊为CEA水平假阳性升高的患者中，只有5例（2%）测量值大于15 ng/mL，且没有大于35 ng/mL的确诊升高是假阳性。CEA检测结果在5至15 ng/mL范围内出现假阳性很常见。在启动影像学检查之前，对该范围内的CEA升高进行确认可能是合适的。大于15 ng/mL的假阳性结果很少见，所有确诊的CEA水平大于35 ng/mL均与癌症复发相关。
