结直肠癌术后 CEA 用于监测原发性结直肠癌切除术后复发的效用。

Utility of postoperative CEA for surveillance of recurrence after resection of primary colorectal cancer.

机构信息

Department of Surgery, Leicester General Hospital, Leicester, UK.

出版信息

Int J Surg. 2015 Apr;16(Pt A):123-128. doi: 10.1016/j.ijsu.2015.03.002. Epub 2015 Mar 11.

DOI:10.1016/j.ijsu.2015.03.002

PMID:25771102

Abstract

INTRODUCTION

To evaluate the usefulness of postoperative CEA levels in the surveillance of colorectal cancer patients.

METHODS

Over a 56 month period a total of 569 patients with measured CEA levels underwent curative resection for colorectal cancer. The median follow up was 40 months, during which period recurrence occurred in 149. Serum CEA levels were measured at 6 monthly intervals starting from 3 months post resection. ROC was used to calculate the optimum cut-off of CEA (5 ng/ml).

RESULTS

Postoperative elevation of CEA levels were more frequent in patients with an aggressive primary colorectal cancer (grade, T stage and nodal disease; p < 0.05). In patients found to have colorectal recurrence, a significantly higher proportion of patients were resectable in the group with a non-elevated CEA (diagnosed by CT with PET imaging p < 0.05). The median interval between CEA elevation and diagnosis of recurrence (diagnostic interval) was 4 weeks. CEA elevation led to a change in the routine surveillance program by bringing imaging forward by 2 months. CEA levels were a significant predictor of survival following resection of colorectal primary (CEA ≤5-38 months, CEA >5-27 months; p < 0.05). CEA (p < 0.05) retained its significance on multivariate analysis along with the T stage (p < 0.05).

CONCLUSION

CEA is a predictor of recurrence, resectability and survival following resection of colorectal cancer. Furthermore, an elevated CEA has a short diagnostic interval (4 weeks) for detecting recurrent disease and therefore should mandate adjustment of the routine surveillance program with the next planned imaging being brought forward (2 months).

摘要

简介

评估结直肠癌患者术后 CEA 水平在监测中的作用。

方法

在 56 个月的时间内，共有 569 例 CEA 水平可测量的患者接受了结直肠癌根治性切除术。中位随访时间为 40 个月，在此期间 149 例患者复发。从术后 3 个月开始，每 6 个月测量一次血清 CEA 水平。ROC 用于计算 CEA 的最佳截断值（5ng/ml）。

结果

术后 CEA 水平升高在具有侵袭性原发性结直肠癌（分级、T 分期和淋巴结疾病；p<0.05）的患者中更为常见。在发现结直肠复发的患者中，CEA 非升高组（通过 CT 和 PET 成像诊断，p<0.05）中有更多的患者可切除。CEA 升高与复发诊断（诊断间隔）之间的中位间隔为 4 周。CEA 升高导致常规监测计划的改变，将影像学检查提前 2 个月。CEA 水平是结直肠原发性切除术后生存的显著预测因子（CEA≤5-38 个月，CEA>5-27 个月；p<0.05）。CEA（p<0.05）在多变量分析中与 T 分期（p<0.05）一样具有重要意义。