Department of Surgical Oncology, Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, India.
Department of Surgical Oncology, Caritas Cancer Institute, Thellakom, Kottayam, Kerala, India.
Colorectal Dis. 2017 Oct;19(10):907-911. doi: 10.1111/codi.13695.
During the follow-up of surgically resected colorectal cancer (CRC), positron emission tomography-contrast-enhanced computed tomography (PET-CECT) is indicated for asymptomatic elevation of carcinoembryonic antigen (CEA) > 5 ng/ml and no obvious site of recurrence on clinical examination and basic imaging. As an institutional policy, a PET-CECT scan was performed at our institute whenever (1) CEA levels rose above 5 ng/ml and (2) CEA values were doubled (even if the CEA level was < 5 ng/ml). Our aim was to correlate the range of CEA elevation with recurrence rates and to evaluate the diagnostic utility of PET-CECT scanning in this setting.
We retrospectively analysed all cases where a PET-CECT scan was performed for elevated CEA levels during surveillance visits after complete resection of the primary tumour followed by adjuvant therapy. This study was conducted from 1 January 2013 to 31 July 2015.
In all, 104 patients underwent a PET-CECT scan for rising CEA values, and 62 patients (59.6%) were found to have recurrent disease. At CEA levels < 5, 5.1-10, 10.1-15, 15.1-50 and > 50 ng/ml, disease recurred in 10%, 45%, 70%, 94% and 100% patients, respectively. Sensitivity, specificity, positive predictive value and negative predictive value of the PET-CECT scan were 92.7%, 95.2%, 96.2% and 90.9%, respectively. Elevation of CEA levels during follow-up was indicative of recurrence in 68% of the secretors and 45% of the non-secretors (based on baseline CEA status).
In the setting of rising CEA levels during follow-up of patients with CRC, a PET-CECT scan is a valuable tool to detect recurrence, irrespective of the baseline CEA secretor status. The likelihood of recurrence of disease was directly proportional to the value of the raised CEA level.
在结直肠癌（CRC）手术后的随访期间，如果癌胚抗原（CEA）>5ng/ml 升高且临床检查和基本影像学检查无明显复发迹象，建议进行正电子发射断层扫描-对比增强计算机断层扫描（PET-CECT）。作为机构政策，只要（1）CEA 水平升高超过 5ng/ml 和（2）CEA 值翻倍（即使 CEA 水平<5ng/ml），我们研究所就会进行 PET-CECT 扫描。我们的目的是将 CEA 升高的范围与复发率相关联，并评估在这种情况下 PET-CECT 扫描的诊断效用。
我们回顾性分析了所有在原发性肿瘤完全切除和辅助治疗后随访期间因 CEA 水平升高而进行 PET-CECT 扫描的病例。这项研究是在 2013 年 1 月 1 日至 2015 年 7 月 31 日进行的。
共有 104 例患者因 CEA 升高而行 PET-CECT 扫描，其中 62 例（59.6%）发现有疾病复发。在 CEA 水平<5ng/ml、5.1-10ng/ml、10.1-15ng/ml、15.1-50ng/ml 和>50ng/ml 时，疾病分别在 10%、45%、70%、94%和 100%的患者中复发。PET-CECT 扫描的敏感性、特异性、阳性预测值和阴性预测值分别为 92.7%、95.2%、96.2%和 90.9%。在 CRC 患者的随访期间，CEA 水平升高提示 68%的分泌者和 45%的非分泌者（基于基线 CEA 状态）有复发。
在结直肠癌患者随访期间 CEA 水平升高的情况下，PET-CECT 扫描是一种有价值的工具，可以检测复发，而与基线 CEA 分泌者状态无关。疾病复发的可能性与升高的 CEA 水平直接成正比。
