Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea.
Int J Clin Oncol. 2018 Oct;23(5):924-929. doi: 10.1007/s10147-018-1293-4. Epub 2018 May 17.
To analyze the causes and patterns of unexplained carcinoembryonic antigen (CEA) elevation after curative treatment in locally advanced rectal cancer patients.
Among the 1309 locally advanced rectal cancer patients treated with curative resection and radiotherapy between January 2001 and June 2011, 325 patients who postoperatively developed abnormal CEA elevation were reviewed. The unexplained CEA elevation was defined as a CEA level higher than 5 ng/mL with no evidence of cancer recurrence at the time of elevation.
Of the 325 patients, 143 (44%) had unexplained CEA elevations. The causes were categorized as delayed recurrence (n = 29, 20%), non-colorectal malignancy (n = 10, 7%), and non-malignancy-related conditions (n = 104, 73%). Shorter intervals between treatment and the first CEA elevation, and a higher peak CEA level, were observed in the delayed recurrence group compared with the non-colorectal malignancy or non-malignancy-related group (intervals of 6.8 vs. 44.9 vs. 23.2 months, respectively, p = 0.002; and peak CEA levels of 9.9 vs. 7.1 vs. 6.2 ng/mL, respectively, p = 0.034). In patients who showed delayed recurrence, the interval between the first CEA elevation and diagnosis of recurrence was a median of 13.0 months (range 3.8-60.6 months). Smoking was the most common cause for non-malignancy-related conditions. The patterns of unexplained CEA elevations were defined as sporadic (n = 78, 55%), stationary (n = 37, 26%), and increasing (n = 28, 20%). The patterns were significantly different depending on the cause (p < 0.001).
Analysis of the patterns of unexplained CEA elevations is a reasonable approach to predict the cause of the cancer.
分析根治性治疗后局部晚期直肠癌患者癌胚抗原（CEA）升高的原因和模式。
在 2001 年 1 月至 2011 年 6 月期间接受根治性切除术和放疗的 1309 例局部晚期直肠癌患者中，回顾分析了术后出现 CEA 异常升高的 325 例患者。将无法解释的 CEA 升高定义为升高时 CEA 水平高于 5ng/mL 且无癌症复发证据。
325 例患者中，143 例（44%）出现无法解释的 CEA 升高。其原因分为延迟复发（29 例，20%）、非结直肠癌恶性肿瘤（10 例，7%）和非恶性相关疾病（104 例，73%）。与非结直肠癌恶性肿瘤或非恶性相关疾病组相比，延迟复发组治疗后首次 CEA 升高的间隔时间更短，峰值 CEA 水平更高（间隔分别为 6.8、44.9 和 23.2 个月，p=0.002；峰值 CEA 水平分别为 9.9、7.1 和 6.2ng/mL，p=0.034）。在出现延迟复发的患者中，首次 CEA 升高和复发诊断之间的间隔中位数为 13.0 个月（范围 3.8-60.6 个月）。吸烟是非恶性相关疾病最常见的原因。无法解释的 CEA 升高的模式定义为散发性（78 例，55%）、静止性（37 例，26%）和递增性（28 例，20%）。这些模式与病因明显不同（p<0.001）。
分析无法解释的 CEA 升高的模式是预测癌症病因的合理方法。
