Shen Dingcheng, Wang Xiaolin, Wang Heng, Xu Gaopo, Xie Yumo, Zhuang Zhuokai, Huang Ziying, Li Juan, Lin Jinxin, Wang Puning, Huang Meijin, Luo Yanxin, Yu Huichuan
1Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, and.
2Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University; and.
J Natl Compr Canc Netw. 2022 Mar 1;20(6):653-662.e3. doi: 10.6004/jnccn.2021.7101.
Serum CEA has been widely used to screen for potential recurrent disease after resection in rectal cancer. However, the influence of baseline CEA on the performance of CEA in recurrence surveillance needs to be investigated.
This longitudinal cohort study included 484 patients with nonmetastatic rectal cancer from 18,013 patients in a prospectively enrolled institutional database program of colorectal disease. Baseline CEA levels were determined before treatment, and CEA-based follow-up tests and examinations were applied in the surveillance after treatment.
A total of 62.6% (62/99) overall, 53.5% (23/43) local, and 64.9% (50/77) distant recurrences were seen in patients who had similar CEA levels with their baseline statuses. The sensitivity of elevated CEA levels during surveillance for overall recurrence was significantly lower in patients with negative baseline CEA than in those with elevated baseline CEA levels (41.3% vs 69.4%; P =.007). Moreover, similar results were observed in the surveillance for local (50% vs 61.5%; P =.048) and distant (39.6% vs 72.4%; P =.005) recurrences between these 2 patient groups. However, CEA had comparable and excellent specificity during surveillance for recurrent disease in these groups. The addition of CA19-9 to the CEA assay significantly improved the sensitivity in recurrence surveillance for patients with negative baseline CEA (49.2% vs 41.3%; P =.037). Finally, we identified a subgroup of CEA-turn recurrences characterized by negative CEA at baseline, elevated CEA at recurrence, and worse survival outcomes after recurrence (hazard ratio, 1.88; 95% CI, 1.07-3.30; P =.026).
In patients with rectal cancer with negative baseline CEA, serum CEA had insufficient sensitivity in recurrence surveillance after treatment, and additional surveillance may improve oncologic outcomes. Baseline CEA should be considered before CEA-based surveillance can be applied in the follow-up trials.
血清癌胚抗原（CEA）已被广泛用于直肠癌切除术后潜在复发疾病的筛查。然而，基线CEA对CEA在复发监测中的表现的影响尚需研究。
这项纵向队列研究纳入了来自一个前瞻性登记的结直肠疾病机构数据库项目中18013例患者中的484例非转移性直肠癌患者。在治疗前测定基线CEA水平，并在治疗后的监测中应用基于CEA的随访检测和检查。
总体上，CEA水平与基线状态相似的患者中，62.6%（62/99）出现了复发，局部复发率为53.5%（23/43），远处复发率为64.9%（50/77）。基线CEA阴性的患者在监测总体复发时CEA水平升高的敏感性显著低于基线CEA升高的患者（41.3%对69.4%；P = 0.007）。此外，在这两组患者的局部复发（50%对61.5%；P = 0.048）和远处复发（39.6%对72.4%；P = 0.005）监测中也观察到了类似结果。然而，在这些组中，CEA在复发疾病监测期间具有相当且出色的特异性。在CEA检测中加入CA19-9可显著提高基线CEA阴性患者复发监测的敏感性（49.2%对41.3%；P = 0.037）。最后，我们确定了一个CEA转变复发亚组，其特征为基线时CEA阴性、复发时CEA升高且复发后生存结果较差（风险比，1.88；95%可信区间，1.07 - 3.30；P = 0.026）。
在基线CEA阴性的直肠癌患者中，血清CEA在治疗后复发监测中的敏感性不足，额外的监测可能改善肿瘤学结局。在基于CEA的监测应用于后续试验之前，应考虑基线CEA情况。
