Moertel C G, O'Fallon J R, Go V L, O'Connell M J, Thynne G S
Cancer. 1986 Aug 1;58(3):603-10. doi: 10.1002/1097-0142(19860801)58:3<603::aid-cncr2820580302>3.0.co;2-k.
A study of preoperative carcinoembryonic antigen (CEA) levels was conducted in 319 patients with surgically treated colorectal cancer, 272 of whom had disease resectable with curative intent. Only three patients could not be completely followed. All of the remaining 316 patients have been followed for a minimum of 5 years or until death. From the standpoint of diagnosis, the CEA test was more frequently positive (greater than 5 ng/ml) in patients with advanced stage disease, with larger primary tumors, and with more differentiated histopathologic characteristics. It was grossly insensitive in diagnosis of resectable cancer (26%) and was only reasonably reliable (72%) in patients with unresectable and metastatic disease. In relationship to surgical pathology of colorectal cancer, CEA levels were significantly correlated with stage of disease and with size of the primary tumor in Dukes' B lesions, but not with extent of nodal metastasis in Dukes' C lesions. In advanced stage lesions, CEA was inversely correlated with degree of anaplasia. In the overall patient group, and also among resectable patients, the preoperative CEA level was strongly associated with survival after adjustment for the effects of a number of other prognostic factors. Within stages of resectable disease, however, CEA was not significantly associated with survival among patients with Dukes' A and B lesions or Dukes' C lesions with one to three nodes involved. CEA was found to be a significant and independent prognostic determinant only in patients with Dukes' C lesions who had four or more metastatically involved lymph nodes. Under these circumstances, a preoperative CEA level could perhaps be of some value for stratification of Dukes' C patients in randomized colorectal cancer surgical adjuvant trials. The value of this test as a prognostic guide in clinical practice, however, would seem to be limited because of a lack of sensitivity in identifying individual poor prognosis patients.
对319例接受手术治疗的结直肠癌患者进行了术前癌胚抗原（CEA）水平研究，其中272例患者的疾病可通过手术根治性切除。仅有3例患者未能得到完整随访。其余316例患者均随访至少5年或直至死亡。从诊断角度来看，CEA检测在疾病晚期、原发性肿瘤较大以及组织病理学特征分化程度较高的患者中更常呈阳性（大于5 ng/ml）。其对可切除性癌症的诊断敏感性极低（26%），而在不可切除及转移性疾病患者中仅具有一定可靠性（72%）。与结直肠癌手术病理相关的是，在Dukes B期病变中，CEA水平与疾病分期及原发性肿瘤大小显著相关，但在Dukes C期病变中与淋巴结转移范围无关。在晚期病变中，CEA与间变程度呈负相关。在总体患者组以及可切除患者中，校正若干其他预后因素的影响后，术前CEA水平与生存率密切相关。然而，在可切除疾病的各分期内，CEA与Dukes A期和B期病变或伴有1至3个淋巴结受累的Dukes C期病变患者的生存率并无显著关联。仅在伴有4个或更多转移淋巴结受累的Dukes C期病变患者中，CEA才是一个显著且独立的预后决定因素。在这种情况下，术前CEA水平或许对Dukes C期患者在随机结直肠癌手术辅助试验中的分层具有一定价值。然而，由于该检测在识别个体预后不良患者方面缺乏敏感性，其在临床实践中作为预后指导的价值似乎有限。
