Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea.
J Gastrointest Surg. 2023 Aug;27(8):1694-1701. doi: 10.1007/s11605-023-05761-2. Epub 2023 Jul 5.
Serum carcinoembryonic antigen (CEA) increase in patients with colorectal cancer (CRC) recurrence was observed to vary depending on their initial values. This study aimed to evaluate the diagnostic accuracy of CEA for detecting CRC recurrence in patients with normal and elevated initial CEA levels.
A total of 261 CRC recurrence patients who underwent curative resection were included and divided into two groups, normal and elevated initial CEA. Analysis was performed comparing patient, tumor, and recurrence characteristics retrospectively.
There were 192 patients with normal and 69 with high initial CEA levels. Patient and tumor characteristics were similar. Eighty-six patients had elevated CEA at the time of recurrence, and the overall sensitivity of CEA for recurrence was 33.0%. In the high initial CEA group, 59.4% exhibited increased CEA level at recurrence, whereas in patients with normal initial CEA levels, only 23.4% showed elevated levels (p < 0.001). Patients with both high CEA preoperatively and at recurrence had more local recurrence, but there was no statistical significance (p = 0.053), and the rate of lung metastasis was higher in patients whose CEA remained normal at recurrence (38.3% vs. 24.4%, p = 0.026). The overall survival of patients with elevated CEA at recurrence was worse than those with normal CEA levels (56.9% vs. 42.4%, p = 0.003).
The diagnostic accuracy of CEA for detecting recurrence depends on initial CEA level. Regardless of the initial CEA level, elevation at recurrence was significantly associated with overall survival in patients with recurrent CRC.
在结直肠癌（CRC）复发患者中，观察到血清癌胚抗原（CEA）的增加因初始值而异。本研究旨在评估 CEA 对检测初始 CEA 水平正常和升高的 CRC 复发患者的诊断准确性。
共纳入 261 例接受根治性切除术的 CRC 复发患者，分为正常和初始 CEA 升高两组。回顾性比较患者、肿瘤和复发特征进行分析。
有 192 例患者初始 CEA 水平正常，69 例患者初始 CEA 水平升高。患者和肿瘤特征相似。86 例患者在复发时 CEA 升高，CEA 对复发的总敏感性为 33.0%。在初始 CEA 升高组中，59.4%的患者在复发时 CEA 水平升高，而在初始 CEA 水平正常的患者中，仅 23.4%的患者 CEA 水平升高（p<0.001）。术前和复发时 CEA 均升高的患者局部复发更多，但无统计学意义（p=0.053），而 CEA 在复发时仍正常的患者肺转移率更高（38.3%比 24.4%，p=0.026）。复发时 CEA 升高的患者总体生存率差于 CEA 水平正常的患者（56.9%比 42.4%，p=0.003）。
CEA 检测复发的诊断准确性取决于初始 CEA 水平。无论初始 CEA 水平如何，复发时的升高均与复发 CRC 患者的总体生存率显著相关。
