Predictive value of plasma CEA in patients with colorectal carcinoma.

Two years follow-up of 46 patients with colorectal carcinoma resected "for cure" shows that of the nine patients with an elevated (less than 5 ng/ml) CEA plasma titer one to six months after surgery, only one, or 11%, had remained disease free. Of the 38 patients with normal (less than 5 ng/ml) plasma CEA, 27, or 71%, were free of disease two years after surgery. In another 85 patients presenting six months to ten years after resection "for cure" of their colorectal carcinoma, normal CEA levels were found in 73, and only five, or 6.4%, of these presented with disease progression when followed for two years; of the 12 patients that presented with CEA values less than 5 ng/ml, disease progression was evident in eight or 67%; in eight patients with CEA levels of greater than 10 ng/ml, the proportion of patients with disease progression increased to 87.5% (7/8). When a patient with a history of colorectal cancer, but seemingly free of disease, presents with levels not only repeatedly above normal (greater than 5 ng/ml) but above the levels found in some nonmalignant conditions (greater than 10 ng/ml), thorough re-examination of the patient to locate the site of possible disease progression is indicated. In 14 such patients further diagnostic methods showed local recurrences in four, metastasis limited to the liver in six, and other metastasis in four. In conclusion, in patients with colorectal carcinoma postoperative elevated CEA plasma levels are a sign of poor prognosis. Consistently elevated CEA levels (greater than 10 ng/ml) are a strong indication of disease progression.