McCall J L, Black R B, Rich C A, Harvey J R, Baker R A, Watts J M, Toouli J
Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia.
Dis Colon Rectum. 1994 Sep;37(9):875-81. doi: 10.1007/BF02052591.
Carcinoembryonic antigen (CEA) estimations are used to facilitate early diagnosis of recurrent disease after treatment for colorectal cancer.
This study was designed to determine the natural history of patients with normal and abnormal levels of CEA.
Patients undergoing potential curative resection of colorectal tumors (Dukes Stage A-C) entered a prospective, randomized trial comparing two follow-up regimens (to be reported separately) had CEA levels measured every 3 months for two years; then every 6 months for the next three years. In the study protocol, a rise in CEA was not an indication for investigation to determine recurrence unless there was also other evidence of recurrent disease.
Three hundred eleven patients were followed for a median of 4.5 (range, 2-5) years. Recurrent disease developed in 98 (32 percent) patients, 57 of whom had an elevated CEA (sensitivity 58 percent), with a median lead time of six (range, 1-30) months from first abnormal CEA to diagnosis of recurrent disease by other means. The specificity, positive predictive value, and negative predictive value of CEA as an indicator of subsequent recurrent disease was 93 percent, 79 percent, and 83 percent, respectively. The sensitivity of CEA for predicting hepatic metastases was 80 percent, with a median lead time of eight (range, 1-30) months, compared with only 46 percent for sites of recurrent disease other than the liver.
CEA was the first indicator of recurrent disease in 58 percent of all patients and in 80 percent of patients with liver metastases. The diagnosis of recurrent disease may be made several months earlier by investigating the first abnormal CEA level, although any benefit in terms of survival remains to be proven.
癌胚抗原（CEA）检测用于辅助结直肠癌治疗后复发性疾病的早期诊断。
本研究旨在确定CEA水平正常和异常的患者的自然病程。
接受结直肠肿瘤潜在根治性切除（杜克分期A - C）的患者进入一项前瞻性随机试验，比较两种随访方案（将另行报告），在两年内每3个月测量一次CEA水平；接下来三年每6个月测量一次。在研究方案中，CEA升高并非进行确定复发的检查的指征，除非同时还有其他复发性疾病的证据。
311例患者的中位随访时间为4.5年（范围2 - 5年）。98例（32%）患者出现复发性疾病，其中57例CEA升高（敏感性58%），从首次CEA异常到通过其他方法诊断复发性疾病的中位提前期为6个月（范围1 - 30个月）。CEA作为后续复发性疾病指标的特异性、阳性预测值和阴性预测值分别为93%、79%和83%。CEA预测肝转移的敏感性为80%，中位提前期为8个月（范围1 - 30个月），而对于肝脏以外的复发性疾病部位，敏感性仅为46%。
CEA是所有患者中58%以及肝转移患者中80%的复发性疾病的首个指标。通过对首次CEA异常水平进行检查，复发性疾病的诊断可能提前数月做出，尽管在生存方面的任何益处仍有待证实。
