Lucha P A, Rosen L, Olenwine J A, Reed J F, Riether R D, Stasik J J, Khubchandani I T
Naval Medical Center, Division of Colon and Rectal Surgery, Portsmouth, Virginia, USA.
Dis Colon Rectum. 1997 Feb;40(2):145-9. doi: 10.1007/BF02054978.
This study is designed to review a carcinoembryonic antigen (CEA)-driven postoperative protocol designed to identify patients suitable for curative reresection when recurrent colorectal cancer is identified.
A total of 285 patients who were operated on for colon or rectal carcinoma between 1981 and 1985 were evaluated (with CEA levels) every two months for the first two years, every three months for the third year, every six months for years 4 and 5, and annually thereafter. CEA levels above 5 microg were considered abnormal and were evaluated with diagnostic imaging and/or endoscopy.
Follow-up was available for 280 patients (98.2 percent). Distribution of patients by Astler-Coller was: A, 14 percent; B1, 20 percent; B2, 39 percent; C1, 5 percent; C2, 21 percent. There were 62 of 280 patients (22 percent) who developed elevated CEA levels, with 44 patients who demonstrated clinical or radiographic evidence of recurrence. Eleven patients were selected for surgery with curative intent (4 hepatic resections, 1 pulmonary wedge resection, 2 abdominoperineal resections, 2 segmental bowel resections, and 2 cranial metastasectomies). Three of 11 patients (27 percent) benefited and have disease-free survivals greater than 60 months. Of the 223 patients without elevated CEA, 22 (9.9 percent) had recurrent cancer without any survivors. Overall, 3 of 285 patients (1.1 percent) were cured as a result of CEA follow-up.
CEA-driven surgery is useful in selected patients and can produce long-term survivors.
本研究旨在回顾一种由癌胚抗原（CEA）驱动的术后方案，该方案旨在确定复发性结直肠癌患者中适合进行根治性再次切除的患者。
对1981年至1985年间接受结肠癌或直肠癌手术的285例患者进行评估，在术后的前两年每两个月检测一次CEA水平，第三年每三个月检测一次，第四年和第五年每六个月检测一次，之后每年检测一次。CEA水平高于5微克被视为异常，并通过诊断性影像学检查和/或内镜检查进行评估。
280例患者（98.2%）获得随访。根据阿斯特勒-科勒（Astler-Coller）分期，患者分布如下：A期，14%；B1期，20%；B2期，39%；C1期，5%；C2期，21%。280例患者中有62例（22%）CEA水平升高，其中44例有临床或影像学复发证据。11例患者被选择进行根治性手术（4例肝切除术，1例肺楔形切除术，2例腹会阴联合切除术，2例节段性肠切除术，2例颅骨转移瘤切除术）。11例患者中有3例（27%）受益，无病生存期超过60个月。在223例CEA水平未升高的患者中，22例（9.9%）出现复发性癌症，无一例存活。总体而言，285例患者中有3例（1.1%）因CEA随访而治愈。
CEA驱动的手术对部分患者有用，可产生长期存活者。
