[The pre- and postoperative monitoring of the immunological indices and tumor markers in colorectal carcinoma].

UNLABELLED

The onset of immunological reaction against colorectal carcinoma is based on superficial changes in the malignant cell components following the formation of antigen structures. This explains the interest in the issue and defines the aim of the study. Over a 5-year period, in the Emergency Surgery Clinic, 86 patients with histologically diagnosed colorectal carcinoma (46 men and 40 women) are examined prior to surgery, and 107 patients (55 men and 52 women)--after the operation. The tumor markers CEA, CA 19-9, AFP and immunoglobulin IgA are tested using ELISA and RIA methods. Conventional ultrasound, scintigraphic and CT studies are carried out to detect liver metastases. The obtained results undergo statistical processing with correlation analysis and sensitivity and specificity coefficients. Among those examined preoperatively elevated CEA levels (CEA > 2.5 ng/ml) are recorded in 42 cases (48.9%), and for CA 19-9 (CA 19-9 > 37 E/ml)--in 40 (46.5%). From the patients with complicated colorectal carcinoma in the postoperative period 83 are clinically healthy (77.6%); of the latter marker-positive are 16 (19.3%), and marker-negative--67 (80.7%). Relapses and metastases are registered in 24 cases (22.4%) of which marker-positive--19 (79.2%). Liver and abdominal lymph node metastases are detected by US, scintigraphy and CT study. All three imaging methods contribute to diagnose liver metastases in 14 patients (13%). In 32 patients (18 men and 14 women) postsurgical monitoring of immunological IgA levels and tumor markers is done over period ranging from 7-10 days to 2 years postoperatively. Correlative dependences between IgA and CEA (R = +0.99), and between IgA and CA 19-9 (R = +0.97) are also documented. The sensitivity of both markers (CEA and CA 19-9) is low, varying between 38 and 51 per cent, with specificity amounting to 61-67 per cent. The paradoxically high elevation of tumor markers prior to operation shows a constant decrease at 3 months after surgery.

CONCLUSIONS

1. The sensitivity of both markers (CEA and CA 19-9) is low (38-51%), and that is why their use in screening examinations lacks clinical relevance. 2. CEA specificity is by no means high (61-67%), and it may become positive in a number of nononcological diseases (liver cirrhosis and hepatitis, inflammation diseases of GIT and lungs). 3. Plasma CEA and CA 19-9 levels correlate well with the neoplastic process progression/regression. 4. Preoperative CEA level has a prognostic value for postsurgical relapses. 5. High IgA levels are indicators for relapses or metastases from colorectal carcinoma. 6. Tumor histological verification correlates also with the high CEA levels and with the depth of tumor infiltration into the intestinal wall. 7. The dynamic assessment of tumor markers postoperatively has a high informative value in all colorectal carcinoma patients. 8. Pre- and postoperative high CEA levels are observed in patients assigned to the poor prognosis group, and should be given adjuvant therapy.