Unexpectedly high disease-free survival was observed in the Dukes C2 subgroup. It allows us to hypothesize that lumboaortic lymphadenectomy could remove neoplastic microfoci present at this level in those patients, enhancing surgical chances of cure. The majority of male patients under 60 years old can retain a satisfactory sexual activity after undergoing a nerve-sparing sphincter-saving cancer surgery.

Analysis of 498 patients with colorectal carcinoma was retrospectively reviewed to evaluate the incidence, risk factors and therapy of local recurrent carcinoma following curative resection. Complete follow-up information was obtained in all but four patients (99.2%). After a median follow up of 42 months, 64 out of 469 (13.6%) patients developed local recurrence (LR). The incidence of LR was higher in rectal than in colon cancer patients (18.3% vs 8.9%) ( P < 0.005). Separate univariate and Cox analyses for rectal patients showed tumor site ( P < 0.02). Dukes stage ( P < 0.002), and adjuvant radiotherapy ( P = 0.05) determined risk of LR. For colon cancer patients risk of LR was determined by histological tumor grade ( P < 0.01). Out of 64 patients, 5 (7.8%) underwent radical excision of LR. Forty percent of these survived at 5-year (P < 0.08).Palliative treatment (radio-chemotherapy) obtained a 5-year survival of 15.3%, with no survivors in no-treatment group. These results suggest that local recurrent colorectal carcinoma remain a difficult treatment problem. More effective combinations of surgery and adjuvant therapy are therefore mandatory to reduce the incidence of local failure in high risk colorectal patients.KEY WORDS: colorectal cancer, local recurrence, risk factors, adjuvant radiotherapy, Dukes staging From 1970From to 1990 patients affected with large bowel adenocarcinoma who were referred to the two senior authors (S.S., R.C.) have been treated with PATIENTS AND METHODS

Background. Serum carcinoembryonic antigen (CEA) is the most frequently chosen tumor marker in the clinical diagnosis of colorectal carcinoma and in the long‐term monitoring of patients after tumor resection. In recent years, monoclonal antibody technology has identified several new markers of neoplasia, two of which, TAG‐72 and CA 19‐9, are found in the sera of patients with adenocarcinoma. Serum CEA, TAG‐72, and CA 19‐9 were evaluated in 300 patients with either malignant (n = 200) or benign (n = 100) colorectal disease. Methods. Serum CEA, TAG‐72 (CA 72‐4), and CA 19‐9 antigen levels were determined with a double‐determinant radioimmunometric assay kit. Samples and appropriate standards were assayed in duplicate. The cutoff limits used for each assay were indicated by the manufacturer. All of the results of the CA 72‐4, CEA, and CA 19‐9 serum assays were separated from the clinical information until the study was completed. Results. Of the 200 patients with colorectal carcinoma, the percentage of patients whose serum samples were positive for CEA, TAG‐72, or CA 19‐9 was 43%, 43%, and 27%, respectively. The measurement of TAG‐72 with CEA for patients with primary or recurrent colorectal carcinoma increased substantially (to 60%) the percentage of positive serum samples when compared with measuring each serum tumor marker alone. Moreover, the apparent advantage gained by measuring the two tumor markers was achieved with little increase in the number of false‐positive results. Conclusions. The findings support previous observations of complementary expression of TAG‐72 and CEA and indicate that a significant advantage could be gained in the detection of primary and, perhaps, recurrent colorectal carcinoma by incorporating the measurement of serum TAG‐72 with that of CEA.

Eighty‐two patients diagnosed with gastrointestinal (GI) adenocarcinoma were evaluated before and for 26 months after primary tumor resection for the presence of two serum tumor markers: tumor‐associated glycoprotein‐72 (TAG‐72) and carcinoembryonic antigen (CEA). Elevated TAG‐72 and CEA serum levels were found preoperatively in 32 (39%) and 34 (41.5%) of the 82 patients, respectively. The percentage of patients with elevated serum levels of either TAG‐72 or CEA was 56.1% (46 of 82). Twelve (15%) patients who had normal CEA serum levels had elevated TAG‐72 serum levels, and conversely, serum from 14 (17%) patients who were TAG‐72 negative were CEA positive. Forty‐five of the 82 patients were diagnosed with advanced disease (i.e., Stages C and D for colorectal, Stages III and IV for stomach), and 29 (64.4%) and 26 (57.8%) of those patients had elevated serum levels of TAG‐72 or CEA, respectively. Elevated levels of either TAG‐72 or CEA, however, were found in sera of 82.2% of patients with advanced GI cancer, which is an increase of 24.4% over the use of CEA antigen alone as a marker of disease. The measurement of both TAG‐72 and CEA may improve the diagnosis of patients with GI malignant disease due to the apparent complementary association which exists between these tumor markers. Serum TAG‐72 and CEA levels were monitored in 31 patients for varying lengths of time after resection of the carcinoma; 11 patients developed recurrent disease. Sera from nine of 11 (81.8%) of these patients had elevated TAG‐72 levels and six of 11 (54.5%) had elevated CEA levels. Tumor marker elevations were observed either before (35 to 166 days) or at the time of diagnosis of recurrence. The elevation of one or both markers correlated with the clinical status in ten of 11 (90.9%) patients with recurrence. In addition, 20 patients who were clinically free of disease after more than 700 days' follow‐up had normal serum levels of both TAG‐72 and CEA. These findings suggest that the combined use of serum TAG‐72 and CEA measurements may improve detection of recurrence in patients with GI cancer and may be useful in the postsurgical management of GI adenocarcinoma patients. 68:2443‐2450, 1991.

A novel tumor marker, tumor‐associated glycoprotein‐72 (TAG‐72), has been identified using monoclonal antibody (MAb) B72.3. Using immunohistochemical techniques, TAG‐72 has been found in carcinomas of various origin including colon, stomach, breast, lung, prostate, and ovary, as well as in body fluids. The presence of TAG‐72 in serum samples from 260 patients with colorectal disease (malignant or benign) has been evaluated using the CA72‐4 assay. Approximately 40% of patients with colorectal cancer exhibit elevated levels of this marker; moreover, the presence of positive levels of TAG‐72 significantly correlates with advanced stages of disease, suggesting that TAG‐72 may be a good marker of advanced colorectal cancer. Only 2% of the patients diagnosed with colorectal disease had elevated TAG‐72 serum levels indicating the high specificity of this marker. A comparative study with carcinoembryonic antigen (CEA) serum levels showed a complementarity of the two tumor markers; in fact, 49.6% of CEA negative cases scored positive for TAG‐72. A longitudinal evaluation of TAG‐72 serum levels in 31 patients with malignant disease was performed. The results indicate that patients with increasing TAG‐72 serum levels postoperatively may be indicative of recurrent disease. In 60% of patients in which significant changes of CEA levels could not be detected, TAG‐72 showed rising positive levels prior to clinical evidence of recurrent disease. These results suggest that the simultaneous use of TAG‐72 and CEA serum markers may be useful in the diagnosis of recurrent disease and therefore play an important role in the clinical management of cancer patients.