The clinical validity of monitoring the tumor markers carcinoembryonic antigen (CEA) and CA 19-9 were investigated in 602 patients with colorectal, gastric, and pancreatic carcinomas. Sensitivity and specificity of the tests were evaluated preoperatively as well as in the postoperative follow-up for early detection of disease progression and recurrence. At a 95% level of specificity as calculated from a group of 150 patients with benign diseases, the CEA test with monoclonal antibody had a preoperative sensitivity of 39% in colorectal cancer and 21% in gastric cancer. On the other hand, CA 19-9 had a sensitivity of 19% in colorectal cancer, 21% in gastric cancer, and 89% in pancreatic cancer. In the postoperative follow-up it was found that a combination of both tumor marker tests was most profitable in gastric carcinomas, yielding an increase of sensitivity from 59%-94%, showing a high degree of complementarity. The gain in sensitivity provided by the CA 19-9 test over the CEA-test in colorectal cancer was very low. The gain in sensitivity, however, provided by the CEA test over the CA 19-9 test in pancreatic carcinoma was also very low. On the basis of these results it has to be recommended that cases with pancreatic carcinoma are to be monitored most efficiently with the CA 19-9 test, whereas in cases with colorectal cancer the CEA test should be used primarily. However, in gastric cancer the combined use of CEA and CA 19-9 represents a highly valuable basis for monitoring the course of disease.

The homogeneity of the schemes for follow-up care after curative surgical treatment of early breast cancer is still a matter of debate in Germany. We investigated whether symptom-oriented follow-up is equivalent in terms of survival rates to conventional surveillance based on scheduled tests. Patients and Methods: In a prospective, non-randomised, multicentre cohort study carried out between 1995 and 2000, 244 patients underwent a conventional follow-up (scheduled laboratory tests including CEA and CA 15-3, chest X-rays and liver ultrasound). 426 patients were monitored in a symptomoriented manner (additional tests only in the case of symptoms indicating possible recurrence). Mammography, structured histories and physical examinations were done regularly in both branches. 1,108 patients did not participate in the project. They represent ‘real world patients’, unaffected by the implications of a study. Results: The symptom-oriented follow- up group produced results not inferior to those of the intensive one (p < 0.05) in terms of overall and relapse-free survival. Furthermore, no difference was indicated in terms of overall survival between study participants and the ‘real world patients’ (p = 0.316). Conclusion: The results confirm that regular imaging and laboratory tests have no relevant effect on overall survival of patients after curative primary therapy of early breast cancer and support the implementation of a symptom-oriented routine follow-up.

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In a clinical study of observed postoperative survival of colorectal cancer patients, we investigated the application of a risk score based on tumor-related prognostic parameters. Six hundred seventy-four patients have been registered for primary surgery of colorectal cancer since 1974 who did not receive further postoperative treatments. The prognostic parameters included operability, tumor extension, and preoperative serum carcinoembryonic antigen (CEA) level. The scoring system was based on the average death-rate ratios of subgroups of patients and their age and sex-matched reference groups derived from the general life table of the population of the Federal Republic of Germany. The individual score sums of the patients exhibited score sum ranges which characterized groups of patients with entirely different observed survival. The prediction of individual survival after primary operation was only partly possible. In the plot of individual survivals vs individual score sums, a marginal risk zone was obtained which evidently represents the zone of maximum expected survival of patients who do not receive further postoperative treatment.

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