Carcinoembryonic Antigen in the Staging and Follow-up of Patients with Colorectal Cancer

Abstract

CEA is a complex glycoprotein produced by 90% of colorectal cancers and contributes to the malignant characteristics of a tumor. It can be measured in serum quantitatively, and its level in plasma can be useful as a marker of disease. Because of its lack of sensitivity in the early stages of colorectal cancer, CEA measurement is an unsuitable modality for population screening. An elevated preoperative CEA is a poor prognostic sign and correlates with reduced overall survival after surgical resection of colorectal carcinoma. A failure of the CEA to return to normal levels after surgical resection is indicative of inadequate resection of occult systemic disease. Frequent monitoring of CEA postoperatively may allow identification of patients with metastatic disease for whom surgical resection or other localized therapy might be potentially beneficial. To identify this group, serial CEA measurement appears to be more effective than clinical evaluation or any other diagnostic modality, although its sensitivity for detecting recurrent disease is not as high for locoregional or pulmonary metastases as it is for liver metastases. Several studies have shown that a small percentage of patients followed postoperatively with CEA monitoring and who undergo CEA-directed salvage surgery for metastatic disease will be alive and disease-free 5 years after surgery. Furthermore, CEA levels after salvage surgery do appear to predict survival in patients undergoing resection of liver or pulmonary metastases. However, several authors argue that CEA surveillance is not cost-effective in terms of lives saved. In support of this argument, there is no clear difference in survival after resection of metastatic disease with curative intent between patients in whom the second-look surgery was performed on the basis of elevated CEA levels and those with other laboratory or imaging abnormalities. There is also no clear consensus on the frequency or duration of CEA monitoring, although the ASCO guidelines currently recommend every 2-3 months for at least 2 years after diagnosis. In the follow-up of patients undergoing palliative therapy, the CEA level correlates well with response, and CEA is indicative of not only response but may also identify patients with stable disease for whom there is also a demonstrated benefit in survival and symptom relief with combination chemotherapy. More recently, scintigraphic imaging after administration of radiolabeled antibodies afforded an important radionuclide technique that adds clinically significant information in assessing the extent and location of disease in patients with colorectal cancer above and beyond or complementary to conventional imaging modalities. Immunotherapy based on CEA is a rapidly advancing area of clinical research demonstrating antibody and T-cell responses.

Postoperative Serum Levels of sCD26 for Surveillance in Colorectal Cancer Patients

“…Compared to other available diagnostic modalities, serial CEA determinations appear to be the most sensitive for the detection of early recurrent disease [6]–[8]. However, the current serum markers used to detect cancer recurrence (CEA, TPS, CA-19.9 and CA-72.4) are not very accurate and, in general, give rise to a considerable number of false negatives and positives [9]–[10]. Therefore additional testing is usually necessary to confirm the recurrence, generating inconveniences for the patients and elevating the healthcare costs, because some of the techniques are expensive and have not been shown to be cost-effective [11].…”

Baseline and On-Treatment Markers Determining Prognosis of First-Line Chemotherapy in Combination with Bevacizumab in Patients with Metastatic Colorectal Cancer

“…Although treatment decisions should be based on radiographically documented response status, this simple and easy to measure serum marker might give timely information about current disease status and, beyond that, trigger early imaging e.g. in the case of suspected progression [30,31,32]. However, about 20-25% of patients do not present with elevated CEA levels at baseline, with the majority remaining normal during the course of their disease.…”

Clinical Predictors of Cetuximab for First-Line Therapy of Metastatic Colorectal Cancer: A Single Institutional Retrospective Study

“…Patients with high serum levels of CEA had better clinical outcome than the other patients, even when limited to all RAS wild-type patients. CEA is a member of the immunoglobulin gene superfamily, and is overexpressed in about 90% of CRCs [21]. Serum CEA is used as a tumor marker for management of CRC [22].…”