Current Surveillance After Treatment is Not Sufficient for Patients With Rectal Cancer With Negative Baseline CEA

Abstract

Background: Serum CEA has been widely used to screen for potential recurrent disease after resection in rectal cancer. However, the influence of baseline CEA on the performance of CEA in recurrence surveillance needs to be investigated. Patients and Methods: This longitudinal cohort study included 484 patients with nonmetastatic rectal cancer from 18,013 patients in a prospectively enrolled institutional database program of colorectal disease. Baseline CEA levels were determined before treatment, and CEA-based follow-up tests and examinations were applied in the surveillance after treatment. Results: A total of 62.6% (62/99) overall, 53.5% (23/43) local, and 64.9% (50/77) distant recurrences were seen in patients who had similar CEA levels with their baseline statuses. The sensitivity of elevated CEA levels during surveillance for overall recurrence was significantly lower in patients with negative baseline CEA than in those with elevated baseline CEA levels (41.3% vs 69.4%; P =.007). Moreover, similar results were observed in the surveillance for local (50% vs 61.5%; P =.048) and distant (39.6% vs 72.4%; P =.005) recurrences between these 2 patient groups. However, CEA had comparable and excellent specificity during surveillance for recurrent disease in these groups. The addition of CA19-9 to the CEA assay significantly improved the sensitivity in recurrence surveillance for patients with negative baseline CEA (49.2% vs 41.3%; P =.037). Finally, we identified a subgroup of CEA-turn recurrences characterized by negative CEA at baseline, elevated CEA at recurrence, and worse survival outcomes after recurrence (hazard ratio, 1.88; 95% CI, 1.07–3.30; P =.026). Conclusions: In patients with rectal cancer with negative baseline CEA, serum CEA had insufficient sensitivity in recurrence surveillance after treatment, and additional surveillance may improve oncologic outcomes. Baseline CEA should be considered before CEA-based surveillance can be applied in the follow-up trials.

Prevalent Pseudoprogression and Pseudoresidue in Patients With Rectal Cancer Treated With Neoadjuvant Immune Checkpoint Inhibitors

“…Bloodbased tumor markers have also been widely used for response evaluation and relapse surveillance in CRC. 47 As part of biologic response, reduced levels of CEA and CA 19-9 have been found to correlate with clinical benefits and thus could indicate the pseudoprogression and pseudoresidue in the current study, which could be supported by the study by Colle et al 37 Of note, acquiring pathologic evidence during treatment is always the gold standard for response evaluation. In patients with pseudoprogression, the pathologic-radiologic disconnection was discovered by using biopsy during nICI treatment.…”

Aberrant methylation in neurofunctional gene serves as a hallmark of tumorigenesis and progression in colorectal cancer

“…Cohort 1 comprises 30 pairs of snap-frozen tumor tissue and adjacent normal tissue from 30 CRC patients, which was used for correlation analysis between the methylation and expression status of RIMS2 in CRC tissue. Cohort 2 comprises 254 formalin-fixed paraffin-embedded (FFPE) tumor tissue from 254 CRC patients who underwent radical surgery between 2009 and 2012 at the Sixth affiliated hospital of Sun Yat-Sen University [ 22 , 23 ]. Cohort 2 was used for prognosis analysis.…”

Automatic treatment outcome prediction with DeepInteg based on multimodal radiological images in rectal cancer

“…The clinical and demographic characteristics along with the imaging profiles of the study patients were obtained from the FOWARC trial working group and the collaborating team of Institutional Database Program of Colorectal Disease of Sixth Affiliated Hospital of Sun Yat-sen University [ [26] , [27] , [28] ]. The pathological response after neoadjuvant treatment was evaluated by two experienced pathologists using the tumor response grading (TRG) system [ 29 ].…”