Preoperative Carcinoembryonic Antigen Level as a Prognostic Indicator in Colorectal Cancer

Wanebo, Harold J.; Rao, B Prakash; Pinsky, Carl M.; Hoffman, Raymond G.; Stearns, Maus W.; Schwartz, Morton K.; Oettgen, Herbert F.

doi:10.1056/nejm197808312990904

Cited by 434 publications

(209 citation statements)

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“…The majority of studies evaluating preoperative CEA levels reveal it to be an independent prognostic factor after surgical resection for colorectal cancer [1][2][3][4][5][6][7][8]10], although some contradictory studies reported that the CEA level is a predictor for survival [12][13][14][15][16]. We concur with this and confirmed a preoperative elevation in serum CEA as an independent prognostic factor for both 5-year overall and disease-free survival in this analysis.…”

Section: Discussionsupporting

confidence: 85%

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Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer

Huh

Kim

et al. 2010

Journal of Surgical Oncology

111

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Objective: We evaluated the prognostic value of the preoperative serum carcinoembryonic antigen (CEA) level in patients with colon cancer. Methods: We reviewed 474 patients who underwent potentially curative resection for nonmetastatic colon cancer. Patients were categorized into two groups according to the preoperative serum CEA level: low CEA (<5 ng/ml) and high CEA ( 5 ng/ml) groups. Results: During the median 45-month follow-up period, the 5-year overall and disease-free survival rates for patients with a low CEA level were 81.7% and 82.4%, respectively, which were significantly higher than the rates for those with a high CEA level (69.9%; P ¼ 0.011 and 70.6%; P ¼ 0.002, respectively). A multivariate analysis revealed that a preoperative serum CEA level was a significant independent prognostic factor for both overall survival (P ¼ 0.021) and disease-free survival (P ¼ 0.026). Both the overall and disease-free survival rates in patients with stage II tumors differed significantly between the low and high CEA groups, whereas the rates did not different between those with stage I and III tumors. Conclusions: Preoperative serum CEA is a reliable predictor of recurrence and survival after curative surgery in patients with colon cancer, particularly in those classified as having stage II disease.

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Section: Discussionsupporting

confidence: 85%

“…High preoperative serum CEA levels are associated with an increased risk of recurrence and poor prognosis [1][2][3][4][5][6][7][8]. Moreover, monitoring of the postoperative CEA level is commonly used in the follow-up of colorectal cancer and perioperative serum CEA change is a useful prognostic indicator for colorectal cancer [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer

Huh

Kim

et al. 2010

Journal of Surgical Oncology

111

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“…(Moertel et al 1986). Wanebo et al (1978) studied 358 patients with colorectal cancer and found that the recurrence rate was higher in patients with Dukes' B and C lesions if their preoperative CEA was greater than 5 ng ml-'. this was hiahl1v statistically significant within the two stages.…”

Section: Resultsmentioning

confidence: 99%

Preoperative carcinoembryonic antigen is related to tumour stage and long-term survival in colorectal cancer

Chapman

Buckley²,

Henson³

et al. 1998

Br J Cancer

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“…Tumor cells (5ϫ10 6 ) of C22.20 line, a subclone of the human colon cancer HT-29 cell line, were admixed with 2 ml of heparinized peripheral blood collected from healthy donors. Blood samples, containing or not C22.20 cells, were then treated with 5 nM ST (Alexis, Laufelfingen, Switzerland) and incubated with gentle rotation at 37°C for 72 hr.…”

Section: Methodsmentioning

confidence: 99%

“…However, it has been demonstrated that about 50% of colorectal cancers are not associated with increased serum CEA levels. 6 Moreover, no correlation has been found between CEA content in tumor tissue and CEA serum levels, and not all CEA positive tumors shed the antigen into circulation. 7 Therefore, in a substantial number of cases this antigen cannot be considered a suitable marker for the detection of sub-clinical residual disease.…”

Section: Dear Sirmentioning

confidence: 99%

Treatment of peripheral blood with staurosporine increases detection of circulating carcinoembryonic antigen positive tumor cells

Aquino

Prete

Balduzzi

et al. 2002

Intl Journal of Cancer

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Key words: carcinoembryonic antigen; staurosporine; colorectal cancer; micrometastasis; immunobead RT-PCR Dear Sir, Staurosporine (ST) is a potent inhibitor of protein kinase C. This agent is able to induce apoptosis, affecting cell cycle progression and modulating the activity of cyclin-dependent kinases in a large variety of tumors. 1,2 Moreover, ST was found to increase the expression of the carcinoembryonic antigen (CEA) in epithelial tumor cell lines of different tissue origin. This effect is particularly evident at concentrations that do not provoke cytotoxicity or cell cycle perturbation. 3,4 The increase of CEA is detected both at the level of protein expression and gene transcription. On this basis, it has been hypothesized that ST might be utilized to increase the sensitivity of methods based on CEA transcript recognition, which is presently employed to detect CEA-positive circulating tumor cells.CEA is a tumor marker that is expressed in a number of tumors of different origin, including gastrointestinal, lung and breast cancer. 5 At present, measurement of serum CEA levels is mainly used to monitor tumor progression during postsurgery follow-up of patients affected by colorectal cancer. However, it has been demonstrated that about 50% of colorectal cancers are not associated with increased serum CEA levels. 6 Moreover, no correlation has been found between CEA content in tumor tissue and CEA serum levels, and not all CEA positive tumors shed the antigen into circulation. 7 Therefore, in a substantial number of cases this antigen cannot be considered a suitable marker for the detection of sub-clinical residual disease.A number of studies provided evidence that RT-PCR based methods for the detection of CEA positive circulating cancer cells are highly sensitive and specific. 8 -11 Of particular interest are the findings that detection of CEA-expressing circulating tumor cells in patients negative for 3 serum markers for colorectal cancer preceded clinical evidence of the disease. 8 Moreover, it has been recently demonstrated that serial examination of CEA mRNA levels might contribute to predict tumor relapse in advanced gastric cancer. 11 No data are presently available in the literature on large randomized prospective studies concerning the clinical value of CEA mRNA detection by RT-PCR analysis in the peripheral blood of cancer patients. However, it can be hypothesized that long-term follow-up of patients by this approach might be helpful for predicting relapse or for monitoring response to therapy.Limitations of this technique have also been reported in terms of possible false positive results, when RNA was extracted from whole blood and a large number of nested PCR cycles (Յ30 cycles) were used. 12,13 Moreover, a limited percentage of untreated patients with metastatic or recurrent colorectal cancer has been found to be negative for CEA mRNA. 8 Recently, it has been demonstrated that specificity of RT-PCR detection of CEA-positive cancer cells admixed with peripheral blood from healthy donors can...

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Preoperative Carcinoembryonic Antigen Level as a Prognostic Indicator in Colorectal Cancer

Cited by 434 publications

References 10 publications

Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer

Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer

Preoperative carcinoembryonic antigen is related to tumour stage and long-term survival in colorectal cancer

Treatment of peripheral blood with staurosporine increases detection of circulating carcinoembryonic antigen positive tumor cells

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