Value of carcinoembryonic antigen monitoring in curative surgery for recurrent colorectal carcinoma

Lucha, Paul A.; Rosen, Lester; Olenwine, Judith A.; Reed, James F.; Riether, Robert D.; Stasik, John J.; Khubchandani, Indru T.

doi:10.1007/bf02054978

Cited by 43 publications

(28 citation statements)

References 21 publications

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“…This would suggest that serial tumour marker assessments should be performed in all patients during follow-up irrespective of the levels before resection of the metastases. While the role of CEA in screening following resection of colorectal liver metastases is welldocumented (Hohenberger et al, 1994;McCall et al, 1994;Paganuzzi et al, 1994;Lucha et al, 1997;Novell et al, 1997;Hocking and Morris, 1998;Wichmann et al, 2000;Ishizuka et al, 2001), there is less published evidence on the use of CA 19-9 (Ishizuka et al, 2001;Carpelan-Holmstrom et al, 2002). In the present study, CEA and CA19-9 were found to be of similar value and complementary in the detection of recurrence following liver resection.…”

Section: Discussionmentioning

confidence: 99%

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

2006

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The aim of the study was to prospectively evaluate an intensive follow-up programme using serial tumour marker estimations and contrast-enhanced computed tomography (CT) of the chest and abdomen in patients undergoing potentially curative resection of colorectal liver metastases. Seventy-six consecutive patients having undergone potentially curative resections of colorectal liver metastases in a single unit were followed up with a protocol of 3 monthly carcinoembryonic antigen and carbohydrate antigen 19-9 estimations and contrast-enhanced spiral CT of the chest, abdomen and pelvis for the first 2 years following surgery and 6 monthly thereafter. The median period of follow-up was 24 months (range 18 -60). Recurrent tumour was classed as early if within 6 months of liver resection. Thirty-seven of the 76 patients (49%) developed recurrence on follow-up. Nineteen recurrences were in the liver alone (51%), 16 liver and extrahepatic (43%) and two extrahepatic alone (6%). Of the 19 patients with isolated liver recurrence, eight developed within 6 months of liver resection none of which were resectable. Of the 11 recurrences after 6 months, five (45%) were resectable. Of the 37 recurrences, CT indicated recurrence despite normal tumour markers in 19 patients. Tumour markers suggested recurrence before imaging in 12 and concurrently with imaging in 6. In the 12 patients who presented with elevated tumour markers before imaging, there was a median lag period of 3 months (range 1 -21) in recurrence being detected on further serial imaging. Seventeen patients who developed recurrence had normal tumour markers before initial resection of their liver metastases. Of these 17, 10 (58%) had an elevation of tumour markers associated with recurrence. Over a median follow-up of 2 years following liver resection, the use of CT or tumour markers alone would have failed to demonstrate early recurrence in 12 and 18 patients respectively. A combination of tumour markers and CT detected significantly more (Po0.05) recurrence than either modality alone. Tumour markers and CT should be used in combination in the follow-up of patients with resected colorectal liver metatases, including patients whose markers are normal at the time of initial liver resection.

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Section: Discussionmentioning

confidence: 99%

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

2006

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“…However, a considerable variation in prognosis has been demonstrated within each stage (Jass et al, 1987;Newland et al, 1987) and some patients with Dukes' stage B have a poorer prognosis than patients in Dukes' C. Several studies have been performed to find new biochemical markers in order to identify patients at high risk for recurrence, who might be candidates for additional therapy after surgery. There are numerous reports on CEA in screening and follow-up of patients with colorectal cancer, but this marker seems to be of limited clinical use (Kievit and Van der Velde, 1990;Virgo et al, 1995;Lucha et al, 1997). Nevertheless, the most frequently used marker is still CEA.…”

Section: Discussionmentioning

confidence: 99%

“…Follow-up regimens after resection for primary colorectal cancer in general consist of periodic interval history, physical examinations and endoscopic surveillance. The usefulness of analysing consecutive serum carcinoembryonic antigen (CEA) levels has been questioned (Kievit and Van der Velde, 1990;Virgo et al, 1995) but CEA is still used as an eventual predictor of residual disease or metastases (Lucha et al, 1997).…”

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confidence: 99%

Serum YKL-40 and colorectal cancer

et al. 1999

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Summary YKL-40 is a mammalian member of the chitinase protein family. Although the function of YKL-40 is unknown, the pattern of its expression suggests a function in remodelling or degradation of extracellular matrix. High serum YKL-40 has been found in patients with recurrent breast cancer and has been related to short survival. In the present study we analysed YKL-40 in preoperative sera from patients with colorectal cancer and evaluated its relation to survival. Serum YKL-40 was determined by RIA in 603 patients. Survival after operation was registered, and median follow-up time was 61 months. Three hundred and forty patients died. Sixteen per cent of the patients with Dukes' A, 26% with Dukes' B, 19% with Dukes' C and 39% with Dukes' D had high serum YKL-40 levels (adjusted for age). Analysis of serum YKL-40 as a continuous variable showed an association between increased serum YKL-40 and short survival (P < 0.0001). Patients with high preoperative serum YKL-40 concentration had significantly shorter survival than patients with normal YKL-40 (HR = 1.7; 95% CI: 1.3-2.1, P < 0.0001). Multivariate Cox analysis including serum YKL-40, serum CEA, Dukes' stage, age and gender showed that high YKL-40 was an independent prognostic variable for short survival (HR = 1.4; 95% CI: 1.1-1.8, P = 0.007). These results suggest that YKL-40 may play an important role in tumour invasion.Keywords: carcinoembryonic antigen; colorectal cancer; metastasis; tumour invasiveness; YKL-40/HC gp-39 1494British Journal of Cancer (1999) 79(9/10), 1494-1499 © 1999 Cancer Research Campaign Article no. bjoc.1998 Received 20 May 1998 Revised 30 September 1998 Accepted 14 October 1998Correspondence to: HJ Nielsen *YKL-40 has been named after its molecular weight (40 kDa) and the one letter code for its three N-terminal amino acids (Johansen et al, 1992). The protein is also called human cartilage glycoprotein-39 (HC gp-39) (Hakala et al, 1993).

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“…After surgical removal of a primary tumour, increasing circulating CEA levels often precede the development of metastases, especially liver metastases (Lucha et al, 1997). Thus, there is a clear relationship between circulating CEA levels and metastases, but it is impossible to demonstrate in humans a connection between cause and effect.…”

mentioning

confidence: 99%

Involvement of circulating CEA in liver metastases from colorectal cancers re-examined in a new experimental model

Leconte¹,

Garambois²,

Ychou³

et al. 1999

Br J Cancer

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Summary Both experimental and clinical data show evidence of a correlation between elevated blood levels of carcinoembryonic antigen (CEA) and the development of liver metastases from colorectal carcinomas. However, a cause-effect relationship between these two observations has not been demonstrated. For this reason, we developed a new experimental model to evaluate the possible role of circulating CEA in the facilitation of liver metastases. A CEA-negative subclone from the human colon carcinoma cell line CO115 was transfected either with CEAcDNA truncated at its 3′ end by the deletion of 78 base pairs leading to the synthesis of a secreted form of CEA or with a full-length CEA-cDNA leading to the synthesis of the entire CEA molecule linked to the cell surface by a GPI anchor. Transfectants were selected either for their high CEA secretion (clone CO115-2C2 secreting up to 13 µg CEA per 10 6 cells within 72 h) or for their high CEA membrane expression (clone CO115-5F12 expressing up to 1 × 10 6 CEA molecules per cell). When grafted subcutaneously, CO115-2C2 cells gave rise to circulating CEA levels that were directly related to the tumour volume (from 100 to 1000 ng ml -1 for tumours ranging from 100 to 1000 mm 3 ), whereas no circulating CEA was detectable in CO115 and CO115-5F12 tumour-bearing mice. Three series of nude mice bearing a subcutaneous xenograft from either clone CO115-2C2 or the CO115-5F12 transfectant, or an untransfected CO115 xenograft, were further challenged for induction of experimental liver metastases by intrasplenic injection of three different CEA-expressing human colorectal carcinoma cell lines (LoVo, LS174T or CO112). The number and size of the liver metastases were shown to be independent of the circulating CEA levels induced by the subcutaneous CEA secreting clone (CO115-2C2), but they were directly related to the metastatic properties of the intrasplenically injected tumour cells.

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Value of carcinoembryonic antigen monitoring in curative surgery for recurrent colorectal carcinoma

Abstract: CEA-driven surgery is useful in selected patients and can produce long-term survivors.

Cited by 43 publications

References 21 publications

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

Serum YKL-40 and colorectal cancer

Involvement of circulating CEA in liver metastases from colorectal cancers re-examined in a new experimental model

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