Prognostic significance of carcinoembryonic antigen in colorectal carcinoma. Serum levels before and after resection and before recurrence
D. Z. Chu, C. A. Erickson, M. P. Russell, C. Thompson, N. P. Lang, R. J. Broadwater and K. C. Westbrook
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock.
The use of carcinoembryonic antigen was evaluated in 425 patients with a
mean follow-up of 48 months. The preoperative and postoperative
carcinoembryonic antigen levels were predictive of recurrence and survival
independent of the tumor stage. In a multivariate regression analysis of
age, location, tumor stage, and preoperative and postoperative
carcinoembryonic antigen levels, the latter three factors were significant
prognostic variables with respect to the adjusted survival. Recurrent
disease was found in 42% of patients, excluding patients with stage IV
disease. The carcinoembryonic antigen level at recurrence was greater than
5 ng/mL in 79% of the patients and in 89% of the intra-abdominal
recurrences. Carcinoembryonic antigen level at recurrence was not
predictive of postrecurrence survival except in the subgroup of
locoregional disease. The life span in patients with liver and lung
metastases was not influenced by carcinoembryonic antigen level at
recurrence. Preoperative and postoperative carcinoembryonic antigen levels
can indicate a poorer prognostic group of patients with colorectal cancer
who may benefit from adjuvant treatment. The carcinoembryonic antigen at
recurrence can be used effectively to diagnose intra-abdominal recurrences
and project survival after development of local/regional disease.
