A prospective evaluation of serum carcinoembryonic antigen (CEA) levels in the management of colorectal carcinoma

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Abstract
The relationship between the pattern of carcinoembryonic antigen (CEA) changes and the types of recurrence was investigated in a prospective study of 146 patients who underwent curative operations for adenocarcinoma of the colon or rectum. Recurrences developed in 51 patients (34.9%) and was local in 14, distant in 23, and both local and distant in 14 of them. CEA slope values were individually calculated beginning with an initial rise of more than 1 ng/ml, and expressed as the % rise in CEA per month. Patients who relapsed had significantly higher slopes than those who remained well (median 20.0% versus 0.3% rise,p<0.001). A slope value of 5% rise per month broadly separated the two groups with an overall accuracy of 79.4%, sensitivity rate for recurrence of 86.3%, and specificity rate for no relapse of 75.8%.Median CEA slope values did not differ significantly among patients with different types of relapse. However, compared with patients who had any distant recurrence, more patients with localized recurrence had slope values of less than 5% rise per month (8.1% versus 28.6%, respectively; one‐tailedp=0.04). Nevertheless, a slope exceeding a 5% rise per month was observed in 10 of the 14 patients with local recurrence.We conclude that serial postoperative CEA monitoring is useful in detecting both local as well as distant recurrence. Furthermore, the use of slope analysis may enhance the sensitivity of postoperative CEA monitoring for detecting relapse.