Carcinoembryonic antigen for the detection of recurrent disease following curative resection of colorectal cancer

Background: During recent years a discussion about cost-effectiveness and importance of follow-up determination of carcinoembryonic antigen (CEA) after curative resection of large bowel cancer has developed. Patients and Methods: Between 1990 and 1998 follow-up CEA levels of 1,321 patients after curative colorectal cancer resection were prospectively collected in cooperation with family physicians. CEA determinations were made with different assays by various laboratories. The reported findings were adjusted for the different methods used. Results: 306 patients developed recurrent disease following curative cancer resection (23.2% of all patients). Regarding the role of follow-up CEA determination, they were divided into: I. no preoperative CEA determination/insufficient follow-up (N=47); II. no elevation of CEA with primary cancer, a) elevation with recurrent disease (N=62), b) no elevation at any time point (N=53), c) role of CEA not completely elucidated (N=41); III. elevated CEA levels with primary cancer, a) no increase with recurrent disease (N=21), b) increase with other symptoms of recurrent disease (N=45), c) increased levels as early symotom of recurrent disease (N=37). 30 patients (9.8% of all patients with recurrent disease; 2.3% of all patients) with increased CEA levels at the time of recurrent disease underwent surgical resection with curative intention (R₀ resection). Conclusions: Our findings indicate that up to 47% of the patients with recurrent disease and 11% of all patients (N= 144, groups IIa +IIIb +IIIc) could benefit from routine follow-up CEA determinations after curative colorectal cancer resection. Nonetheless, only 2.3% of all patients with elevated CEA levels underwent R₀ resection of recurrent disease. Despite these detection and R₀ resectability rates, CEA plays a crucial role in the early detection of recurrent disease and remains an important part of routine patient care after curative resection of colorectal cancer.