title: Carcinoembryonic antigen for the detection of recurrent disease following curative resection of colorectal cancer.
abstract: 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.
  
  
  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 symptom 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.
authors.affiliation: Department of Surgery, Ludwig-Maximilians-University, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
authors.forename: M W
authors.initials: MW
authors.lastname: Wichmann
authors.forename: U
authors.initials: U
authors.lastname: Lau-Werner
authors.forename: C
authors.initials: C
authors.lastname: Müller
authors.forename: H M
authors.initials: HM
authors.lastname: Hornung
authors.forename: P
authors.initials: P
authors.lastname: Stieber
authors.forename: F W
authors.initials: FW
authors.lastname: Schildberg
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis*; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D011379:Prognosis
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen