title: Intensive risk-adjusted follow-up with the CEA, TPA, CA19.9, and CA72.4 tumor marker panel and abdominal ultrasonography to diagnose operable colorectal cancer recurrences: effect on survival.
abstract: OBJECTIVE
  Intensive risk-adjusted follow-up leads to improved resectability of tumor recurrences and better overall survival among patients who have undergone surgery for colorectal cancer.
  
  
  METHODS
  Long-term observational single-center study.
  
  
  METHODS
  University of Pisa, Pisa, Italy.
  
  
  METHODS
  One hundred eight disease-free patients who had undergone surgery for colorectal cancer were submitted to long-term follow-up with the serum CEA, TPA, CA19.9, and CA72.4 tumor marker (TM) panel and abdominal ultrasonography.
  
  
  METHODS
  Sensitivities and specificities of TMs, abdominal ultrasonography, and abdominal and chest computed tomography (CT); the median survival among patients operated on and those not operated on and the cumulative 5-year overall survival among the entire group.
  
  
  RESULTS
  Twenty-two patients with asymptomatic colorectal cancer recurred 32 times. The CEA, TPA, CA19.9, CA72.4, and TM panel sensitivities were 46.9%, 34.4%, 9.4%, 9.4%, and 81.0%, respectively, and the mean (SD) lead times before confirmation of recurrence were 4.3 (4.8), 4.1 (4.7), 8.3 (10.9), 5.0 (7.0), and 5.3 (5.8) months, respectively. Abdominal and chest CT sensitivities were 100.0%. Among 86 patients without recurrence, specificities of the TM panel and all panel markers were 100.0%, while specificities of abdominal ultrasonography, abdominal CT, and skeletal CT were 99.9%, 99.0%, and 100.0%, respectively. The median survival after first recurrence was 16 months (range, 3-48 months) for 8 patients with recurrence who did not undergo second-line surgery. Among 14 remaining patients who underwent metastasectomy, the median survival after first recurrence was 37 months (range, 12-187 months; P = .03). Among the entire group of 108 patients, the cumulative 5-year overall survival was 88.7%.
  
  
  CONCLUSIONS
  Long-term intensive risk-adjusted monitoring using the CEA, TPA, CA19.9, and CA72.4 TM panel and abdominal ultrasonography allows early detection of most recurrences. Patients can then undergo radical metastasectomy, with potentially improved overall survival.
authors.affiliation: Department of Internal Medicine, University of Pisa, Italy. a.nicolini@int.med.unipi.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Nicolini
authors.forename: Paola
authors.initials: P
authors.lastname: Ferrari
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Duffy
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Metelli
authors.forename: Franca
authors.initials: F
authors.lastname: Fulceri
authors.forename: Loretta
authors.initials: L
authors.lastname: Anselmi
authors.forename: Massimo
authors.initials: M
authors.lastname: Conte
authors.forename: Piero
authors.initials: P
authors.lastname: Berti
authors.forename: Paolo
authors.initials: P
authors.lastname: Miccoli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging / Q000379:methods; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011956:Receptors, Cell Surface / Q000097:blood; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D019396:Tissue Polypeptide Antigen / Q000097:blood; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; C083825:CA-72-4 antigen; D011956:Receptors, Cell Surface; D019396:Tissue Polypeptide Antigen; C065686:carcinoembryonic antigen binding protein, human