title: The Role of High Frequency Dynamic Threshold (HiDT) Serum Carcinoembryonic Antigen (CEA) Measurements in Colorectal Cancer Surveillance: A (Revisited) Hypothesis Paper.
abstract: Following curative treatment for colorectal cancer (CRC), 30% to 50% of patients will develop recurrent disease. For CRC there are several lines of evidence supporting the hypothesis that early detection of metachronous disease offers a second opportunity for cure. This paper revisits the potential role of serum carcinoembryonic antigen (CEA) in follow-up. A comprehensive review of the literature (1978-2008) demonstrates that the initial promise of serum CEA as an effective surveillance tool has been tarnished through perpetuation of poorly designed studies. Specific limitations included: testing CEA as only an 'add-on' diagnostic tool; lack of standardization of threshold values; use of static thresholds; too low measurement frequency. Major changes in localizing imaging techniques and treatment of metastatic CRC further cause a decrease of clinical applicability of past trial outcomes. In 1982, Staab hypothesized that the optimal benefit of serum CEA as a surveillance tool is through high-frequency triage using a dynamic threshold (HiDT). Evidence supporting this hypothesis was found in the biochemical characteristics of serum CEA and retrospective studies showing the superior predictive value of a dynamic threshold. A multi-centred randomized phase III study optimizing the usage of HiDT against resectability of recurrent disease is commencing recruitment in the Netherlands.
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands. irenegrossmann@me.com.
authors.forename: Irene
authors.initials: I
authors.lastname: Grossmann
authors.forename: Charlotte
authors.initials: C
authors.lastname: Verberne
authors.forename: Geertruida
authors.initials: G
authors.lastname: De Bock
authors.forename: Klaas
authors.initials: K
authors.lastname: Havenga
authors.forename: Ido
authors.initials: I
authors.lastname: Kema
authors.forename: Joost
authors.initials: J
authors.lastname: Klaase
authors.forename: Andrew
authors.initials: A
authors.lastname: Renehan
authors.forename: Theo
authors.initials: T
authors.lastname: Wiggers