title: Transient elevation in serum carcinoembryonic antigen while on adjuvant chemotherapy for colon cancer: Is this of prognostic importance?
abstract: OBJECTIVE
  Serum carcinoembryonic antigen (CEA) is used to detect relapses from colon cancer following initial surgical or adjuvant treatment. There are little data on transient elevations of CEA while receiving chemotherapy in the adjuvant setting. We aimed to review patterns of change in CEA levels while receiving adjuvant chemotherapy and investigate associations between transient rises and patient survival.
  
  
  METHODS
  A retrospective review of patients in Auckland with a new diagnosis of colon cancer in 2001 or 2005 was performed and CEA values were collected. Three patient groups were defined: no increase in CEA; transient elevation in CEA; and persistent elevation in CEA. Kaplan-Meier methods were used to estimate 5-year survival; Cox regression and log-rank P-values were used to compare survival.
  
  
  RESULTS
  Sixty-one patients with stage II or III disease who had received adjuvant chemotherapy had sufficient CEA data to be included in the analysis. Patients were followed up for a minimum of 7.4 years (or death). The 5-year overall survival was higher in the transient elevation in CEA group 95.0% and the no increase in CEA group 85.2% compared with the persistent elevation in CEA group 42.9%. There was no statistically significant difference in overall survival between the transient elevation group and the no increase group (P = 0.2).
  
  
  CONCLUSIONS
  The group with a transient elevation in CEA during adjuvant chemotherapy did not have a poorer prognosis compared with the group that had no increase in CEA. This will be further examined in a population-based New Zealand-wide study of colorectal cancer diagnosis, treatment and outcome.
authors.affiliation: Medical Oncology Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Nicola
authors.initials: N
authors.lastname: Lawrence
authors.affiliation: Cancer Trials New Zealand, Discipline of Oncology, University of Auckland, Auckland, New Zealand.
authors.forename: Victoria
authors.initials: V
authors.lastname: Hinder
authors.affiliation: Cancer Trials New Zealand, Discipline of Oncology, University of Auckland, Auckland, New Zealand.
authors.forename: Melissa
authors.initials: M
authors.lastname: Murray
authors.affiliation: Cancer Trials New Zealand, Discipline of Oncology, University of Auckland, Auckland, New Zealand.
authors.forename: Jerome
authors.initials: J
authors.lastname: Macapagal
authors.affiliation: Medical Oncology Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Paul
authors.initials: P
authors.lastname: Thompson
authors.affiliation: Cancer Trials New Zealand, Discipline of Oncology, University of Auckland, Auckland, New Zealand.|Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Katrina
authors.initials: K
authors.lastname: Sharples
authors.affiliation: Cancer Trials New Zealand, Discipline of Oncology, University of Auckland, Auckland, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Findlay
mesh_terms: D000368:Aged; D002272:Carcinoembryonic Antigen / Q000097:blood*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D002272:Carcinoembryonic Antigen
keywords: carcinoembryonic antigen; chemotherapy adjuvant; colonic neoplasm; prognosis; survival rate