title: The prognostic significance and treatment modality for elevated pre- and postoperative serum CEA in colorectal cancer patients.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the prognostic significance of serum CEA (s-CEA) changes in colorectal cancer (CRC) patients with sustained elevated postoperative s-CEA levels.
  
  
  METHODS
  Between January 1999 and December 2008, 9,380 CRC patients underwent surgery. Curative resection was performed in 1,242 CRC patients with high preoperative s-CEA levels (>6 ng/mL). High s-CEA levels were normalized in 924 patients (74.4%) within 2 weeks from surgery, whereas high s-CEA levels were persistent in 318 patients (25.6%). Patients were divided into 2 groups according to their postoperative s-CEA levels: group 1 (37 patients with a 1-year postoperative s-CEA>6 ng/mL) and group 2 (281 patients with a 1-year postoperative s-CEA≤6 ng/mL).
  
  
  RESULTS
  A postoperative recurrence was identified in 24 patients (64.9%) in group 1 and 65 patients (23.1%) in group 2 (P < 0.001). A curative resection after recurrence was performed in 22 patients (33.8%) from group 2, but no patients from group 1 (P = 0.001). The 5-year overall survival and time to recurrence were significantly lower in patients with recurrent cancer in group 1 (P < 0.001).
  
  
  CONCLUSIONS
  Patients with persistent elevated postoperative s-CEA levels are at high risk for recurrence and a low survival rate. More intensive surveillance of patients with high postoperative s-CEA levels should be mandatory.
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Kwan Mo
authors.initials: KM
authors.lastname: Yang
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: In Ja
authors.initials: IJ
authors.lastname: Park
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Institute of Innovative Cancer Research, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.
authors.forename: Chan Wook
authors.initials: CW
authors.lastname: Kim
authors.affiliation: Institute of Innovative Cancer Research, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.
authors.forename: Seon Ae
authors.initials: SA
authors.lastname: Roh
authors.affiliation: Institute of Innovative Cancer Research, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.; Graduate School of East-West Medical Science, Kyung Hee University, Yongin, Korea.
authors.forename: Dong-Hyung
authors.initials: DH
authors.lastname: Cho
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Institute of Innovative Cancer Research, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
keywords: Colorectal neoplasms; Recurrence; Serum carcinoembryonic antigens; Survival