Current Surveillance After Treatment is Not Sufficient for Patients With Rectal Cancer With Negative Baseline CEA
Background: Serum CEA has been widely used to screen for potential recurrent disease after resection in rectal cancer. However, the influence of baseline CEA on the performance of CEA in recurrence surveillance needs to be investigated. Patients and Methods: This longitudinal cohort study included 484 patients with nonmetastatic rectal cancer from 18,013 patients in a prospectively enrolled institutional database program of colorectal disease. Baseline CEA levels were determined before treatment, and CEA-based follow-up tests and examinations were applied in the surveillance after treatment. Results: A total of 62.6% (62/99) overall, 53.5% (23/43) local, and 64.9% (50/77) distant recurrences were seen in patients who had similar CEA levels with their baseline statuses. The sensitivity of elevated CEA levels during surveillance for overall recurrence was significantly lower in patients with negative baseline CEA than in those with elevated baseline CEA levels (41.3% vs 69.4%; P =.007). Moreover, similar results were observed in the surveillance for local (50% vs 61.5%; P =.048) and distant (39.6% vs 72.4%; P =.005) recurrences between these 2 patient groups. However, CEA had comparable and excellent specificity during surveillance for recurrent disease in these groups. The addition of CA19-9 to the CEA assay significantly improved the sensitivity in recurrence surveillance for patients with negative baseline CEA (49.2% vs 41.3%; P =.037). Finally, we identified a subgroup of CEA-turn recurrences characterized by negative CEA at baseline, elevated CEA at recurrence, and worse survival outcomes after recurrence (hazard ratio, 1.88; 95% CI, 1.07–3.30; P =.026). Conclusions: In patients with rectal cancer with negative baseline CEA, serum CEA had insufficient sensitivity in recurrence surveillance after treatment, and additional surveillance may improve oncologic outcomes. Baseline CEA should be considered before CEA-based surveillance can be applied in the follow-up trials.
Submitted August 22, 2021; final revision received October 8, 2021; accepted for publication October 11, 2021. Published online March 1, 2022.
Author contributions: Study concept and design: Yu. Supervision: Yu. Data collection: Shen, X. Wang, H. Wang, Xu, Xie, Zhuang, Z. Huang, JL, P. Wang, Yu. Data analysis and interpretation: Shen, Yu. Provision of study materials and patients: X. Wang, JL, P. Wang, M. Huang, Luo. Financial support: M. Huang, Luo, Yu. Writing – original draft: Shen. Writing – revision: Yu. Dr. Yu had full access to all data for this study and takes responsibility for the integrity and accuracy of the data.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: This study was supported by the National Natural Science Foundation of China (number 81972245, Y. Luo; number 81902877, H. Yu), the Natural Science Foundation of Guangdong Province (number 2018A0303130303, H. Yu; number 2021A1515010134, M. Huang), the Sun Yat-sen University Clinical Research 5010 Program (number 2018026, Y. Luo), the “Five Five” Talent Team Construction Project of The Sixth Affiliated Hospital of Sun Yat-sen University (number P20150227202010251, Y. Luo), the Excellent Talent Training Project of The Sixth Affiliated Hospital of Sun Yat-sen University (number R2021217202512965, Y. Luo), The Sixth Affiliated Hospital of Sun Yat-sen University Clinical Research-“1010” Program (M. Huang), the Program of Introducing Talents of Discipline to Universities, and the National Key Clinical Discipline (2012).
Supplementary Materials
- Supplemental Materials (PDF 592 KB)
© 2019-2022 National Comprehensive Cancer Network