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. 2022 Mar;407(2):769-778.
doi: 10.1007/s00423-021-02352-0. Epub 2021 Oct 16.

Elevated CEA with negative PET scan on surveillance of colorectal cancers-a role of CEA kinetics

Anand Ebin Thomas  1 , Mufaddal Kazi  2 , Sanket Bankar  3 , Smruti Mokal  4 , Archi Agarwal  5 , Ventakesh Rangarajan  5 , Ashwin Desouza  2 , Avanish Saklani  6
Affiliations

Elevated CEA with negative PET scan on surveillance of colorectal cancers-a role of CEA kinetics

Anand Ebin Thomas et al. Langenbecks Arch Surg. 2022 Mar.

Abstract

Introduction: The management of patients with elevated CEA after curative treatment of colorectal cancers without structural disease is uncertain. The aim was to study the clinical risk factors, CEA thresholds, and kinetics that could predict relapses.

Methods: Retrospective study of colorectal cancers patients that were detected to have an elevated CEA (> 5 ng/ml on 2 separate occasions) and normal clinical exam, colonoscopy, and positron emission tomography (PET). Receiver operating characteristic (ROC) curves were generated to determine the optimal cutoff for absolute CEA values and proportional rise that could predict recurrences.

Results: 162 patients were followed for a median of 42 months. 32 patients (19.7%) relapsed of which 11 (34.4%) had a peritoneal disease. Besides known clinical risk factors, higher CEA at the time of negative PET and rising CEA trend predicted disease recurrence on multivariate logistic regression. CEA threshold of 10.05 ng/ml provided a sensitivity/specificity of 53%/86.2%, while CEA velocity of 1.36 ng/ml over 3 months presented a sensitivity/specificity of 80%/70.6% for subsequent relapse.

Conclusions: The discriminatory value of CEA kinetics was more than that of a single absolute value. An algorithm for managing these patients based on clinical risk factors, absolute CEA value, and its kinetics is suggested.

Keywords: CEA; Colorectal cancer; PET.

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