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. 2024 Jul 27;7(3):60.
doi: 10.3390/reports7030060.

Diagnosis of Relapse of Colorectal Adenocarcinoma through CEA Fluctuation

Zsolt Fekete  1   2 , Patricia Ignat  1   2 , Laura Gligor  3 , Nicolae Todor  2 , Alina-Simona Muntean  2 , Alexandra Gherman  1   2 , Dan Eniu  1   2
Affiliations

Diagnosis of Relapse of Colorectal Adenocarcinoma through CEA Fluctuation

Zsolt Fekete et al. Reports (MDPI). .

Abstract

Carcinoembryonic antigen(CEA) is a routine marker employed for follow-up of colorectal tumors. We aimed to determine whether a CEA increase within the normal range can be linked to a risk of recurrence. From the period of 2006-2013 we selected 78 consecutive patients with colorectal cancer, who underwent curative surgery with or without neo-/adjuvant chemo- or radiotherapy and had proper follow-up procedures. For analyzing CEA fluctuation, we used the smallest value of the CEA during follow-up as the reference. With the aid of a Chi-squared test, we have chosen the value of 1.1 ng/mL for significant CEA fluctuation. A total of 43.6% of patients had fluctuations in CEA of at least 1.1 ng/mL, with or without increases above 5 ng/mL. From these, in 79.4% of patients, the increases in CEA were explained either by recurrence (44.1%), adjuvant chemotherapy (20.6%) or benign pathology (14.7%). In 23% of the recurrences, a CEA increase of at least 1.1 ng/mL, but below 5 ng/mL, preceded the clinical relapse by a median of 8 months. Our conclusion is that an increase in CEA levels by at least 1.1 ng/mL within the normal range after curative treatment for colorectal cancer may serve as an early indicator of relapse or could be associated with other pathological conditions.

Keywords: CEA 1; colorectal cancer 2; early chemotherapy 6; early intervention 5; follow-up 3; tumor markers 4.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Chi-squared test to identify an alarm value for the increase in CEA (the difference between the smallest value and the highest value which would be associated with an event, i.e., relapse, chemotherapy, benign causes of increase in CEA. x: p values, y: CEA fluctuations in ng/mL.
Figure 2
Figure 2
Increases in CEA below 5 ng/mL but at least 1.1 ng/mL, which predicted relapse in 5/22 patients. The colored lines represent different patients.
Figure 3
Figure 3
CEA fluctuation of at least 1.1 ng/mL under adjuvant chemotherapy. Colored lines represent patients.
Figure 4
Figure 4
CEA fluctuation of at least 1.1 ng/mL for patients with no relapse and no adjuvant chemotherapy. Different colored lines designate different patients.
Figure 5
Figure 5
OS and DFS at 4 years.
Figure 6
Figure 6
The post-surgery value of CEA marker and the DFS.
See this image and copyright information in PMC

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