Carcinoembryonic antigen measurements in the management of esophageal cancer: an indicator of subclinical recurrence

Am J Surg. 1995 Dec;170(6):597-600; discussion 600-1. doi: 10.1016/s0002-9610(99)80023-3.

Abstract

Background: Detection of subclinical recurrence after surgical resection of esophageal cancer would allow earlier treatment of recurrent disease and potentially offer a better outcome for rescue therapy.

Methods: The utility of serum carcinoembryonic antigen (CEA) assay was evaluated in the management of patients with esophageal cancer.

Results: Serum carcinoembryonic antigen was measured preoperatively in 74 patients. Elevation of the CEA level (> 5 ng/mL) was present in 14 patients (19%). There was no relationship between preoperative CEA elevation and the stage of the tumor or the patients' survival. Eighty-three patients had CEA assay at regular follow-up intervals after resection. Objective evidence of recurrent disease was determined at similar intervals by chest radiography and abdominal and thoracic computed tomography scans. During follow-up, 53 of 83 patients developed recurrence. Postoperative elevation of CEA levels occurred in 32 patients, resulting in a sensitivity of 55% for detecting recurrent disease. Twenty-nine of the 32 patients who developed CEA elevation had objective evidence of metastatic disease. In 13 patients, the rise in CEA levels predated objective evidence of recurrence by a median of 4 months (range 3 to 35), and in 16 patients, it occurred concomitantly. The specificity with which an elevated postoperative CEA level indicated recurrence was high, 90%, with a positive predictive value of 91%.

Conclusions: Postoperative CEA elevation is highly predictive of recurrent disease. In 16% of patients, elevation of CEA was the earliest objective sign of recurrence; such elevation should prompt consideration of adjuvant therapy.

MeSH terms

  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / secondary
  • Adenocarcinoma / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / analysis
  • Carcinoembryonic Antigen / analysis*
  • Carcinoma, Adenosquamous / diagnosis
  • Carcinoma, Adenosquamous / secondary
  • Carcinoma, Adenosquamous / surgery
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / secondary
  • Carcinoma, Squamous Cell / surgery
  • Esophageal Neoplasms / diagnosis*
  • Esophageal Neoplasms / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Lymphatic Metastasis / diagnosis
  • Male
  • Middle Aged
  • Prognosis
  • Reoperation
  • Sensitivity and Specificity

Substances

  • Biomarkers, Tumor
  • Carcinoembryonic Antigen