Serum carcinoembryonic antigen levels in patients operated for colorectal carcinoma.

BACKGROUND: The only method of treatment that offers a favourable prognosis for colorectal carcinoma is radical resection of a part of the colon or rectum including the pertinent lymph glands and radical removal of metastases. However, even such presumably curative surgery does not ensure full recovery, as recurrences are frequent and, according to several analyses, the 5-year survival rate is less than 50%. The most significant reason for this poor therapeutic success are residual micrometastases. Therefore, additional treatment strategies are attempted in several patients. Various prognostic factors of disease recurrence are known. One such prognostic sign is the serum carcinoembryonic antigen (CEA) level measured shortly after surgery.

PATIENTS AND METHODS: All patients operated on electively for colorectal carcinoma at our institution within one year were followed. According to preoperative serum CEA levels, the patients were divided into a study group (preoperative CEA more than 10 ng/mL) and controls (preoperative CEA less than 10 ng/mL). In the former category, patients who underwent radical R0 resection were divided into three groups according to their postoperative serum CEA levels and CEA half-life: (CEA) R0-, (CEA) R1- and (CEA) R2-resected patients. All patients were then followed for 24 months; the number of recurrences and survival rates were registered.

RESULTS: A statistically significant difference in regard of survival and the number of recurrences was noted in patients divided according to the stage of disease, particularly between the three groups of patients from the study group undergoing curative surgery. After two years, survival was 96.97% in the CEA R0 group, 66.66% in the (CEA) R1 group and 50% in the (CEA) R2 group. Recurrences were as follows; 3.03% in (CEA) R0, 83.3% in (CEA) R1 and 100% in (CEA) R2.

CONCLUSIONS: The results of our study confirm the prognostic value of serum CEA measurement, in particular its half-life, following surgery for colorectal carcinoma.