Plasma levels of carcinoembryonic antigen in bronchial carcinoma and chronic bronchitis.

The plasma levels of carcinoembryonic antigen were increased in 80% of 49 patients with bronchial carcinoma and in 68% of 25 patients with an acute exacerbation of chronic bronchitis. There was no statistically significant difference between the two groups. A single determination of the plasma carcinoembryonic antigen level has no prognostic value in patients with bronchial carcinoma.     

Roôle of carcinoembryonic antigen in bronchial carcinoma.

It has been reported that lung cancer patients often have raised carcinoembryonic antigen (CEA) levels but the significance of this in diagnosis and follow-up has yet to be established. The results of 256 preoperative investigations in patients with lung cancer are reported. Sequential values after radical surgery and chemotherapy and immunotherapy have been performed in 57 patients during treatment and outpatient follow-up. Ninety-nine per cent of preoperative values were more than 5 ng/ml and 41% greater than 15 ng/ml. Only 6% reached diagnostic levels for malignancy (greater than 52ng/ml) and adenocarcinomas formed 47% (7 out of 15) of these. Sequential estimation in patients during and after treatment showed fluctuations which were related to disease status in 7 (32%) of 22 who have developed secondary disease. In three patients levels of greater than 50 ng/ml preceded clinical evidence of recurrence, and two patients have developed very high levels but have not yet developed other evidence of recurrent disease. It is concluded that raised CEA levels in lung cancer are infrequent, but in those patients who have or develop raised levels sequential investigation may be of value in monitoring response to treatment and clinical coourse.     

Sequential galactosyltransferase and carcinoembryonic antigen levels in advanced breast carcinoma

UDP-galactosyltransferase (GT), an enzyme that functions in the biosynthesis of glycoproteins, has recently been found to be a sensitive biologic tumor marker. In the present study, sequential GT levels were compared to simultaneous CEA determinations to establish which biomarker more accurately reflects changes in tumor activity in patients receiving therapy for advanced breast carcinoma. Serum levels of GT and CEA were measured each month in 38 patients undergoing combination chemotherapy for metastatic breast carcinoma. The results were correlated with the objective responses observed to chemotherapy during this period. Prior to the institution of chemotherapy, significant serum GT elevations were observed in 84.2% ($\text{32}\text{38}$) of the patients, while 55.3% ($\text{21}\text{38}$) had elevations in levels of CEA. During therapy 71.4% ($\text{10}\text{14}$) and 50% ($\text{7}\text{14}$) of the GT and CEA levels, respectively, decreased in patients who had an objective response to therapy. In the patients whose disease progressed on therapy, 75% ($\text{18}\text{24}$) had significant increases in GT levels during this interval, while 41.6% ($\text{10}\text{24}$) had increases in CEA (P < 0.01). Furthermore, in 11 patients (29.5%) serum GT alterations correctly reflected changes in tumor activity, while CEA levels remain static. These data indicate that GT is more sensitive than CEA as a marker for breast carcinoma and suggest that GT may be clinically useful in the management of patients with metastatic breast disease.     

Elevated carcinoembryonic antigen levels correlating with disease recurrence in a patient with adenoid cystic carcinoma

Background. Carcinoembryonic antigen (CEA) is an oncofetal glycoprotein involved in cell recognition and adhesion. Serum CEA has been extensively studied as a potential chemical marker for malignancy, most notably in patients with colon carcinoma. Serum CEA measurements have not been reported for patients with salivary gland carcinomas. Methods. Serum CEA was measured in a case study using enzyme immunoassay with monoclonal antibody specific for CEA. Tissue was examined with standard histologic and immunohistologic methods. Results. A patient was initially seen with adenoid cystic carcinoma (ACC) of the trachea and had a markedly elevated serum CEA level which declined after surgical resection. The serum CEA level became elevated again when the patient developed abdominal metastases and then declined after debulking of the tumor. Immunohistochemical study of the tumor was positive for CEA. Conclusions. The measurement of serum CEA levels may play a role in the management of patients with ACC. Clinical investigation utilizing monoclonal antibodies against CEA, for imaging and for the delivery of chemotherapy and radiotherapy may be worthwhile. © 1995 Jons Wiley & Sons, Inc.     

Preoperative staging of rectal carcinoma

BACKGROUND: The development of treatment modalities for rectal cancer, including local excision, total mesorectal excision and preoperative radiotherapy, has increased the importance of accurate preoperative staging to allow the optimum treatment to be selected. METHODS: A literature review was undertaken of methods of preoperative staging of rectal carcinoma and the evidence for each was evaluated critically. RESULTS: Clinical assessment of rectal carcinoma may give an indication of fixity but is not accurate for staging. Endoanal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), radioimmunoscintigraphy and positron emission tomography have all been used for staging. The extent of tumour spread through the bowel wall (T stage) is most accurately assessed by endoanal ultrasonography, although this technique is poor at assessing tumour extension into adjacent organs for which both CT and MRI are more accurate. No method accurately determines lymph node involvement, but endoanal ultrasonography is the best available. Liver metastases may be assessed by abdominal ultrasonography, CT, MRI and CT portography (with increasing sensitivity and cost in that order). CONCLUSION: Endoanal ultrasonography is the most effective method of local tumour staging, with the addition of either CT or MRI if adjacent organ involvement is suspected. Abdominal ultrasonography or CT is recommended for routine preoperative assessment of the liver.     

Prognostic value of postoperative serum carcinoembryonic antigen levels in colorectal cancer patients with chronic kidney disease

BackgroundChronic kidney disease (CKD) can increase serum carcinoembryonic antigen (CEA) levels. We thus aimed to evaluate the impact of CKD on CEA prognostic accuracy in colorectal cancer.MethodsAltogether, 429 patients who underwent curative resection for stages I–III colorectal adenocarcinoma were grouped according to postoperative CEA levels and history of CKD.ResultsThree-year disease-free survival (DFS) was higher in patients with normal postoperative CEA (group A, 83.4%) than in those with elevated postoperative CEA (group B, 64.3%) (p < 0.001). CKD patients had higher postoperative CEA levels than non-CKD patients (odds ratio 3.27, 95% confidence interval 1.78–5.99, p < 0.001). In multivariable analysis, postoperative CEA level was an independent prognostic factor for DFS in non-CKD, but not CKD, patients.ConclusionsCKD can increase postoperative CEA levels in colorectal cancer patients. Elevated postoperative CEA levels were associated with shorter DFS in non-CKD, but not CKD, patients.     

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目的 评价超声微型探头（mini-probe-sonography,MPS)对大肠癌术前分期的应用价值。方法 对50例大肠癌病人进行前瞻性的术前肠镜下MPS检查,全部病人进行手术治疗,将术前分期与术后病理结果进行对比分析。结果 MPS对肿瘤浸润程度（T）的符合率T1、T2、T3、T4分别为75％、80％、88％、67％,总符合率为84％（P＜0．01）。区域淋巴结受累程度（N）的敏感性为79％,特异性为91％,阳性预测值为92％,阴性预测值为77％,总符合率为84％（P＜0．01）。结论 MPS对大肠癌提供较为准确的术前分期,提示肿瘤浸润程度及淋巴结转移,对制定治疗方案有指导意义。     

Sequential antitumour immunoreactivity and carcinoembryonic antigen levels as a guide to prognosis in colorectal carcinoma.

Twenty-five patients with colorectal carcinoma were tested for blood-lymphocyte anti-tumour cytotoxicity and carcinoembryonic antigen (CEA) levels at three-monthly intervals for eighteen months or more after resection, and examined clinically every three to six months. Twelve of the patients were followed for two years and one for four years. The six patients whose tumours recurred showed positive blood lymphocyte antitumour cytotoxicity and elevated plasma CEA levels at some time from six months after operation, usually well before the recurrence was clinically detectable.     

Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for the evaluation of curability and resectability in patients with pancreatic adenocarcinoma

Background Purpose Although carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most studied serum tumor markers that have been evaluated for diagnosis and prognosis in patients with pancreatic cancer, little is known of the value of these markers for the prediction of curability and resectability. Methods We retrospectively reviewed preoperative serum levels of CEA and CA 19-9 in 244 consecutive patients with pancreatic operations. Results Although 159 pancreatic operations seemed “resectable”, 93 of them were judged curative (R0) and the other 66 turned out to be noncurative (R1/2). The remaining 85 failed resection because of unexpected metastasis or locally advanced disease (LD), which was unresectable compared with levels in those patients without liver metastasis or LD. CEA levels were significantly higher in patients with liver metastasis and LD, while CA 19-9 levels were correlated with liver and peritoneal metastases. When both markers were negative, curative (R0) and respectable (R0 + R1/2) operation were performed in 70% and 85% of patients, respectively. Logistic regression analysis indicated that under conditions where both CEA and CA 19-9 were negative, the odds ratios for curative and respectable operations were 4.43 and 3.58, respectively. Conclusions Our data suggest that combined preoperative CEA and CA 19-9 levels are suitable for assessing expected curability and resectability in patients with pancreatic cancer.     

Preoperative staging by multidetector-row computed tomography in patients with rectal carcinoma

BACKGROUND: Multidetector-row computed tomography (MDCT, or multi-slice CT) has been introduced in 2000. So far, there has been no published study on this modality in patients with rectal carcinoma. METHODS: Twenty patients with rectal carcinoma were preoperatively examined by MDCT and conventional CT (CCT). Diagnostic accuracies of both modalities were compared regarding the evaluation of depth of tumor invasion (Tis/T1/T2, T3, T4) and lymph node metastasis based on the pathologic findings. RESULTS: Although CCT detected a tumor in 13 (65%) of 20 patients, MDCT revealed a tumor in all 20 patients (P = 0.004). Regarding depth of tumor invasion, the concordance rate was significantly higher for MDCT (20/20: 100%) than for CCT (12 of 20: 60%; P = 0.002). Regarding lymph node metastasis, the overall accuracy was 70.0% in CCT, and also 70.0% in MDCT. CONCLUSIONS: MDCT was superior to CCT in the evaluation of depth of tumor invasion, but was equal to CCT in the evaluation of lymph node metastasis.     

Preoperative staging of renal cell carcinoma. Comparison with operative or pathologic finding

Fifty-two cases of renal cell carcinoma (cases with metastatic episode during follow-up period excluded) operated on and whose pathohistological staging had been established at our department clinic during a period of 11 years from January 1973 to December 1983 were studied. Renal arteriography i.e., selective renal arteriography, aortography, was performed on 49 cases, and CT scan and ultrasonic examination were performed on 19 and 15 cases, respectively for analytical comparison of the preoperative staging with the postoperative staging as based on the operative or pathological findings (Robson et al.). Staging was found correct in 33 of the 49 cases (67.3%) by arteriography and 16 of the 19 cases (84.2%) by CT scan. In the current study, ultrasonic assessment was possible only in those cases of venous infiltrations i.e., tumor embolism affecting the renal vein or the vena cava inferior. Most effective in the cases with extracapsular infiltrations or localized lymph node metastases was the CT scan. Correct diagnosis was also possible in 6 of the 8 cases (75%) with venous infiltrations if the arteriograms had been analysed in detail, and both the CT scan and the ultrasonic examination proved effective in this type of cases as well. These findings may suggest that the CT scan alone is sufficient for making a localized staging.     

Prognostic significance of carcinoembryonic antigen levels in peritoneal washes in patients with gastric cancer.

BACKGROUND: Peritoneal metastasis is the most frequent cause of death in patients with gastric cancer. Detection of free cancer cells in the peritoneal cavity at the time of surgery, therefore, is considered to be of great value in predicting the peritoneal recurrence and accordingly in the prognosis in patients with gastric cancer. This study examined the clinical significance of intraoperative determination of carcinoembryonic antigen (CEA) levels in peritoneal washes (pCEA) in patients with gastric cancer. METHODS: CEA levels in peritoneal washes were correlated retrospectively with several clinicopathologic factors including clinical outcome in 56 patients with resectable gastric cancer. RESULTS: Among several clinicopathologic factors, the depth of tumor invasion significantly and independently correlated with pCEA levels as revealed by multivariate stepwise logistic regression analysis. A significant difference in overall survival rates was observed between pCEA-positive and pCEA-negative groups: 5-year survival rates were 95.7% in pCEA-negative and 20% in pCEA-positive patients (P <0.0001). Multivariate analysis indicated that pCEA level is a statistically significant independent prognostic factor for the survival of patients with gastric cancer, and is an important factor for predicting peritoneal recurrence. CONCLUSIONS: pCEA could be a potential predictor of a poor prognosis as well as peritoneal recurrence in patients with gastric cancer. We believe that this information could contribute to determining the optimal intraoperative and postoperative therapeutic plan including adjuvant chemotherapy of gastric cancer.     

Preoperative staging and early postoperative complications in radical prostatectomy. Experiences in 35 cases

It is already a textbook item that in patients with prostatic cancer stage T₁−T₂ N0M0 radical prostatectomy is the only curative treatment. Radical prostatectomy is indicated also for patients in stage T₃ N0M0 who underwent antiandrogenic (Fugerel) treatement for 3 months with the aim of reducing tumour volume. In the following 35 cases will be scrutinized, with special regard to preoperative staging and early postoperative complications.     

Prognostic significance of carcinoembryonic antigen in colorectal carcinoma. Serum levels before and after resection and before recurrence

The use of carcinoembryonic antigen was evaluated in 425 patients with a mean follow-up of 48 months. The preoperative and postoperative carcinoembryonic antigen levels were predictive of recurrence and survival independent of the tumor stage. In a multivariate regression analysis of age, location, tumor stage, and preoperative and postoperative carcinoembryonic antigen levels, the latter three factors were significant prognostic variables with respect to the adjusted survival. Recurrent disease was found in 42% of patients, excluding patients with stage IV disease. The carcinoembryonic antigen level at recurrence was greater than 5 ng/mL in 79% of the patients and in 89% of the intra-abdominal recurrences. Carcinoembryonic antigen level at recurrence was not predictive of postrecurrence survival except in the subgroup of locoregional disease. The life span in patients with liver and lung metastases was not influenced by carcinoembryonic antigen level at recurrence. Preoperative and postoperative carcinoembryonic antigen levels can indicate a poorer prognostic group of patients with colorectal cancer who may benefit from adjuvant treatment. The carcinoembryonic antigen at recurrence can be used effectively to diagnose intra-abdominal recurrences and project survival after development of local/regional disease.     

螺旋CT扫描在肾癌术前分期中的应用价值

目的探讨螺旋CT检查在肾癌术前临床分期中的应用价值。方法回顾性分析经手术病理证实的93例肾癌患者资料。男63例，女30例。年龄15～78岁，平均55岁。术前均采用螺旋CT平扫加多期增强扫描。将CT分期与病理分期结果进行比较分析。结果93例患者CT分期Ⅰ期55例、Ⅱ期17例、Ⅲ期6例、Ⅳ期15例；手术病理分期Ⅰ期44例、Ⅱ期28例、Ⅲ期8例、Ⅳ期13例。线性趋势检验结果提示2种分期方法密切相关（P〈0．01），Pearson积矩相关系数rp=0．91，呈正相关关系，但这种关联不是简单的直线关系。螺旋CT对肾癌术前分期的敏感性、特异性和准确性分别为77．4％、92．5％和88．7％。结论螺旋CT能很好地显示肾癌的影像学特征，并进行准确的临床分期，应列为肾癌术前的常规检查项目。