4.6 Article

No benefit of more intense follow-up after surgery for colorectal cancer in the risk group with elevated CEA levels - An analysis within the COLOFOL randomized clinical trial

期刊

EJSO
卷 47, 期 8, 页码 2053-2059

出版社

ELSEVIER SCI LTD
DOI: 10.1016/j.ejso.2021.03.235

关键词

Carcinoembryonic antigen; Clinical trial; Colorectal cancer; Follow-up; Post-hoc analysis

资金

  1. Nordic Cancer Union (Finland)
  2. A. P. Moller Foundation (Denmark)
  3. Beckett Foundation (Denmark)
  4. Grosserer Chr. Andersen and wife bursary (Denmark)
  5. Sigvald and Edith Rasmussens Memorial Fund (Denmark)
  6. Martha Margrethe and Christian Hermansens Fund (Denmark)
  7. Danish Medical Association (Denmark)
  8. Danish Cancer Society (Denmark)
  9. Danish Council for Independent Research/Medical Sciences (Denmark)
  10. Swedish Cancer Foundation (Sweden) [CAN 2013/553]

向作者/读者索取更多资源

The study found that elevated serum CEA levels before treatment or after surgery in colorectal cancer patients were associated with increased overall or colorectal cancer-specific mortality or recurrence risk. High-intensity follow-up did not show benefits over low-intensity follow-up for patients with elevated CEA levels.
Background: Patients with colorectal cancer were examined to determine (1) whether elevated carcinoembryonic antigen (CEA) levels, either before treatment or after surgery, was associated with an increased risk of overall or colorectal cancer-specific mortality or recurrence, and (2) whether high intensity follow-up would benefit those patients. Materials and methods: Post-hoc analysis based on 2509 patients that underwent surgery for colorectal cancer, stage II or III, in the COLOFOL randomized trial with 5-year follow-up. Serum CEA levels were ascertained before treatment and one month after surgery. Follow-up examinations included computed tomography of the thorax and abdomen and serum CEA sampling. Patients were randomized to examinations at either 6, 12, 18, 24, and 36 months (high-intensity group) or at 12 and 36 months after surgery (low-intensity group). Levels of CEA >5 mg/l were defined as elevated. Results: Elevated CEA levels before treatment were associated with increased risk of recurrence (hazard ratio [HR], 1.49; 95% confidence interval [CI]: 1.22-1.83), colorectal cancer-specific mortality (HR, 1.44; 95% CI: 1.08-1.91), and overall mortality (HR, 1.38; 95% CI: 1.07-1.78). Elevated CEA levels after surgery were associated with increased colorectal cancer-specific mortality (HR, 1.68; 95% CI: 1.08-2.61) and overall mortality (HR, 1.79; 95% CI: 1.22-2.63). The intensity of the follow-up regimen had no effect on 5-year outcomes in patients with elevated CEA levels. Conclusion: Both pre-treatment and post-surgery elevated serum CEA levels were associated with increased overall and cancer-specific mortality. Intensified follow-up showed no benefit over low-intensity follow-up in this high-risk group of patients with elevated CEA levels. (C) 2021 The Authors. Published by Elsevier Ltd.

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