Project details

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Evaluation of CEA combined with routinely CT-scans on oncological outcomes in colorectal cancer patients.

Keywords:
colorectal cancer, CEA value, CT-scan, follow up

Researchers:
Prof. dr. G.A.P. Hospers
dr. K. Havenga
Dr. B. van Etten
E.A. Dijkstra

Nature of the research:
Retrospective, single-center descriptive

Fields of study:
surgery oncology

Background / introduction
One of the purposes of follow-up after curative treatment of colorectal cancer is early detection of recurrent disease in the hope of improving prognosis. Carcinoembryonic Antigen (CEA) determination is performed, just as the national guidelines, 4 times a year in the first 3 years of follow-up, thereafter twice a year until 5 years of follow up. In our center, however, the CEA determination is routinely combined with CT-scans of thorax and abdomen 1, 2, 3 and 5 years of follow-up (and an extra CT-scan after 7 years of follow-up in case of locally advanced colorectal cancer). Only when a CT-scan is contraindicated, an ultrasound of the liver is made. In addition a CT-scan is made when CEA is clearly elevated. In the Dutch guideline, ultrasound of the liver will be made half yearly in the first year, thereafter yearly until 5 years follow-up.
It has long been known that CEA is important in signaling recurrent disease in colorectal cancer1. About half of the recurrences are found by an increased CEA2. The other half must be discovered by imaging, therefore, in our center, we use CT-scans. The CEAwatch trial demonstrated that more frequent CEA determination results in earlier recurrent disease detection. In addition, a significantly higher proportion can be treated with a curative intent3. However, there is no direct survival benefit by this intensified CEA determination2, 4. If there is a survival benefit by using CT-scans of thorax and abdomen instead of ultrasound of the liver is unknown. It also is unknown what the value of CEA determination combined with routinely CT-scans is on oncological outcomes. In addition, there is no clear cut-off value of CEA.
Research question / problem definition
What is the value of CEA combined with routinely CT-scans of thorax and abdomen on oncological outcomes in colorectal cancer patients and can we predict recurrent disease on basis of the CEA value?
References
1. Staab HJ, Anderer FA, Stumpf E, Fischer R. Slope analysis of the postoperative CEA time course and its possible application as an aid in diagnosis of disease progression in gastraointestinal cancer. Am J Surg. 1978;136(3):322-7.
2. Verberne CJ, Zhan Z, van den Heuvel ER, Oppers F, de Jong AM, Grossmann I, et al. Survival analysis of the CEAwatch multicentre clustered randomized trial. Br J Surg. 2017;104(8):1069-77.
3. Verberne CJ, Zhan Z, van den Heuvel ER, Grossmann I, Doornbos PM, Havenga K, et al. Intensified follow-up in colorectal cancer patients using frequent Carcino-Embryonic Antigen (CEA) measurements and CEA-triggered imaging: Results of the randomized “CEAwatch” trial. Eur J Surg Oncol. 2015;41(9):1188-96.
4. Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2019. Doi: 10.1002/14651858.CD002200.pub4.
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