The role of high frequency dynamic threshold (HiDT) serum carcinoembryonic antigen (CEA) measurements in colorectal cancer surveillance: A (revisited) hypothesis paper

Irene Grossmann, Charlotte Verberne, Geertruida de Bock, Klaas Havenga, Ido Kema, Joost Klaase, Andrew Renehan, Theo Wiggers

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Following curative treatment for colorectal cancer (CRC), 30% to 50% of patients will develop recurrent disease. For CRC there are several lines of evidence supporting the hypothesis that early detection of meta chronous disease offers a second opportunity for cure. This paper revisits the potential role of serum carcinoem bryonic antigen (CEA) in follow-up. A comprehensive review of the literature (1978-2008) demonstrates that the initial promise of serum CEA as an effective surveillance tool has been tarnished through perpetuation of poorly designed studies. Specific limitations included: testing CEA as only an 'add-on' diagnostic tool; lack of standardization of threshold values; use of static thresholds; too low measurement frequency. Major changes in localizing imaging techniques and treatment of metastatic CRC further cause a decrease of clinical applicability of past trial outcomes. In 1982, Staab hypothesized that the optimal benefit of serum CEA as a surveillance tool is through high-frequency triage using a dynamic threshold (HiDT). Evidence supporting this hypothesis was found in the biochemical characteristics of serum CEA and retrospective studies showing the superior predictive value of a dynamic threshold. A multi-centred randomized phase III study optimizing the usage of HiDT against resectability of recurrent disease is commencing recruitment in the Netherlands. © 2011 by the authors; licensee MDPI, Basel, Switzerland.
    Original languageEnglish
    Pages (from-to)2302-2315
    Number of pages13
    JournalCancers
    Volume3
    Issue number2
    DOIs
    Publication statusPublished - Jun 2011

    Keywords

    • Carcinoembryonic antigen
    • Colorectal cancer
    • Follow-up
    • Metastases
    • Recurrent disease

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