Prognostic use of preoperative and immediate postoperative carcinoembryonic antigen determinations in colonic cancer

Preoperative and postoperative carcinoembryonic antigen (CEA) concentrations are useful in predicting the likelihood of recurrence in patients undergoing curative operations for cancer of the colon. The incidence of recurrence was studied in three groups of patients followed for 6 to 18 months after such an operation: 36 patients (group 1) had preoperative and postoperative plasma CEA concentrations less than 2.5 ng/ml; 11 patients (group 2) had a preoperative CEA value above but a postoperative value below 2.5 ng/ml; and 11 patients (group 3) had preoperative and postoperative concentrations greater than 2.5 ng/ml. Cumulative rates of recurrence at 6, 12 and 18 months after operation were as follows: 0, 3 and 17% in group 1; 0, 9 and 21% in group 2; and 27, 79 and 79% in group 3. Statistically there was no difference in the recurrence rate between groups 1 and 2, but the rate was significantly lower in group 2 compared with group 3. The data show that patients in whom the immediate postoperative CEA concentration returns to normal have a much lower incidence of recurrent cancer of the colon than patients whose CEA concentration remains elevated.