The pattern of repeated CEA-measures is linear linked to the recurrence of colorectal cancer.
ID
Bron
Verkorte titel
Aandoening
Maligne colorectal tumor.
Ondersteuning
Onderzoeksproduct en/of interventie
Uitkomstmaten
Primaire uitkomstmaten
The aim of the study is to create a serum CEA-measurement based algorithm of CEA rising. If the algorithm proves higher sensitivity of detecting recurrence, and therefore higher curable treatment, it can result in an application which helps professionals in health care, mainly general practitioners, with decision making. One should think of decisions like closer monitoring of CEA measurements, additional imaging based on serum CEA measurements (“CEA-triggered imaging”) or referring to a specialist
Achtergrond van het onderzoek
Patients with colorectal cancer who underwent a curative resection are offered a follow up program of five years in the Netherlands to detect early recurrence. The follow up program consists of laboratory measurements, imaging and physical examination.
The serum Carcino-Embryogenic antigen (CEA) is known for detection of recurrence in colorectal cancer. Follow up schedules with CEA measurement have better survival compared without CEA measurements and is also cheap.
The Dutch national guideline ‘colorectal carcinoma 2014’ advises routine CEA measurements every three to six months in the first three years after resection and once annually in the following two years. If metastatic disease is detected and curative treatment was possible, the 5-year follow-up starts from that moment once again as mentioned above.
Furthermore, the guideline advises ultrasonography of the liver every six months for the first two years and once annually in the last three years after resection. An alternative for ultrasonography is abdominal computed tomography (CT) to detect recurrence, e.g. for patients with obesities because abdominal CT is known to have higher sensitivity compared to ultrasonography. For distant metastasis one might consider pulmonary imaging in patients with rectum cancer.
However, the sensitivity and specificity for detection of recurrence with CEA is not high, and there’s no consensus of an absolute value of CEA measurement for triggered imaging.
In current literature and the guideline, it is not specified which percentage of raise in CEA should be a trigger to perform additional imaging. The lower limit of an acceptable raise in CEA, in combination with physical examination, is unknown. The study of Verberne et a showed that an intensified protocol with CEA and assessment on CEA rise increases the curable recurrence rate, rather than the standard protocol with absolute values. The FACS study uses an absolute CEA cutt-off point of 7 μg/l compared to baseline instead of slope analyses. It showed better specificity but at the cost of sensitivity.
Doel van het onderzoek
The pattern of repeated CEA-measures is linear linked to the recurrence of colorectal cancer.
Onderzoeksopzet
Preoperative CEA measurement till the last follow up CEA measurement.
Onderzoeksproduct en/of interventie
None.
Publiek
Wetenschappelijk
Belangrijkste voorwaarden om deel te mogen nemen (Inclusiecriteria)
Patients older than eighteen years of age after resection of colorectal maligne tumor with at least one serum CEA measurement in follow up.
Belangrijkste redenen om niet deel te kunnen nemen (Exclusiecriteria)
None, only if data showed no evidence of cancer.
Opzet
Deelname
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In overige registers
| Register | ID |
|---|---|
| NTR-new | NL7882 |
| Ander register | Zuyderland Medical Centre Heerlen : METCZ20180119 |