Prospective evaluation of CEA and CA 19-9 for monitoring patients with colorectal cancer

高雄長庚紀念臀院，自民國76年7月至76年12月，共有102例大腸直腸癌病人接受手術治療。其中80例有術前CEA及CA19-9檢查資料。剔除20例Dukes' D，共有60例接受術後之追蹤檢查，每例追蹤時間，至少18個月。 結果發現，對於大腸直腸癌術後癌復發或轉移之診斷敏感度(Sensitivity)，特異性(Specificity)及kappn值：CEA>5 ng/ml各為70%，90%，及0.55：CA 19-9>40 U/ml各為60%，88%，及0.44；連續兩次CEA>5 ng/ml各為70%，98%及0.74；及CEA + CA 19-9，各為60%，92%及0.52。 我們結論是合併檢查CEA及CA19-9，或是單獨檢查CA19-9，對於大腸直腸癌術後復發或轉移的診斷不優於單獨CEA檢查。在還沒有發展出較好的腫瘤標記之前，CEA>5 ng/ml (尤其是CEA連續2次 >5 ng/ml)仍是比較好的一種檢查。
Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9), both determined by immunoradiometric assays utilizing monoclonal antibodies, were evaluated in the sera of 80 patients with colorectl cancer in order to assess and compare their diagnostic value in the diagnosis of colorectal cancer, and to detect recurrent disease. Sensitivity in the diagnosis of colorectal cancer was 29% for CA 19-9, 48% for CEA, and 50% for CEA or CA 19-9, respectively. Sensitivity, specificity, and kappa in detecting recurrent disease were 70%, 90%, and 0.55 for CEA; and 60%, 88%, and 0.44 for CA 19-9 respectively. Combined evaluation gave an estimated kappa of only 0.5. CA 19-9 determination seems to be unsatisfactory in detecting recurrent colorectal cancer, and combined assessment does not improve the results of CEA alone. A decision rule based on consecutive CEA values exceeding 5.0 ng/ml had an estimated kappa of 0.74. This criteria may be useful in monitoring patients with colorectal cancer.