The role of high frequency dynamic threshold (HiDT) serum carcinoembryonic antigen (CEA) measurements in colorectal cancer surveillance

A (revisited) hypothesis paper

Review (2011)

Authors

I. Grossmann University Medical Center Groningen, Catharina Hospital
C. J. Verberne University Medical Center Groningen
G. H. de Bock University Medical Center Groningen
K. Havenga University Medical Center Groningen
Ido Kema University Medical Center Groningen
J. Klaase Medisch Spectrum Twente
Andrew Renehan The University of Manchester
T. Wiggers University Medical Center Groningen
Affiliation
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Published Date

2011

Language

English

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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.