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首页> 外文期刊>Annals of oncology: official journal of the European Society for Medical Oncology >CEA and CA 19-9 measurement as a monitoring parameter in metastatic colorectal cancer (CRC) under palliative first-line chemotherapy with weekly 24-hour infusion of high-dose 5-fluorouracil (5-FU) and folinic acid (FA).
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CEA and CA 19-9 measurement as a monitoring parameter in metastatic colorectal cancer (CRC) under palliative first-line chemotherapy with weekly 24-hour infusion of high-dose 5-fluorouracil (5-FU) and folinic acid (FA).

机译：在姑息性一线化疗下每周24小时输注大剂量5-氟尿嘧啶（5-FU）和亚叶酸（FA），以CEA和CA 19-9测量作为转移性结直肠癌（CRC）的监测参数。

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BACKGROUND: There have been contradictory reports on the benefit of CEA and CA 19-9 measurements in patients with metastatic colorectal cancer using palliative chemotherapy. The object of this study was to examine the diagnostic accuracy of monitoring of palliative chemotherapy by means of CEA and CA 19-9. PATIENTS AND METHODS: The tumour markers CEA and CA 19-9 were subjected to serial measurement in patients with metastatic colorectal cancer (n = 90) using palliative first-line chemotherapy with weekly 24-hour infusion of high-dose 5-FU with FA and were compared with objective response according to WHO criteria. 85 patients could be evaluated. 43 patients (51%) initially had elevated CEA (> or = 10 ng/ml) and 33 patients (39%) elevated CA19-9 (> or = 50 IE/ml). In 24 patients (28%), both markers were initially increased. With CEA positive patients, 143 cycles of chemotherapy were carried out, which showed the following response in the various cycles: 21 episodes with progressions (ePD), 69 episodes with no change (eNC), 53 episodes with partial/complete remission (ePR/eCR). With CA 19-9 positive patients, 100 cycles of chemotherapy were carried out with the following results: 21 episodes with progressions (ePD), 48 episodes with eNC, and 31 episodes with ePR/eCR. RESULTS: A CEA rise by at least 50% differentiated between ePD versus eNC/ePR/eCR with a sensitivity of 76% and specificity of 90%. With CEA decreases of at least 30% in 99% of these patient episodes (78 of 79), a tumour progression could be excluded. Patients with an initial drop in CEA after the first cycle of chemotherapy of at least 50% of the initial level had a significantly higher probability of achieving an ePR/eCR in further therapy (relative risk 2.9; P = 0.002). With an CA 19-9 increase of at least 30%, a sensitivity progression of 62% and a specifity of 90% could be calculated. A CA 19-9 decrease of at least 60% excludes a progression in 95% of the patient episodes. CONCLUSIONS: A CEA or CA 19-9 rise is only conditionally appropriate for recording progressions. A progression however, can be excluded with falling levels with high diagnostic accuracy, in which CEA offers a greater degree of certainty than CA 19-9. With a drop in CEA 79 of 143 (= 55%) of the CT scans could be saved, in which case 78 of 79 patient episodes (99%) were correctly assessed as 'no progression'. In patients with an increased CEA and CA 19-9 the CEA determination is sufficient for the further monitoring. A confirmation of these results by multicenter trials can result in a considerable decrease of monitoring costs for palliative treatment.
机译：背景：关于使用姑息性化疗治疗转移性结直肠癌患者使用CEA和CA 19-9的益处的报道相互矛盾。这项研究的目的是检查通过CEA和CA 19-9监测姑息化疗的诊断准确性。病人和方法：采用姑息性一线化疗，每周24小时大剂量5-FU输注FA，对转移性结直肠癌（n = 90）患者的肿瘤标志物CEA和CA 19-9进行系列检测。并根据WHO标准与客观反应进行比较。可以评估85位患者。最初有43例（51％）CEA升高（>或= 10 ng / ml）和33例（39％）CA19-9升高（>或= 50 IE / ml）。在24例患者（占28％）中，两种标志物最初均升高。对于CEA阳性患者，进行了143个化疗周期，在各个周期中显示出以下反应：进展21次（ePD），69次无变化（eNC），53次部分/完全缓解（ePR / eCR）。对于CA 19-9阳性的患者，进行了100个化疗周期，结果如下：进展21例（ePD），eNC 48例和ePR / eCR 31例。结果：ePD与eNC / ePR / eCR之间的CEA升高至少提高了50％，灵敏度为76％，特异性为90％。在这些患者中有99％发生CEA降低至少30％（79个中的78个），可以排除肿瘤的进展。在化疗的第一周期后，CEA初始下降至少为初始水平的50％的患者，在进一步治疗中实现ePR / eCR的可能性显着更高（相对风险2.9; P = 0.002）。随着CA 19-9至少增加30％，可以计算出62％的灵敏度进展和90％的特异性。 CA 19-9下降至少60％排除了95％的患者发作的进展。结论：CEA或CA 19-9升高仅在条件上适合记录进展。但是，可以用诊断准确性高的下降水平排除进展，其中CEA比CA 19-9更具确定性。随着CEA的减少，可以节省143例CT扫描（= 55％），在这种情况下，可以正确评估79例患者发作中的78例（99％）为“无进展”。对于CEA和CA 19-9升高的患者，CEA测定足以进行进一步的监测。通过多中心试验对这些结果的确认可以大大降低姑息治疗的监测成本。

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