Rendimiento del antígeno carcinoembrionario como prueba diagnóstica del cancer colorrectal

Daniel González González; Gabriela  Wagner; Luis Ruso Martínez

doi:10.29193/RMU.37.2.1

Authors

Daniel González González Universidad de la República, Facultad de Medicina, Hospital Maciel, Clínica Quirúrgica 3, Profesor titular. Cooperativa Médica de Florida, Servicio de Cirugía, Jefe
Gabriela Wagner Universidad de la República, Facultad de Medicina, Hospital Maciel, Clínica Quirúrgica 3, Asistente
Luis Ruso Martínez Universidad de la República, Facultad de Medicina, Hospital Maciel, Clínica Quirúrgica 3, Profesor titular

DOI:

https://doi.org/10.29193/RMU.37.2.1

Keywords:

CARCINOEMBRYONIC ANTIGEN, COLORECTAL NEOPLASMS, DIAGNOSIS, SCREENING

Abstract

Introduction: carcinoembryonic antigen (CEA) is a tumor marker used for follow up rather than a screening and diagnostic test for colorectal cancer (CCR). However, it continues to be requested in the regular clinical practice for initial diagnosis.
Objective: to evaluate the effectiveness of CEA to diagnose colorectal cancer at Maciel Hospital and Cooperativa Medica de Florida Hospital from 2000 to 2019.
Method: prospective study to evaluate CEA as a diagnostic test for colorectal cancer. The following inclusion criteria were used: 1) total videocolonoscopy in all users without CLC and total or partial videocolonoscopy for those with CRC and histologic confirmation of adenocarcinoma; 2) CEA determination within 30 days before or after videocolonoscopy and 3) for the purpose of staging, pathology report of the surgical piece and histological confirmation of distant metastases. The number of cases included was defined by a 10-case minimum in each cell of the contingency table.
Results: 211 cases were analysed. The general analysis revealed 33.6% sensitivity, 70.4% specificity, VPP 69.1%, VPN 35%, accuracy 45.9%. In the case of staging II, sensitivity was 18.8%, specificity 70.4%, VPP 30%, VPN 56.2%, accuracy 49.5%. In the case of staging III, sensitivity 31.6%, specificity 70.4%, VPP 36.4%, VPN 65.8%, accuracy 56.8%. In the case of staging IV, sensitivity 65%, specificity 70.4%, VPP 55.3%, VPN 78.1%, accuracy 68.4%.
Conclusions: CEA evidences low effectiveness to diagnose colorectal cancer, and it is still less effective in early stages of the disease.

References

1) Comisión Honoraria de Lucha Contra el Cáncer. Registro Nacional de Cáncer. Situación epidemiológica del Uruguay en relación al cáncer. Incidencia del cáncer en el quinquenio 2011-2015. Tendencia de la mortalidad por cáncer hasta 2017. Montevideo: CHLC, 2019. 61p. Disponible en: http://www.comisioncancer.org.uy [Consulta:5 febrero 2020].
2) Antígeno carcinoembrionario. En: Ministerio de Salud Pública. Dirección General de la Salud. Programa Nacional de Prevención del Cáncer. Muse IM, Masetti D, Sosa Basaistegui MA, Suarez Hinojosa L, Terradas ML, eds. Manual de oncología para el primer nivel de atención. Montevideo: Del Este Sol, 2008. 88p.
3) ASCO; Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol 2006; 24(33):5313-27.
4) Sturgeon CM, Dubby MJ, Stenman UH, Lilja H, Brunner N, Chan DW et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use os tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem 2008; 54(12):e11-79.
5) González González D, Ruso Martínez L. Criterio de solicitud del antígeno carcinoembrionario (CEA) en el Hospital de Florida (julio 2012-julio 2013). Rev Méd Urug 2016; 32(2):98-103.
6) Sánchez Pedraza R, Echeverry Raad J. Aspectos sobre diseño y tamaño de muestra en estudios de pruebas diagnósticas. Rev Fac Med UN Col 2001; 49(3):175-80.
7) Kim NH, Lee MY, Park JH, Park DI, Sohn CI, Choi K, et al. Serum CEA and CA 19-9 levels are associated with de presence and severity of colorectal neoplasia. Yonsei Med J 2017; 58(5):918-24.
8) Zhang SY, Lin M, Zhang HB. Diagnostic value of carcinoembryonic antigen and carcinoma antigen 19-9 for colorectal carcinoma. Int J Clin Exp Pathol 2015; 8(8):9404-9.
9) Nikolouzakis TK, Vassilopoulou L, Fragkiadaki P, Sapsakos TM, Papadakis GZ, Spandidos DA, et al. Improving diagnosis, prognosis and prediction by using biomarkers in CRC patientes (Review). Oncol Rep 2018; 39:2455-72.
10) Tan E, Gouvas N, Nicholls RJ, Ziprin P, Xynos E, Tekkis PP. Diagnostic precision of carcinoembryionic antigen in the detection of recurrence of colorectal cancer. Surg Oncol 2009; 18:15-24.
11) Duffy MJ, Lamerz R, Haglund C, Nicolini A, Kalousová M, Holubec L, et al. Tumor markers in colorectal cancer, gastric cancer and gastrointestinal stromal cancers: European group on tumor markers 2014 guideline update. Int J Cancer 2014; 134: 2513-22.
12) Lech G, Slotwinsky R, Slodkowki M, Krasnodębski IW. Colorectal cancer tumor markrers and biomarers: recent therapeutic advences. World J Surg 2016; 22(5):1745-55.
13) Carbajal Garcés CF, Morales Clavijo M. Sensibilidad y especificidad de los marcadores tumorales. Rev Méd (Cochabamba) 2010; 21(1):86-97.
14) López J, Hornig A, Molt F, Mariángel P, Avendaño R. Antígeno carcinoembrionario preparatorio y riesgo de metástasis en el cáncer colorectal. Cuad Cir 2005; 19:22-6.
15) Duffy MJ. Carcinoembryonic antigen as a marker for colorectal cancer: is it clinically useful? Clin Chem 2001; 47(4):624-30.
16) Sørbye H, Dahl O. Carcinoembryonic antigen surge in metastatic colorectal cancer patients responding to oxaliplatin combination chemotherapy: implications for tumor marker monitoring and guidelines. J Clin Oncol 2003; 21(23): 4466-7.
17) Davis T, Arnold C, Rademaker A, Bennett C, Bailey S, Platt D, et al. Improving colon cancer screening in community clinics. Cancer 2013; 119(21):3879-86.
18) Téllez-Avila FI, García-Osogobio SM. El antígeno carcinoembrionario: a propósito de un viejo conocido. Rev Invest Clin 2005; 57(6):814-9.
19) Walsh JM, Terdiman JP. Colorectal cancer screening: scientific review. JAMA 2003; 289(10):1288-96.
20) Leddin D, Hunt R, Champion M, Cockeram A, Flook N, Gould M et al. Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation: guidelines on colon cancer screening. Can J Gastroenterol 2004; 18(2):93-9.
21) Iade B, Tchekmedyian A, Bianchi C, San Martín J, Raggio A, Rocha M, et al. Recomendaciones de la Sociedad de Gastroenterología del Uruguay para la detección precoz y el seguimiento del cáncer colorrectal. Rev Méd Uruguay 2003; 19(2):172-7.
22) Bast RC Jr, Ravdin P, Hayes DF, Bates S, Fritsche H Jr, Jessup JM, et al. 2000 update of recommendations for the use of tumor markers in breast and colorectal cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001; 19(6):1865-78.
23) Ruiz de Adana Pérez R. Eficacia de una prueba diagnóstica: parámetros utilizados en el estudio de un test. JANO 2009; (1736):30.
24) Fletcher RH. Carcinoembryonic antigen. Ann Intern Med 1986; 104:66-73.
25) Wilson AP, Van Dalen A, Sibley PE, Kasper LA, Durham AP, El Shami AS. Multicentre tumour marker reference range study. Anticancer Res 1999; 19(4A):2749-52.