More Recurrences Treated in Monitored Colorectal Cancer Patients

After curative colorectal cancer surgery, patients benefit from regular monitoring for recurrence with CEA test or computed tomography

medwireNews: Monitoring colorectal cancer patients using carcinoembryonic Antigen (CEA) blood testing or computed tomography (CT) significantly increases the likelihood of being able to treat recurrent disease with curable intent compared with minimal follow-up, study findings show.

However, the research, published in JAMA, found that combining the two techniques did not significantly improve the chance of detecting treatable recurrent disease beyond the use of either protocol alone.

“If there is a survival advantage to any strategy, it is likely to be small,” say John Primrose (Southampton General Hospital, UK) and co-authors.

Of the 1202 patients who underwent curative surgery for primary colorectal cancer, 16.6% were diagnosed with recurrent disease over an average 4.4 years of follow-up, and 5.9% had recurrence that could be treated with curative intent.

Overall, just 2.3% of 301 patients who received minimum follow-up after initial surgery – defined as investigation only with new symptoms – underwent surgical treatment with curative intent for recurrent disease.

By comparison, 6.7% of 300 patients who underwent regular CEA blood tests had surgery with curative intent for recurrent disease, as did 8.0% of the 299 patients who underwent regular CT screening, and 6.6% of the 302 patients who received CEA and CT.

Thus, compared with patients given minimal follow-up, surgery of curative intent for recurrent colorectal cancer was 3.00 times more common in those given CEA only, 3.63 times more common in those given CT only, and 3.10 times more common in those given CEA plus CT follow-up.

Analysis also suggested a trend towards earlier detection of recurrence with monitoring over minimal follow-up, although this was not statistically significant.

John Primrose and co-authors report that the absolute difference in the proportion of patients treated with curative intent for recurrent disease who did and did not receive either CEA or CT screening was 5% in the intention-to-treat analysis and 8% in the per protocol analysis.

This suggests that between 12 and 20 patients would have to be followed up with CEA or CT to identify one potentially curable recurrence, they explain.

The researchers also note that they found a lower absolute number of treatable recurrences than did previous studies, but a higher proportion of recurrences that were treatable with curative intent.

Attributing this to careful investigation to rule out residual cancer on entry to the trial, John Primrose et al comment that a “key finding of this study is therefore the need to fully stage colorectal cancer before embarking on follow-up”.


Primrose JN, Perera R, Gray A, et al. Effect of 3 to 5 Years of Scheduled CEA and CT Follow-up to Detect Recurrence of Colorectal Cancer: The FACS Randomized Clinical Trial. JAMA. 2014; 311: 263–270.  doi:10.1001/jama.2013.285718.

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