To the Editor.
—Moertel and colleagues1 are unable to see the trees for the forest. The incremental overall survival benefit in patients with elevated CEA levels in their cohort of patients is slightly less than 1%. However, a larger group of patients actually benefited in that they underwent potentially curative reoperation, particularly hepatic resection.Probable outcomes in the operative treatment of hepatic metastases from colorectal cancer should be related to patient subsets. There are approximately 150 000 new colorectal cancer patients per year, patients with early cancers and synchronous metastases are excluded, and so there are about 100 000 patients to be followed up. One half of these cancers will recur (50 000); one third of these will have only liver disease (17 000)2; one third of these will have resectable hepatic metastases (5500)3; and one third of these will be cured (1850).4,5 Hence, the incremental
Cohen AM, Paty P. CEA for Monitoring Colon Cancer. JAMA. 1994;271(5):346. doi:10.1001/jama.1994.03510290027024