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Invited Commentary
March 2018

Carcinoembryonic Antigen—Still More to Learn From the Real World

Author Affiliations
  • 1Flatiron Health, New York, New York
  • 2Harvard Medical School (Leave of Absence 2017-2018), Boston, Massachusetts
  • 3Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
JAMA Oncol. 2018;4(3):315-316. doi:10.1001/jamaoncol.2017.4408

Carcinoembryonic antigen (CEA) is a group of oncofetal glycoprotein antigens involved in cell adhesion that was first described in 1965. Measurement of CEA has long been recommended as a blood-based prognostic indicator in colorectal cancer and as a surveillance tool for early detection of potentially curable recurrence after primary resection.1,2 Multiple studies have demonstrated that elevated preoperative CEA is associated with worse survival in patients with early-stage disease (stages I-III) independent of tumor stage. For this reason, the American Joint Committee on Cancer has proposed adding preoperative CEA level (C-stage) to TNM staging.3 In addition, lack of CEA normalization after resection is associated with residual occult disease. It is often assumed that the value of CEA in surveillance is restricted to patients who have elevated serum levels at baseline, thus supporting preoperative assessment.

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