VALUE OF SERIAL CARCINOEMBRYONIC ANTIGEN LEVELS IN PATIENTS WITH RESECTABLE ADENOCARCINOMA OF THE ESOPHAGUS AND STOMACH

Background. Adenocarcinomas of the esophagus and the stomach are highl y virulent and remain a major health problem worldwide; 5-year surviva l rates have not changed in the past 30 years. Recently, preoperative chemotherapy has been used to treat these adenocarcinomas. The authors evaluated the usefulness of serial serum carcinoembryonic antigen (CE A) levels in diagnosing these patients and compared the prognosis of p atients with high or normal CEA levels. Methods. Ninety consecutive pa tients with potentially resectable adenocarcinoma of the esophagus or stomach treated with preoperative chemotherapy were evaluated, Serum C EA levels were determined before registration, after each chemotherapy course, every 3 months for the first year after completion of all the rapy, and every 6 months thereafter for 5 years. Results. The CEA posi tivity rate before chemotherapy was 22.2% (20/90); after chemotherapy, it dropped to 10.9% (9/82). An increasing CEA level predicted relapse and correlated well with liver, lung, or pleural involvement in some patients. Most patients with peritoneal involvement did not show eleva ted levels of CEA. Clinical responses correlated with declining levels of CEA in the patients who showed a negative conversion in CEA level after chemotherapy. Conclusions. An elevated serum CEA level enabled e arly detection of relapse in the absence of clinical symptoms in patie nts with adenocarcinoma of the esophagus or the stomach. The level of CEA was also useful in monitoring the response to chemotherapy in pati ents who had a high CEA level before treatment. Although the pre- and postchemotherapy CEA-positive group had a higher relapse rate than tha t of other group, the CEA level did not predict resectability or survi val. Future research with labeled monoclonal anti-CEA antibodies may p rove useful for certain groups of patients.