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J Thorac Cardiovasc Surg 2003;125:1565
© 2003 The American Association for Thoracic Surgery

Letters to the Editor

Problems in assessment of serum carcinoembryonic antigen levels in cancers

Division of Surgery, Toneyama National Hospital, Osaka, Japan

To the Editor:

In a recent issue, Saito and colleagues ¹ reported on a multicenter retrospective review of surgery for pulmonary metastasis from colorectal cancer. They concluded that the status of the hilar or mediastinal lymph nodes and prethoracotomy carcinoembryonic antigen (CEA) level were significant independent prognostic factors. I believe these findings are useful in the follow-up of patients who have undergone resection of pulmonary metastasis of colorectal cancer. Prethoracotomy serum CEA levels are also a prognostic indicator in non-small cell lung cancer when the cutoff level is defined as 6. 9 ng/dL on the basis of the 95% specificity level for benign lung disease. ²

There are many kits to measure serum CEA levels. The antibodies used by the various methods vary. Thus there are some cross-reactive normal antigens that are calculated by some kits, and the maximum normal serum level of CEA ranges from 2.5 ng/dL to 6.9 ng/dL. ³ In the study that Saito and colleagues ¹ conducted, 10.0 ng/dL was used as a cutoff level that influenced the prognosis. This level is from 1.4 times to 4 times the upper limit of normal for serum CEA level.

In a multicenter study, the variable for serum CEA level should be considered normal or high according to a cutoff level established by each individual institution. Otherwise, the specification of a single type of kit to measure serum CEA levels is needed when a specific serum CEA level is defined as the cutoff level. Either method, I believe, will make serum CEA levels a more significant prognostic indicator for patients with lung cancer or patients with pulmonary metastases from colorectal cancer.

References

1. Saito Y, Omiya H, Kohno K, Kobayashi T, Itoi K, Teramachi M, et al. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J Thorac Cardiovasc Surg. 2002;124:1007-13.[Abstract/Free Full Text]
   
2. Sawabata N, Ohta M, Takeda S, Hirano H, Okumura Y, Asada H, et al. Serum carcinoembryonic antigen level in surgically resected clinical stage I patients with non-small cell lung cancer. Ann Thorac Surg. 2002;74:174-9.[Abstract/Free Full Text]
   
3. Kuroki M, Haruno M, Arakawa F, Wakisaka M, Matsuoka Y. Reaction profiles of seven enzyme immunoassay kits for carcinoembryonic antigen (CEA) analysed with purified preparations of CEA and related normal antigens. Clin Biochem. 1992;25:29-35.[Medline]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Noriyoshi Sawabata Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sawabata, N. Search for Related Content PubMed PubMed Citation Articles by Sawabata, N.