Cancers 2011, 3(2), 2302-2315; doi:10.3390/cancers3022302
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The Role of High Frequency Dynamic Threshold (HiDT) Serum Carcinoembryonic Antigen (CEA) Measurements in Colorectal Cancer Surveillance: A (Revisited) Hypothesis Paper

1 Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands 2 Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands 3 Department Epidemiology and Biostatistics, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands 4 Department of Clinical Chemistry, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands 5 Department of Surgery, Medical Spectrum Twente, Haaksbergertsraat 55, 7513 ER Enschede, the Netherlands 6 The Christie NHS Foundation Trust, School of Cancer, Enabling Sciences and Technology, University of Manchester, Wilmslow Road, Manchester M20 4BX, UK
* Author to whom correspondence should be addressed.
Received: 25 January 2011; in revised form: 22 April 2011 / Accepted: 4 May 2011 / Published: 11 May 2011
(This article belongs to the Special Issue Prognostic and Predictive Factors in Colorectal Cancer)
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Abstract: Following curative treatment for colorectal cancer (CRC), 30% to 50% of patients will develop recurrent disease. For CRC there are several lines of evidence supporting the hypothesis that early detection of metachronous disease offers a second opportunity for cure. This paper revisits the potential role of serum carcinoembryonic antigen (CEA) in follow-up. A comprehensive review of the literature (1978–2008) demonstrates that the initial promise of serum CEA as an effective surveillance tool has been tarnished through perpetuation of poorly designed studies. Specific limitations included: testing CEA as only an ‘add-on’ diagnostic tool; lack of standardization of threshold values; use of static thresholds; too low measurement frequency. Major changes in localizing imaging techniques and treatment of metastatic CRC further cause a decrease of clinical applicability of past trial outcomes. In 1982, Staab hypothesized that the optimal benefit of serum CEA as a surveillance tool is through high-frequency triage using a dynamic threshold (HiDT). Evidence supporting this hypothesis was found in the biochemical characteristics of serum CEA and retrospective studies showing the superior predictive value of a dynamic threshold. A multi-centred randomized phase III study optimizing the usage of HiDT against resectability of recurrent disease is commencing recruitment in the Netherlands.
Keywords: carcinoembryonic antigen; colorectal cancer; follow-up; recurrent disease; metastases

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MDPI and ACS Style

Grossmann, I.; Verberne, C.; De Bock, G.; Havenga, K.; Kema, I.; Klaase, J.; Renehan, A.; Wiggers, T. The Role of High Frequency Dynamic Threshold (HiDT) Serum Carcinoembryonic Antigen (CEA) Measurements in Colorectal Cancer Surveillance: A (Revisited) Hypothesis Paper. Cancers 2011, 3, 2302-2315.

AMA Style

Grossmann I, Verberne C, De Bock G, Havenga K, Kema I, Klaase J, Renehan A, Wiggers T. The Role of High Frequency Dynamic Threshold (HiDT) Serum Carcinoembryonic Antigen (CEA) Measurements in Colorectal Cancer Surveillance: A (Revisited) Hypothesis Paper. Cancers. 2011; 3(2):2302-2315.

Chicago/Turabian Style

Grossmann, Irene; Verberne, Charlotte; De Bock, Geertruida; Havenga, Klaas; Kema, Ido; Klaase, Joost; Renehan, Andrew; Wiggers, Theo. 2011. "The Role of High Frequency Dynamic Threshold (HiDT) Serum Carcinoembryonic Antigen (CEA) Measurements in Colorectal Cancer Surveillance: A (Revisited) Hypothesis Paper." Cancers 3, no. 2: 2302-2315.

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