No benefit of more intense follow-up after surgery for colorectal cancer in the risk group with elevated CEA levels – An analysis within the COLOFOL randomized clinical trial

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No benefit of more intense follow-up after surgery for colorectal cancer in the risk group with elevated CEA levels – An analysis within the COLOFOL randomized clinical trial. / Egenvall, Monika; Martling, Anna; Veres, Katalin; Horváth-Puhó, Erzsébet; Wille-Jørgensen, Peer; Høirup Petersen, Sune; Laurberg, Søren; Sørensen, Henrik Toft; Syk, Ingvar; Buchwald, Pamela (Medarbetare); The COLOFOL Study Group.

I: European Journal of Surgical Oncology, 2021.

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift

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Egenvall, Monika ; Martling, Anna ; Veres, Katalin ; Horváth-Puhó, Erzsébet ; Wille-Jørgensen, Peer ; Høirup Petersen, Sune ; Laurberg, Søren ; Sørensen, Henrik Toft ; Syk, Ingvar ; Buchwald, Pamela ; The COLOFOL Study Group. / No benefit of more intense follow-up after surgery for colorectal cancer in the risk group with elevated CEA levels – An analysis within the COLOFOL randomized clinical trial. I: European Journal of Surgical Oncology. 2021.

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TY - JOUR

T1 - No benefit of more intense follow-up after surgery for colorectal cancer in the risk group with elevated CEA levels – An analysis within the COLOFOL randomized clinical trial

AU - Egenvall, Monika

AU - Martling, Anna

AU - Veres, Katalin

AU - Horváth-Puhó, Erzsébet

AU - Wille-Jørgensen, Peer

AU - Høirup Petersen, Sune

AU - Laurberg, Søren

AU - Sørensen, Henrik Toft

AU - Syk, Ingvar

AU - The COLOFOL Study Group

A2 - Buchwald, Pamela

PY - 2021

Y1 - 2021

N2 - Background: Patients with colorectal cancer were examined to determine (1) whether elevated carcinoembryonic antigen (CEA) levels, either before treatment or after surgery, was associated with an increased risk of overall or colorectal cancer-specific mortality or recurrence, and (2) whether high intensity follow-up would benefit those patients. Materials and methods: Post-hoc analysis based on 2509 patients that underwent surgery for colorectal cancer, stage II or III, in the COLOFOL randomized trial with 5-year follow-up. Serum CEA levels were ascertained before treatment and one month after surgery. Follow-up examinations included computed tomography of the thorax and abdomen and serum CEA sampling. Patients were randomized to examinations at either 6, 12, 18, 24, and 36 months (high-intensity group) or at 12 and 36 months after surgery (low-intensity group). Levels of CEA >5 μg/l were defined as elevated. Results: Elevated CEA levels before treatment were associated with increased risk of recurrence (hazard ratio [HR], 1.49; 95% confidence interval [CI]: 1.22–1.83), colorectal cancer-specific mortality (HR, 1.44; 95% CI: 1.08–1.91), and overall mortality (HR, 1.38; 95% CI: 1.07–1.78). Elevated CEA levels after surgery were associated with increased colorectal cancer-specific mortality (HR, 1.68; 95% CI: 1.08–2.61) and overall mortality (HR, 1.79; 95% CI: 1.22–2.63). The intensity of the follow-up regimen had no effect on 5-year outcomes in patients with elevated CEA levels. Conclusion: Both pre-treatment and post-surgery elevated serum CEA levels were associated with increased overall and cancer-specific mortality. Intensified follow-up showed no benefit over low-intensity follow-up in this high-risk group of patients with elevated CEA levels.

AB - Background: Patients with colorectal cancer were examined to determine (1) whether elevated carcinoembryonic antigen (CEA) levels, either before treatment or after surgery, was associated with an increased risk of overall or colorectal cancer-specific mortality or recurrence, and (2) whether high intensity follow-up would benefit those patients. Materials and methods: Post-hoc analysis based on 2509 patients that underwent surgery for colorectal cancer, stage II or III, in the COLOFOL randomized trial with 5-year follow-up. Serum CEA levels were ascertained before treatment and one month after surgery. Follow-up examinations included computed tomography of the thorax and abdomen and serum CEA sampling. Patients were randomized to examinations at either 6, 12, 18, 24, and 36 months (high-intensity group) or at 12 and 36 months after surgery (low-intensity group). Levels of CEA >5 μg/l were defined as elevated. Results: Elevated CEA levels before treatment were associated with increased risk of recurrence (hazard ratio [HR], 1.49; 95% confidence interval [CI]: 1.22–1.83), colorectal cancer-specific mortality (HR, 1.44; 95% CI: 1.08–1.91), and overall mortality (HR, 1.38; 95% CI: 1.07–1.78). Elevated CEA levels after surgery were associated with increased colorectal cancer-specific mortality (HR, 1.68; 95% CI: 1.08–2.61) and overall mortality (HR, 1.79; 95% CI: 1.22–2.63). The intensity of the follow-up regimen had no effect on 5-year outcomes in patients with elevated CEA levels. Conclusion: Both pre-treatment and post-surgery elevated serum CEA levels were associated with increased overall and cancer-specific mortality. Intensified follow-up showed no benefit over low-intensity follow-up in this high-risk group of patients with elevated CEA levels.

KW - Carcinoembryonic antigen

KW - Clinical trial

KW - Colorectal cancer

KW - Follow-up

KW - Post-hoc analysis

U2 - 10.1016/j.ejso.2021.03.235

DO - 10.1016/j.ejso.2021.03.235

M3 - Article

C2 - 33846037

AN - SCOPUS:85103983480

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 1532-2157

ER -