Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2023; 15(12): 2907-2918
Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2907
Significance of carcinoembryonic antigen detection in the early diagnosis of colorectal cancer: A systematic review and meta-analysis
Rui Wang, Qin Wang, Pan Li
Rui Wang, Pan Li, Department of Nuclear Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
Qin Wang, Delivery Room, Chengdu Women’s and Children’s Central Hospital, Chengdu 610000, Sichuan Province, China
Author contributions: Wang R, Wang Q and Li P jointly designed this study; Wang R, Wang Q, wrote the paper; Wang R and Li P were responsible for collating the data and reviewing the articles.
Conflict-of-interest statement: Dr. Li has nothing to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pan Li, MBBS, Doctor, Department of Nuclear Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu 610072, Sichuan Province, China. lp1759lp@163.com
Received: September 7, 2023
Peer-review started: September 7, 2023
First decision: September 20, 2023
Revised: September 30, 2023
Accepted: November 14, 2023
Article in press: November 14, 2023
Published online: December 27, 2023
Processing time: 111 Days and 9.6 Hours
Abstract
BACKGROUND

Colorectal cancer (CRC) is a prevalent malignant tumor involving adenomas that develop into malignant lesions. Carcinoembryonic antigen (CEA) is a non-specific serum biomarker upregulated in CRC. The concentration of CEA is modulated by tumor stage and grade, tumor site in the colon, ploidy status, and patient smoking status. This study aimed to evaluate current evidence regarding the diagnostic power of CEA levels in the early detection of CRC recurrence in adults.

AIM

To evaluate current evidence regarding the diagnostic power of CEA levels in the early detection of CRC recurrence in adults.

METHODS

A systematic search was performed using four databases: MEDLINE, Cochrane Trials, EMBASE, and the Web of Science. The inclusion criteria were as follows: Adult patients aged ≥ 18 years who had completed CRC curative treatment and were followed up postoperatively; reporting the number of CRC recurrences as an outcome; and randomized, clinical, cohort, and case-control study designs. Studies that were not published in English and animal studies were excluded. The following data were extracted by three independent reviewers: Study design, index tests, follow-up, patient characteristics, and primary outcomes. All statistical analyses were performed using the RevMan 5.4.1.

RESULTS

A total of 3232 studies were identified, with 73 remaining following the elimination of duplicates. After screening on predetermined criteria, 12 studies were included in the final analysis. At a reference standard of 5 mg/L, CEA detected only approximately half of recurrent CRCs, with a pooled sensitivity of 59% (range, 33%–83%) and sensitivity of 89% (range, 58%–97%).

CONCLUSION

CEA is a significant marker for CRC diagnosis. However, it has insufficient sensitivity and specificity to be used as a single biomarker of early CRC recurrence, with an essential proportion of false negatives.

Keywords: Carcinoembryonic antigen; Colorectal cancer; Reference standard; Sensitivity and specificity; Curative carcinoembryonic antigen treatment

Core Tip: Colorectal cancer (CRC) is a prevalent malignant tumor involving adenomas that develop into malignant lesions. Carcinoembryonic antigen (CEA) is a non-specific serum biomarker upregulated in CRC. The concentration of CEA is modulated by tumor stage and grade, tumor site in the colon, ploidy status, and patient smoking status. Overall, CEA remains an important diagnostic tool for CRC detection and management. When used in combination with other diagnostic tests, such as colonoscopy and imaging examinations, CEA can provide valuable information regarding the presence and progression of CRC and treatment effectiveness.