医生是如何看待CEA的

提问：

My wife (on Tarceva now 5 months) just got some blood test results and her CEA tumor marker score went from 17 to 30 (five months ago it was over 800). She still feels great (except for a pretty extensive facial rash) but we will be getting a Pet scan in a couple of weeks. Do any of the Grace doctors know if these markers can fluctuate slightly from month to month? I have to say we were pretty bummed out at the possibility that she might be starting  resistance to Tarceva after only 5 months. Also, our doctor mentioned Alimta as a possibly maintenance therapy if indeed the Tarceva stops working. Any thoughts on Alimta?


回答：

Yes, you can certainly see a waxing and waning in these results from one blood draw to the next. Frankly, I would say that this is the kind of situation that makes some of us hate serum tumor markers.  I would emphasize that 30 is a lot closer to 17 than to 800, and I cringe at the thought of doctors and/or patients concluding that their cancer is progressing based on this finding.  In the absence of seeing very convincing evidence of clinically meaningful progression on imaging (and I would not include an increase in the PET uptake of a tumor that hasn't changed in size in that category), I couldn't be less inclined to move on to a subsequent therapy.  Beyond that, Alimta (pemetrexed) is a very fine choice as treatment for someone with advanced non-squamous NSCLC.

-Dr. West

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I couldn't agree more with Dr. West about CEA.  While it does correlate well for some patients, it more often leads to worse decisions than to better ones.  When it reliably increases to show progression, the imaging will also show it.  On the other hand, CEA can fluctuate, leading to mistaken conclusions about shrinkage or progression and therefor bad decisions.  I never get CEA in my practice.

Dr. Weiss



http://cancergrace.org/forums/index.php/topic,9877.15.html

我总结一下，
Dr.west:
CEA从17升高到30，相对800来说，只是微小的变化，在没有影像证据情况下，并不能作为特耐药的证据，不建议换药或
进行下一步治疗。另外，力比泰是个非常好的药物。
Dr. Weiss
我非常赞同Dr.west的看法。尽管某些病人对cea敏感，但往往导致糟糕的决定，而不是更好的。当cea稳定地增加，显示进展，影像也将证明这一点。另一方面，cea可能出现波动，使人错误地作出收缩或进展的结论。我从来没有在工作参考过CEA。
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另外补充一点：
美国国家临床生化研究院关于肺癌的肿瘤标志物临床指南中指出CEA等肿瘤标志物在临床中仅用于肺癌诊断，而不建议用于判断病情进展及治疗效果。
美国国家临床生化研究院_肺癌的肿瘤标志物临床指南.pdf (203.04 KB, 下载次数: 107)

2011-11-30 19:29 上传

点击文件名下载附件

我爸腺癌晚期，但他的CEA ，CA125等指标一直正常。。。后续不知道该以何种指标去判定是否有进展？难道真的要等每个月的影像去证明？

3个月一次。

Dr wesis的话也要总结啊，和Dr west的观点可不太一样。
老马你不能只总结一个，误导嫌疑

那两医生是一伙的，意见一样。

我感觉cea对监测病情还是有价值的，只是因人而异，自己要注意分析判断。

到目前为止，我弟弟的CEA变化和CT结果一致，难道是巧合？
我们倒没有拿CEA断定，只是在做CT之间找一个大概的判断方式。
以前为了拿赠药2个月一次CT，现在打算3个月一次，这之间那什么判断药效呢？问题！

老马下面的论文看不懂··············

Dr. West：“眼见为实”
Dr. Weiss：“不假”

老马：“”