Blood CEA levels for detecting recurrent colorectal cancer

Brian D Nicholson; Bethany Shinkins; Indika Pathiraja; Nia W Roberts; Tim J James; Susan Mallett; Rafael Perera; John N Primrose; David Mant

doi:10.1002/14651858.CD011134.pub2

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Figure 1

PRISMA flow diagram: results of the search for studies evaluating the diagnostic accuracy of blood CEA to detect recurrent colorectal cancer in patients following curative resection.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

QUADAS‐2 risk of bias and applicability concerns summary including review authors' judgements about each domain for each included study

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

QUADAS‐2 risk of bias and applicability concerns graph including review authors' judgements about each domain presented as percentages across included studies

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 4

Forest plot for all 52 included studies for the threshold reported closest to 5 µg/L

TP = true positive; FP = false positive; FN = false negative; TN = true negative

The blue square depicts the sensitivity and specificity for each study and the horizontal line represents the corresponding 95% confidence interval for these estimates.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 5

Scatter plot of sensitivity versus specificity for all 52 studies, regardless of threshold.

Each box represents the 2 x 2 data extracted from each study, with the width of the boxes being proportional to the inverse standard error of the specificity and the height of the boxes proportional to the inverse standard error of the sensitivity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 6

Forest plot broken down by threshold: CEA at 2.5µg/L, CEA at 5µg/L, CEA at 10µg/L.

TP = true positive; FP = false positive; FN = false negative; TN = true negative

The blue square depicts the sensitivity and specificity for each study and the horizontal line represents the corresponding 95% confidence intervals for these estimates.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 7

Summary ROC plot of accuracy at a threshold of 2.5 µg/L.

Each box represents the 2 x 2 data extracted from each study. The width of the box is proportional to the number of patients who did not experience recurrence in each study, and the height is proportional to the number of patients that did develop recurrent CRC.

The filled circle is the pooled estimate for sensitivity and specificity and the line running through it is the summary ROC curve.

The smaller dotted ellipse represents the 95% credible region around the summary estimate; the larger dashed ellipse represents the 95% prediction region.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 8

Summary ROC plot of accuracy at a threshold of 5 µg/L.

Each box represents the 2 x 2 data extracted from each study.

The width of the box is proportional to the number of patients who did not experience recurrence in each study, and the height is proportional to the number of patients that did develop recurrent CRC.

The filled circle is the pooled estimate for sensitivity and specificity and the line running through it is the summary ROC curve.

The smaller dotted ellipse represents the 95% credible region around the summary estimate; the larger dashed ellipse represents the 95% prediction region.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 9

Summary ROC plot of accuracy at a threshold of 10 µg/L.

Each box represents the 2 x 2 data extracted from each study.

The filled circle is the pooled estimate for sensitivity and specificity and the line running through it is the summary ROC curve.

The smaller dotted ellipse represents the 95% credible region around the summary estimate; the larger dashed ellipse represents the 95% prediction region.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Test 1

CEA ‐ all thresholds.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Test 2

CEA at 2.5µg/L.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Test 3

CEA at 5µg/L.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Test 4

CEA at 10µg/L.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings 1. Summary of results table: different cut‐offs

Review question: What is the accuracy of single‐measurement blood CEA as a triage test to prompt further investigation for colorectal cancer recurrence after curative resection?
Population: adults with no detectable residual disease after curative surgery (with or without adjuvant therapy)
Studies: cross‐sectional diagnostic test accuracy studies, cohort studies, and RCTs, reporting 2 x 2 data
Index test: Blood carcino‐embryonic antigen (CEA)
Reference standard: appropriate¹ imaging, histology, or routine clinical follow‐up
Setting: primary or hospital care.
Subgroup	Number (Studies)	Sensitivity (95% CI)	Specificity (95% CI)	Interpretation Assuming a constant incidence of 2%² recurrence at each measurement point, testing 1000 people will have the following outcome depending on the CEA threshold applied
2.5 µg/L	1515 (7)	82% (78 to 86)	80% (59 to 92)	16 cases of recurrence will be detected and 4 cases will be missed. 196 people will be referred unnecessarily for further testing
5 µg/L	4585 (23)	71% (64 to 76)	88% (84 to 92)	14 cases of recurrence will be detected and 6 cases will be missed. 118 people will be referred unnecessarily for further testing
10 µg/L	2341 (7)	68% (53 to 79)	97% (90 to 99)	14 cases of recurrence will be detected and 6 cases will be missed. 29 people will be referred unnecessarily for further testing
¹as defined in the Reference standards section of the Methods. ²three‐monthly prevalence is estimated as 2%, as the median prevalence amongst the included studies was 30% and a standard follow‐up schedule will include 14 to 15 CEA tests over five years.

Summary of findings 1. Summary of results table: different cut‐offs

Ir a la tabla de la revisión

Summary of findings 2. Outcome of follow‐up testing using a CEA threshold of 2.5 µg/L

*Month when CEA measured*	per 1000 patients tested at a threshold of 2.5 µg/L					False alarm rate
*Month when CEA measured*	Estimated recurrences¹	Referrals for raised CEA	Cases of recurrence detected	Cases of recurrence missed	False alarms (cases investigated when cancer not present)	False alarm rate
Follow‐up years 1 and 2: 3‐monthly CEA testing
3	19	212	16	3	196	92%
6	19	212	16	3	196	92%
9	39	224	32	7	192	86%
12	39	224	32	7	192	86%
15	37	223	30	7	193	87%
18	37	223	30	7	193	87%
21	31	219	25	6	194	89%
24	31	219	25	6	194	89%
Follow‐up years 3, 4 and 5: 6‐monthly CEA testing
30	46	229	38	8	191	83%
36	36	223	30	6	193	87%
42	27	217	22	5	195	90%
48	25	216	21	4	195	90%
54	17	211	14	3	197	93%
60	14	208	11	3	197	95%
¹Estimates are based on data reported by Sargent 2007. Three‐monthly data were unavailable, and so constant rates were assumed during each six‐month period for the first two years. Estimates are rounded.

Summary of findings 2. Outcome of follow‐up testing using a CEA threshold of 2.5 µg/L

Ir a la tabla de la revisión

Summary of findings 3. Outcome of follow‐up testing using a CEA threshold of 5 µg/L

*Month when CEA measured*	per 1000 patients tested at a threshold of 5 µg/L					False alarm rate
*Month when CEA measured*	Estimated recurrences¹	Referrals for raised CEA	Cases of recurrence detected	Cases of recurrence missed	False alarms (cases investigated when cancer not present)	False alarm rate
Follow‐up years 1 and 2: 3‐monthly CEA testing
3	19	131	13	6	118	90%
6	19	131	13	6	118	90%
9	39	143	28	11	115	80%
12	39	143	28	11	115	80%
15	37	142	26	11	116	82%
18	37	142	26	11	116	82%
21	31	138	22	9	116	84%
24	31	138	22	9	116	84%
Follow‐up years 3, 4 and 5: 6‐ monthly CEA testing
30	46	147	33	13	114	78%
36	36	142	26	10	116	82%
42	27	136	19	8	117	86%
48	25	135	18	7	117	87%
54	17	130	12	5	118	91%
60	14	128	10	4	118	92%
¹Estimates are based on data reported by Sargent 2007. Three‐monthly data were unavailable, and so constant rates were assumed during each six‐month period for the first two years. Estimates are rounded.

Summary of findings 3. Outcome of follow‐up testing using a CEA threshold of 5 µg/L

Ir a la tabla de la revisión

Summary of findings 4. Outcome of follow‐up testing using a CEA threshold of 10 µg/L

*Month when CEA measured*	per 1000 patients tested at a threshold of 10 µg/L					False alarm rate
*Month when CEA measured*	Estimated recurrences¹	Referrals for raised CEA	Cases of recurrence detected	Cases of recurrence missed	False alarms (cases investigated when cancer not present)	False alarm rate
Follow‐up years 1 and 2: 3‐ monthly CEA testing
3	19	42	13	6	30	70%
6	19	42	13	6	29	70%
9	39	55	27	13	29	52%
12	39	55	27	13	29	52%
15	37	54	25	12	29	53%
18	37	54	25	12	29	53%
21	31	50	21	10	29	58%
24	31	50	21	10	29	58%
Follow‐up years 3, 4 and 5: 6‐ monthly CEA testing
30	46	60	31	15	29	48%
36	36	53	24	12	29	54%
42	27	48	19	9	29	61%
48	25	46	17	8	29	63%
54	17	41	11	6	30	72%
60	14	39	10	5	30	75%
¹Estimates are based on data reported by Sargent 2007. Three‐monthly data were unavailable, and so constant rates were assumed during each six‐month period for the first two years. Estimates are rounded.

Summary of findings 4. Outcome of follow‐up testing using a CEA threshold of 10 µg/L

Ir a la tabla de la revisión

Table Tests. Data tables by test

Test	No. of studies	No. of participants
1 CEA ‐ all thresholds Show forest plot	52	9717

2 CEA at 2.5µg/L Show forest plot	7	1515

3 CEA at 5µg/L Show forest plot	23	4585

4 CEA at 10µg/L Show forest plot	7	1607

Table Tests. Data tables by test

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet