The Role of Circulating Tumour Cells and Carcinoembryonic Antigen as Diagnostic Tool for Metastatic Colorectal Cancer in Indonesia
), Murdani Abdullah(2), Irsan Hasan(3), Ikhwan Rinaldi(4), Achmad Fauzi(5), Cleopas Martin(6), Hamzah Shatri(7), Cosphiadi Irawan(8), Saskia Aziza Nursyirwan(9), Febiansyah Ibrahim(10), Lianda Siregar(11), Imelda Maria Loho(12), Agus Sudiro Waspodo(13), Ariansah Margaluta(14), Fajar Firsyada(15), Nikko Darnindro(16), Evah Lutfiah(17), Caroline Tanadi(18), Mohammad Ilyas(19),
(1) Division of Gastroenterology, Pancreatobiliary and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
(2) Division of Gastroenterology, Pancreatobiliary and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia Human Cancer Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
(3) Division of Hepatology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
(4) Division of Haematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
(5) Division of Gastroenterology, Pancreatobiliary and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
(6) Division of Respirology and Critical Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
(7) Division of Psychosomatic and Palliative Care, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
(8) Division of Haematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
(9) Division of Gastroenterology, Pancreatobiliary and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
(10) Division of Digestive Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
(11) Division of Gastroenterology and Hepatology, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
(12) Division of Gastroenterology and Hepatology, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
(13) Division of Gastroenterology and Hepatology, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
(14) Division of Digestive Surgery, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
(15) Division of Digestive Surgery, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
(16) Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fatmawati Hospital, Jakarta, Indonesia
(17) Human Cancer Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
(18) School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
(19) University of Nottingham, Nottingham, UK
Corresponding Author
Abstract
Background: Patients with metastatic colorectal cancer (CRC) have a poor prognosis, with a 5-year survival rate of only 14%. Early detection and early intervention may improve outcome. Both circulating tumour cells (CTC) and serum carcinoembryonic antigen (CEA) have been suggested as diagnostic biomarkers for metastatic CRC. This study explored the performance of CTC and CEA as a tools for the detection of metastatic colorectal cancer in Indonesia.
Methods: This study was conducted from December 2024 to April 2025 on metastatic colorectal cancer patients from three hospitals in Jakarta. CTC was analysed using the gradient density method and flow cytometry. CEA was analysed using chemiluminescent microparticle immunoassay.
Results: This study recruited 160 patients with colorectal cancer patients of whom, 45% were known to have metastatic colorectal cancer. The median age was 57 (47—66) years and analysis was done at one time point only. The area under the curve (AUC) for CTC, CEA, and the combination of both CTC and CEA in diagnosing metastatic colorectal cancer was 0.579, 0.811, and 0.703, respectively. CTC showed 56.94% sensitivity and 50.00% specificity in detecting metastatic colorectal cancer. Meanwhile, CEA showed higher sensitivity (72.22%) and specificity (72.72%). Combination of both CTC and CEA increased sensitivity to 91.67%, but with a lower specificity of 37.50%. The optimal cut-off for CTC and CEA were 34.5 cells/3 ml and 18.31 ng/ml, respectively.
Conclusion: CEA showed a better performance than CTC in diagnosing metastatic colorectal cancer. Combination of CTC and CEA showed promising potential as a valuable surveillance tool for detecting metastasis in colorectal cancers, but not as a primary diagnostic tool.
Keywords
References
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DOI: 10.24871/2632025245-254
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