The Role of Circulating Tumour Cells and Carcinoembryonic Antigen as Diagnostic Tool for Metastatic Colorectal Cancer in Indonesia

Authors

  • Sri Angraeni Division of Gastroenterology, Pancreatobiliary and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
  • Murdani Abdullah 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
  • Irsan Hasan Division of Hepatology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
  • Ikhwan Rinaldi Division of Haematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
  • Achmad Fauzi Division of Gastroenterology, Pancreatobiliary and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
  • Cleopas Martin Division of Respirology and Critical Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
  • Hamzah Shatri Division of Psychosomatic and Palliative Care, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
  • Cosphiadi Irawan Division of Haematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
  • Saskia Aziza Nursyirwan Division of Gastroenterology, Pancreatobiliary and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
  • Febiansyah Ibrahim Division of Digestive Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
  • Lianda Siregar Division of Gastroenterology and Hepatology, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
  • Imelda Maria Loho Division of Gastroenterology and Hepatology, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
  • Agus Sudiro Waspodo Division of Gastroenterology and Hepatology, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
  • Ariansah Margaluta Division of Digestive Surgery, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
  • Fajar Firsyada Division of Digestive Surgery, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
  • Nikko Darnindro Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fatmawati Hospital, Jakarta, Indonesia
  • Evah Lutfiah Human Cancer Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
  • Caroline Tanadi School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
  • Mohammad Ilyas University of Nottingham, Nottingham, UK

DOI:

https://doi.org/10.24871/2632025245-254

Keywords:

Metastatic colorectal cancer, circulating tumour cell, carcinoembryonic antigen, cacner surveillance

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.

 

References

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA and Jemal A. Global cancer statistics 2018: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (6): 394-424.

Ionescu VA, Gheorghe G, Bacalbasa N, Chiotoroiu AL and Diaconu C. Colorectal cancer: From risk factors to oncogenesis. Medicina (Kaunas) 2023; 59 (9).

Yoshino T, Cervantes A, Bando H, Martinelli E, Oki E, Xu RH, et al. Pan-asian adapted esmo clinical practice guidelines for the diagnosis, treatment and follow-up of patients with metastatic colorectal cancer. ESMO Open 2023; 8 (3): 101558.

Patelli G, Vaghi C, Tosi F, Mauri G, Amatu A, Massihnia D, et al. Liquid biopsy for prognosis and treatment in metastatic colorectal cancer: Circulating tumor cells vs circulating tumor DNA. Target Oncol 2021; 16 (3): 309-24.

Kimman M, Norman R, Jan S, Kingston D and Woodward M. The burden of cancer in member countries of the association of southeast asian nations (asean). Asian Pac J Cancer Prev 2012; 13 (2): 411-20.

Jeo W and Subrata F. The survival rate of colorectal cancer in dr. Cipto mangunkusumo hospital. New Ropanasuri J Surg 2020; 5 (2): 4.

Liu X, Lan H, Yang D, Wang L and Hu L. Prognostic value of circulating tumor cells in patients with recurrent and metastatic colorectal cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103 (1): e36819.

Rahbari NN, Bork U, Kircher A, Nimitz T, Schölch S, Kahlert C, et al. Compartmental differences of circulating tumor cells in colorectal cancer. Ann Surg Oncol 2012; 19 (7): 2195-202.

Yang CY, Lin CC, Huang SC, Lu RH, Lo LC, Tseng JY, et al. Enhanced prognostic value of combined circulating tumor cells and serum carcinoembryonic antigen in patients with colorectal cancer. J Chin Med Assoc 2023; 86 (5): 465-71.

Chiu SY, Hsieh CH, You JF, Chu PY, Hung HY, Chu PH, et al. Enhancing prediction performance by add-on combining circulating tumor cell count, cd45(neg) epcam(neg) cell count on colorectal cancer, advance, and metastasis. Cancers (Basel) 2021; 13 (11).

He Y, He X, Zhou Y and Luo S. Clinical value of circulating tumor cells and hematological parameters in 617 chinese patients with colorectal cancer: Retrospective analysis. BMC Cancer 2023; 23 (1): 707.

Liu G, Zhu J, Zhang P, Zhang T, Cui Z, Jiao F, et al. Exploring the diagnostic and prognostic significance of circulating tumor cells in stage ii-iv colorectal cancer using a nano-based detection method. J Chin Med Assoc 2024; 87 (10): 945-52.

Petrik J, Verbanac D, Fabijanec M, Hulina-Tomašković A, Čeri A, Somborac-Bačura A, et al. Circulating tumor cells in colorectal cancer: Detection systems and clinical utility. Int J Mol Sci 2022; 23 (21).

Saadi S, Aarab M, Tabyaoui I and Jouti NT. Circulating tumor cells in colorectal cancer - a review of detection methods and clinical relevance. Contemp Oncol (Pozn) 2023; 27 (3): 123-31.

Ding R, Chen Z, He M, Cen H, Liu Z and Su Y. Application value of combined detection of nlr, pni, d-dimer, cd3(+) t lymphocytes, and cea in colorectal cancer screening. Dis Markers 2022; 2022: 7913025.

Luo S, Ou Y, Zheng T, Jiang H, Wu Y, Zhao J, et al. Optimal strategy for colorectal cancer patients' diagnosis based on circulating tumor cells and circulating tumor endothelial cells by subtraction enrichment and immunostaining-fluorescence in situ hybridization combining with cea and ca19-9. J Oncol 2021; 2021: 1517488.

Tao XY, Li QQ and Zeng Y. Clinical application of liquid biopsy in colorectal cancer: Detection, prediction, and treatment monitoring. Mol Cancer 2024; 23 (1): 145.

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Published

2025-12-29

How to Cite

Angraeni, S., Abdullah, M., Hasan, I., Rinaldi, I., Fauzi, A., Martin, C., … Ilyas, M. (2025). The Role of Circulating Tumour Cells and Carcinoembryonic Antigen as Diagnostic Tool for Metastatic Colorectal Cancer in Indonesia. The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy, 26(3), 245–254. https://doi.org/10.24871/2632025245-254

Issue

Vol. 26 No. 3 (2025): VOLUME 26, NUMBER 3, December, 2025

Section

Original Articles

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