Background The primary objective of this study is to comparatively assess the safety of nasogastric (NG) feeding versus nasojejunal (NJ) feeding in patients with acute pancreatitis (AP), with a special focus on the initiation of these feeding methods within the first 48 h of hospital admission.Methods Studies were identified through a systematic search in PubMed, EMbase, Cochrane Central Register of Controlled Trials, and Web of Science. Four studies involving 217 patients were included. This systematic review assesses the safety and efficacy of nasogastric versus nasojejunal feeding initiated within 48 h post-admission in moderate/severe acute pancreatitis, with a specific focus on the timing of initiation and patient age as influential factors.Results The results showed that the mortality rates were similar between NG and NJ feeding groups (RR 0.86, 95% CI 0.42 to 1.77, P = 0.68). Significant differences were observed in the incidence of diarrhea (RR 2.75, 95% CI 1.21 to 6.25, P = 0.02) and pain (RR 2.91, 95% CI 1.50 to 5.64, P = 0.002) in the NG group. The NG group also showed a higher probability of infection (6.67% vs. 3.33%, P = 0.027) and a higher frequency of multiple organ failures. Subgroup analysis for early intervention (within 48 h) showed a higher risk of diarrhea in the NG group (RR 2.80, P = 0.02). No significant differences were found in the need for surgical intervention, parenteral nutrition, or success rates of feeding procedures.Conclusion This meta-analysis highlights the importance of considering the method and timing of nutritional support in acute pancreatitis. While NG feeding within 48 h of admission increases the risk of certain complications such as diarrhea and infection, it does not significantly impact mortality or the need for surgical intervention.

BACKGROUND:Reflux esophagitis has an increasing prevalence and complex and diverse symptoms. Identifying its risk factors is crucial to understanding the etiology, prevention, and management of the disease. The occurrence of reflux esophagitis may be associated with food reactions, Helicobacter pylori (H. pylori) infection, and metabolic syndromes.AIM:To investigate the risk factors for reflux esophagitis and analyze the effects of immunoglobulin (Ig) G-mediated food intolerance, H. pylori infection, and metabolic syndrome on reflux esophagitis.METHODS:Outpatients attending the Second Medical Center of the PLA General Hospital between 2017 and 2021 were retrospectively enrolled. The patients' basic information, test results, gastroscopy results, H. pylori test results, and IgG-mediated food intolerance results were collected. Multivariate logistic regression analysis was used to analyze risk factors for reflux esophagitis. Statistical mediation analysis was used to evaluate the effects of IgG-mediated food intolerance and metabolic syndrome on H. pylori infection affecting reflux esophagitis.RESULTS:A total of 7954 outpatients were included; the prevalence of reflux esophagitis, IgG-mediated food intolerance, H. pylori infection, and metabolic syndrome were 20.84%, 61.77%, 35.91%, and 60.15%, respectively. Multivariate analysis showed that the independent risk factors for reflux esophagitis included IgG-mediated food intolerance (OR = 1.688, 95%CI: 1.497-1.903, P < 0.00001) and metabolic syndrome (OR = 1.165, 95%CI: 1.030-1.317, P = 0.01484), and the independent protective factor for reflux esophagitis was H. pylori infection (OR = 0.400, 95%CI: 0.351-0.456, P < 0.00001). IgG-mediated food intolerance had a partially positive mediating effect on H. pylori infection as it was associated with reduced occurrence of reflux esophagitis (P = 0.0200). Metabolic syndrome had a partially negative mediating effect on H. pylori infection and reduced the occurrence of reflux esophagitis (P = 0.0220).CONCLUSION:Patients with IgG-mediated food intolerance and metabolic syndrome were at higher risk of developing reflux esophagitis, while patients with H. pylori infection were at lower risk. IgG-mediated food intolerance reduced the risk of reflux esophagitis pathogenesis in patients with H. pylori infection; however, metabolic syndrome increased the risk of patients with H. pylori infection developing reflux esophagitis.

Background There is a link between Helicobacter pylori (HP) infection and small intestinal bacterial overgrowth (SIBO) with nonspecific digestive symptoms. Nonetheless, whether HP infection is associated with SIBO in adults remains unclear. Based on a meta-analysis, we evaluated this relationship. Results Observational studies relevant to our research were identified by searching PubMed, Embase, the Cochrane Library, and the Web of Science. We evaluated between-study heterogeneity using the Cochrane Q test and estimated the I 2 statistic. Random-effects models were used when significant heterogeneity was observed; otherwise, fixed-effects models were used. Ten datasets from eight studies, including 874 patients, were involved in the meta-analysis. It was shown that HP infection was related to a higher odds of SIBO (odds ratio [OR]: 1.82, 95% confidence interval: 1.29 to 2.58, p < 0.001) with mild heterogeneity ( p for Cochrane Q test = 0.11, I 2 = 7%). Subgroup analyses showed that HP infection was related to SIBO in young patients (mean age < 48 years, OR: 2.68, 95% CI: 1.67 to 4.28, p < 0.001; I 2 = 15%) but not in older patients (mean age ≥ 48 years, OR: 1.15, 95% CI: 0.69 to 1.92, p < 0.60; I 2 = 1%; p for subgroup difference = 0.02). Subgroup analyses further indicated that the association was not significantly affected by the country of study, comorbidities, exposure to proton pump inhibitors, or methods of evaluating HP infection and SIBO. Conclusions HP infection may be related to SIBO in adults, which supports the detection of SIBO in patients with digestive symptoms and HP infection.

Background: Epidemiological studies have illustrated that regular aspirin consumption may decrease the risk of non-small cell lung cancer (NSCLC). The present study aims to investigate the mechanism of aspirin-induced inhibition of NSCLC development during hypoxia. Methods: A549 cells were pre-treated with the vehicle control or aspirin and then subjected to hypoxic culture. Cell viability was monitored by CCK-8 assay, and flow cytometry was performed to detect cell cycle distributions, apoptosis, and proportion of cancer stem cells (CSCs). Flow cytometric cell sorting was used to separate CSCs. Quantitative reverse transcription-polymerase chain reaction and Western blot were used to detect the mRNA and protein levels of stem cell markers and the related signaling molecules. The abundance of prostaglandin E2 was detected by enzyme-linked immunosorbent assay. Exosomes in the cell culture medium were isolated using ExoQuick, and the number of exosomes was quantified by the EXOCET exosome quantification assay kit. Cell migration and angiogenesis were monitored by transwell migration assay and in vitro angiogenesis experiments. Results: Aspirin inhibited cell proliferation and induced G2/M cell cycle arrest in hypoxic A549 cells; it also inhibited hypoxia-enhanced sternness in both A549 and ALDH(+) cells. The drug reduced hypoxia-enhanced numbers of exosomes in A549 cells and exerted negative effects on the hypoxia-mediated up-regulation of exosomal HIE-1 alpha/COX-2 and expression of exosomal miR-135b and miR-210. While hypoxic-induced exosomes can promote the proliferation, migration, and angiogenesis of other A549 cells, aspirin can weaken this promotion by reducing the amount of exosome secreted and changing exosome contents. Conclusions: Aspirin inhibits the hypoxia-induced sternness, hypoxic-mediated exosome release, and malignant paracrine effects of A549 cells.

OBJECTIVE:To study the clinical discrepancy between patients with post infectious irritable bowel syndrome (PI-IBS) and non post infectious irritable bowel syndrome (NPI-IBS) , and assess the value of serum intestinal fatty acid binding protein (I-FABP) for differential diagnosis. METHODS:A total of 117 patients with PI-IBS, 201 patients with NPI-IBS and 31 healthy controls were prospectively recruited in General Liberation Army Hospital from 2010 to 2013. Plasma samples and clinical data were collected. Serum I-FABP level was measured by an enzyme-linked immunosorbent assay. RESULTS:The median age of patients with PI-IBS was 36 years. The median time to diagnosis in PI-IBS group was significantly longer than that in NPI-IBS group [(19.7 ± 10.3)months vs (11.4 ± 5.3) months, P < 0.05]. Similarly, the proportion of anxiety [58.1%(68/117) vs 28.9%(58/201), P < 0.05] and the value of I-FABP [(42.6 ± 14.8) µg/L vs (17.3 ± 11.5) µg/L, P < 0.05] in PI-IBS group were significant higher than NPI-IBS patients. The level of I-FABP of healthy controls [(10.6 ± 8.2) µg/L] was also significantly lower than that of PI-IBS patients (P < 0.05), yet no difference from that of NPI-IBS group. The I-FABP value of subgroup PI-IBS patients with diarrhoea (IBS-D) was significant higher than that of NPI-IBS group [(54.8 ± 9.3)µg/L vs (12.3 ± 6.2) µg/L, P < 0.05]. However, other parameters including gender, age, GSRS score, and I-FABP value of subgroup constipation (IBS-C) and mix (IBS-M), were not different between PI-IBS group and NPI-IBS group (all P > 0.05). CONCLUSION:PI-IBS is an occult intestinal inflammation disease with mucosa injury. I-FABP might be a potential testing marker for the diagnosis of PI-IBS.

OBJECTIVE:To analyze the characteristics and trends of gastrointestinal mucosal injury for age ≥ 45 years male health care patients during gastro-endoscopic follow-up.METHODS:Endoscopic reports of age ≥ 45 years male health care patients with long-term aspirin undergoing gastroscopy from October 1999 to April 2014 were retrospectively reviewed. The proportion of different lesions, the distribution at different anatomic sites, and the trends of the number of gastrointestinal mucosal injury in different follow up years were analyzed.RESULTS:A total of 2 281 endoscopic reports of 259 health care cases aged ≥ 45 years with aspirin used 3 years at least were collected. After the initial gastroscopy screening, there are 239, 103 and 20 cases followed up to the 5(th), 10(th) and 15(th) years. The patients were between 45-91 years of age, their mean age was 67 years. The mean followed-up time was 5 years. In the follow-up process each patient had 8 gastroscopies performed. A total of 4 442 lesions were detected and the mean number was 2 per person for once. The number of gastrointestinal mucosal injuries were different. The number of the gastrointestinal mucosal injury of the 1(st) year was higher than that of initial gastro-endoscopy (P < 0.05). The numbers of the gastrointestinal mucosal injury of the 2(se)-5(th) years during the follow up period were lower than those of initial gastro-endoscopy (all P < 0.05). The numbers of three different lesions of gastrointestinal mucosal injury were different (P < 0.05). The number of erosion was more than petechia and ulcer (both P < 0.05). The Modified Lanza's Score (MDS) were in descending trend during the follow up period. The numbers of gastrointestinal mucosal injury in different anatomic sites were different in the same follow-up years (all P < 0.05).CONCLUSIONS:The numbers and degree of gastrointestinal mucosal injury for middle aged and aged health care patients with long-term aspirin used during gastro-endoscopic follow-up are in descending trend, however, there is a transient increasing in number of gastrointestinal mucosal injury in the first two years since the aspirin used. The common lesion in gastrointestinal mucosal injury is erosions. Gastric antrum and body are vulnerable anatomical parts during follow-up.

BACKGROUND AND OBJECTIVE:To evaluate the clinical usefulness of serum intestinal fatty acid binding protein (I-FABP) and D-lactate measurements in the early diagnosis of acute intestinal ischemia. METHODS:A total of 272 patients with a clinical diagnosis of acute abdomen were recruited for this trial over a 24-month period, and 37 healthy people were included in the study as controls. Serum I-FABP and D-lactate levels were measured by an enzyme-linked immunosorbent assay and compared in patients with intestinal ischemia vs. non-intestinal ischemia. RESULTS:Of the 272 patients, 39 were diagnosed with intestinal ischemia and 233 were diagnosed with other cause of acute abdomen. The mean serum I-FABP and D-lactate levels in the patients with intestinal ischemia were 149.74±57.81ng/mL and 52.73±26.46 ug/mL, respectively, and were significantly higher compared with patients with non-intestinal ischemia (36.78±11.25ng/mL and 15.58±5.17 ug/mL, respectively) and with levels in the healthy control group (8.33±6.25 ng/mL and 5.47±1.64 ug/mL, respectively). Area under the curve for I-FABP and D-lactate were 0.85 and 0.69, and cut-off values of 93.07 ng/mL and 34.28 ug/mL, respectively. CONCLUSION:Serum I-FABP and D-lactate can improve the diagnosis of intestinal ischemia in patients with acute abdomen who are at risk.

High-quality evidence suggests that aspirin is a promising agent for cancer prevention and treatment. Direct inhibition of cyclooxygenase-2 (COX-2) pathway is generally thought to be the main mechanism by which aspirin inhibits cancer development. However, either pharmacological properties of aspirin or recent results of epidemiologic studies do not support that mechanism. To address this inconsistency, we hypothesize that antiplatelet effect of aspirin via inhibition of COX-1 may be one of potential mechanisms to inhibit carcinogenesis. Aberrant platelet activation will lead to promote hostility of tumor microenvironment by releasing an abundant array of angiogenesis regulators. Given the outstanding ability of antiplatelet, aspirin may restore balance of pro- and anti-angiogenic factors released from platelet to “normalize” tumor vasculature and shape tumor microenvironment to some extent, which will not only diminish tumor aggressiveness and progression, but also enhance the sensitivity to therapeutic treatment. Thus, targeting the platelet activation leading to alter tumor microenvironment may provide a novel way to tumor therapy.

结直肠癌是最常见的消化道恶性肿瘤,利用天然或人工合成的化合物来预防结直肠肿瘤逐步成为研究热点.本文将着重论述具有临床潜力的结直肠癌化学预防制剂.

Purpose The aim of this study was to evaluate the relationship between long-term aspirin use with pretreatment 18 Fluorodeoxyglucose (FDG) uptake of primary lesions of Colorectal cancer (CRC) and evaluate their clinical significance. Materials and Methods We enrolled 84 patients with CRC who underwent 18F-FDG PET/CT scanning before surgery between 1st July 2008 and 1st March 2013 and followed up until 1st March 2014. Maximum standardized uptake value (SUVmax) of the primary tumor was measured by 18F-FDG PET/CT. The history of aspirin taken and other clinicopathogical factors were also obtained and their relationships were examined by Mann-Whitney or χ2 tests. Progression-free survival (PFS) was determined by standard Kaplan-Meier survival analysis. Cox proportional hazards regression was performed to determine whether history of aspirin taken, pretreatment SUVmax, age, gender, TNM stage, tumor sizes and differentiation influenced outcomes. Results CRC Patients with long-term history of aspirin use had lower SUVmax of primary lesions than control group (9.74±2.62 vs. 13.91±6.18) and showed a trend towards improved PFS after curative surgery. However, pretreatment of SUVmax showed no prognostic value in patients with CRC. Conclusions Long-term aspirin use is associated with lower pretreatment SUVmax of CRC and is a promising prognostic factor for predicting PFS in patients with CRC.

AIM:To investigate the potential therapeutic effects of mesenchymal stem cells (MSCs) in inflammatory bowel disease (IBD), we transplanted MSCs into an experimental model of IBD.METHODS:A rectal enema of trinitrobenzene sulfonic acid (TNBS) (100 mg/kg body weight) was administered to female BALB/c mice. Bone marrow mesenchymal stem cells (BMSCs) were derived from male green fluorescent protein (GFP) transgenic mice and were transplanted intravenously into the experimental animals after disease onset. Clinical activity scores and histological changes were evaluated. GFP and Sex determining region Y gene (SRY) expression were used for cell tracking. Ki67 positive cells and Lgr5-expressing cells were determined to measure proliferative activity. Inflammatory response was determined by measuring the levels of different inflammatory mediators in the colon and serum. The inflammatory cytokines included tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), interleukin-2 (IL-2), IL-6, IL-17, IL-4, IL-10, and transforming growth factor (TGF-β). Master regulators of Th1 cells (T-box expressed in T cells, T-bet), Th17 cells (retinoid related orphan receptor gamma(t), RORγt), Th2 cells (GATA family of transcription factors 3, GATA3) and regulatory T cells (forkhead box P3, Foxp3) were also determined.RESULTS:Systemic infusion of GFP-BMSCs ameliorated the clinical and histopathologic severity of colitis, including body weight loss, diarrhea and inflammation, and increased survival (P < 0.05). The cell tracking study showed that MSCs homed to the injured colon. MSCs promoted proliferation of intestinal epithelial cells and differentiation of intestinal stem cells (P < 0.01). This therapeutic effect was mainly mediated by down-regulation of both Th1-Th17-driven autoimmune and inflammatory responses (IL-2, TNF-α, IFN-γ, T-bet; IL-6, IL-17, RORγt), and by up-regulation of Th2 activities (IL-4, IL-10, GATA-3) (P < 0.05). MSCs also induced activated CD4(+)CD25(+)Foxp3(+) regulatory T cells (TGF-β, IL-10, Foxp3) with a suppressive capacity on Th1-Th17 effecter responses and promoted Th2 differentiation in vivo (P < 0.05).CONCLUSION:MSCs are key regulators of immune and inflammatory responses and may be an attractive candidate for cell-based therapy of IBD.

OBJECTIVE To observe the occurrence characteristics, dynamic variations and potential risks of smaller gastrointestinal submucosal tumor (SMT) in elderly patients. METHODS A total of 54 SMT patients were retrospectively recruited from January 1981 to September 2010. There were 51 males (94.4%) and 3 females (5.6%) with an average age of (74 ± 1) years. During each visit, all the relevant data were collected, including symptoms, number of lesion, lesion location, shape, size (maximum transverse diameter under endoscope or endoscopic ultrasonography (EUS), morphology of mucosa, frequency and duration of follow-ups, treatment and pathological results. And the data were analyzed to examine the characteristics of SMT in elderly patients and their dynamic variations. Further more, according to lesion diameter, they were divided into two groups: a diameter ≤ 1 cm (n = 36) and a diameter > 1 cm and ≤ 3 cm (n = 16). Then the change of two groups were observed and compared during the follow-ups. RESULTS Two cases were not under surveillance after direct surgical resection. The other 52 patients received a follow-up of 22 years. Among them, 5 patients underwent surgical resection for fast-growing tumor and mucosal ulcer. And all their pathologic diagnoses were malignant. Only 1 patient (2.8%) in the diameter ≤ 1 cm group and 4 in the diameter > 1 cm and ≤ 3 cm group turned malignant at 6 years. But, among 4 patients, the shortest interval was merely 14 months. Therefore, compared with the diameter > 1 cm group, the diameter ≤ 1 cm group had a lower rate of malignancy (P < 0.05). CONCLUSIONS The incidence of smaller SMT (especially diameter ≤ 1 cm) is high in elderly patients, but the malignant potential remains low. Therefore, for elderly patients whose diameters of SMT are no bigger than 3 cm and without obvious malignancy under endoscope or EUS, we may plan an appropriate surveillance interval based on the size of tumor during a long follow-up period.

AIMTo determine whether serum levels of carcinoembryonic antigen (CEA) correlate with the presence of primary colorectal cancer (CRC), and/or recurrent CRC following radical resection.METHODSA total of 413 patients with CRC underwent radical surgery between January 1998 and December 2002 in our department and were enrolled in this study. The median follow-up period was 69 mo (range, 3-118 mo), and CRC recurrence was experienced by 90/413 (21.8%) patients. Serum levels of CEA were assayed preoperatively, and using a cutoff value of 5 ng/mL, patients were divided into two groups, those with normal serum CEA levels (e.g., ≤ 5 ng/mL) and those with elevated CEA levels (> 5 ng/mL).RESULTSThe overall sensitivity of CEA for the detection of primary CRC was 37.0%. The sensitivity of CEA according to stage, was 21.4%, 38.9%, and 41.7% for stages I-III, respectively. Moreover, for stage II and stage III cases, the 5-year disease-free survival rates were reduced for patients with elevated preoperative serum CEA levels (P < 0.05). The overall sensitivity of CEA for detecting recurrent CRC was 54.4%, and sensitivity rates of 36.6%, 66.7%, and 75.0% were associated with cases of local recurrence, single metastasis, and multiple metastases, respectively. In patients with normal serum levels of CEA preoperatively, the sensitivity of CEA for detecting recurrence was reduced compared with patients having a history of elevated CEA prior to radical resection (32.6% vs 77.3%, respectively, P < 0.05).CONCLUSIONCRC patients with normal serum CEA levels prior to resection maintained these levels during CRC recurrence, especially in cases of local recurrence vs cases of metastasis.

OBJECTIVE To assess the differential diagnostic value of serum intestinal fatty acid binding protein (I-FABP) in distinguishing intestinal ischemia patients from acute abdomen patients. METHODS A total of 151 patients with acute abdomen and 17 healthy controls from the PLA General Hospital were enrolled from November, 2009 to August, 2011. Serum I-FABP levels were measured by ELISA. According to the ROC curve, the cut-off value, sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS Of the 151 acute abdomen patients, there were 24 intestinal ischemia patients and 127 without intestinal ischemia. Serum I-FABP level in intestinal ischemia group [(109.67 ± 48.82) µg/L] was significantly higher than those in patients without intestinal ischemia [(36.78 ± 11.25) µg/L] and healthy controls[(8.33 ± 6.25) µg/L](all P values < 0.01). The serum I-FABP cut-off value for the diagnosis of intestinal ischemia was 87.52 µg/L. Serum I-FABP was efficient in terms of sensitivity (0.762), NPV(0.963), PLR(3.05) and NLR (0.24) in the diagnosis of intestinal ischemia. CONCLUSION I-FABP is potentially useful for discriminating intestinal ischemia from acute abdomen.

1病例摘要 现病史:患者男性,82岁,主因“间断上腹部不适20余年,胃窦早癌根治术后1月余”于2011年7月18日入院.患者自1987年起出现上腹部不适,多次胃镜检查提示胃窦慢性萎缩性胃炎.

OBJECTIVE:To investigate the prognostic and relapsing factors of ulcerative colitis by a 5-year population-based follow-up. METHODS:A total of 525 patients diagnosed with ulcerative colitis during the period from 1994 to 2005 at our hospital were recruited and followed prospectively for 5 years or until a relapse. The evaluation at 5 years included interview, clinical examination, laboratory tests and colonoscopy. RESULTS:Among these patients, 367 patients suffered from a relapse of ulcerative colitis with a median age of 42 years old. And 263 (50.1%) patients took part in the follow-up study. The median duration of maintenance treatment was (16.3±3.9) months. The proportion of relapse was significant greater in females (P<0.05) and in patients over 60 years old versus those under 60 (P<0.05). The value of CRP was unrelated with the relapsing rate (P>0.05). During the follow-up, 36.5% of the patients relapsed within 12 months, 75.3% within 2 years and 87.8% within 5 years. And 61.5% of the patients relapsed after drug withdrawal, 11.3% in maintenance treatment and 27.2% with no treatment. Severity, extent of disease and duration of maintenance treatment showed significant differences between the relapsing group and relapsing-free groups (P<0.05). CONCLUSION:The relapsing factors of ulcerative colitis are gender, age, severity, extent of disease and duration of maintenance treatment.

To provide the evidence of predicting and preventing the postoperative recurrence by investigating the relationship between the recurring types of colorectal carcinoma (CRC) after radical resection and clinicopathologic factors.

目的:通过探讨结直肠癌根治术后患者的复发类型与临床病理因素之间的关系,为预防结直肠根治术后复发提供依据.方法:收集本院1998年1月至2002年12月期间,行根治性手术且临床病理证实为Ⅰ至Ⅲ期的结直肠癌464例患者,对术后复发的90例患者的临床病理资料进行回顾性分析,并按复发时间,分为两组.复发时间≤30个月定为早期复发组,＞30个月为晚期复发组.单因素分析采用χ~2检验,多因素分析采用二分类Logistic回归分析.结果:早期复发78例(86%),晚期复发12例(14%).I期结直肠癌的中位复发时间为35.1个月,Ⅱ期、Ⅲ期分别为13.6个月、12.9个月,在复发时间上具有显著性差异(P=0.001).复发中位时间为17.4个月.其中,局部复发中位时间为16.9个月,单发转移中位时间为13.3个月,多发转移中位时间为7.7个月.单因素分析显示原发肿瘤浸润深度、淋巴结转移数及肿瘤的肉眼类型是影响肿瘤复发的因素,多因素分析显示肿瘤浸润深度是影响早期复发时间的独立因素(P=0.049).结论:大部分结直肠癌术后复发发生在术后30个月内,但仍有部分患者属于晚期复发.术后早期复发者以远处转移为主,晚期复发以局部复发为主.肿瘤浸润深度是影响结肠癌术后复发时间的独立因素,肿瘤浸润至浆膜层及浆膜外是结直肠癌早期复发的独立相关因素.

Objective To study the correlation of serum carcinoembryonic antigen(CEA) level with the prognosis and relapse of colorectal cancer(CRC) after operation.Methods A total of 464 consecutive patients with CRC after radical surgery included in this study were retrospectively analyzed.Cox multivariate regression model was used to observe independent predicting factors for the prognosis of CRC.Receiver operating characteristic curve(ROC) was used to evaluate the cutoff value of S-CEA level as a predicting factor for the prognosis of CRC.Results Multivariate analysis showed that elevated CEA level before operation was the independent predicting factor for the relapse of CRC(P=0.01).The cutoff value of CEA level(4.1μg/L) in ⅢB stage CRC patients before operation was found to be a predicting factor for the prognosis of CRC,with a sensitivity of 69% and a specificity of 80%.The CEA level was elevated in 36.6% patients with local recurrence,in 66.7% patients with single organ metastasis,and in 75.0% in patients with multi-organ metastasis,respectively,after operation.Conclusion Preoperative serum CEA level is a reliable predictive factor for the recurrence of CRC after radical operation.As a predicting factor for the relapse and prognosis of CRC,the cutoff value of serum CEA level may be used as a diagnostic index different from the current diagnostic criteria for CRC.CEA test provides a method for the early detection of relapse,especially distant metastasis of CRC.