Although elevated preoperative carcinoembryonic antigen (CEA) levels are associated with a poor prognosis, little has been written regarding the correlation of CEA response following curative resection of colorectal cancer and its relationship to survival. The purpose of this study, therefore, was to retrospectively evaluate survival in three groups of patients undergoing curative resection (Dukes B and C) for colorectal carcinoma: 1) elevated preoperative CEA/elevated postoperative CEA (EL/EL); 2) elevated preoperative CEA/normal postoperative CEA (EL/NL); and 3) normal preoperative CEA/normal postoperative CEA (NL/NL). A normal CEA was defined as a value < 5.0 ng/mL. Levels were drawn the day before surgery and between 2 and 4 weeks postoperatively. Patients were evaluated for age, sex, histologic grade, CEA levels (pre and postoperative), nerve and venous invasion, tumor site, and survival. There were no significant differences with respect to age, sex, Dukes stage, tumor site, histologic grade, or incidence of nerve or vascular invasion among the three groups. Five-year survival was significantly worse for patients with elevated preoperative CEA levels compared to those with normal preoperative CEA (53% versus 64%, P < 0.05), and for the EL/EL group compared with either of the other two groups (EL/EL: 66.6 +/- 11.8; EL/NL: 87.7 +/- 10.2; Group 3: 93.4 +/- 9.5, P < 0.05 ANOVA). The results indicate that a preoperative elevated CEA, particularly one that fails to decrease to normal postoperatively following a curative resection for colorectal carcinoma, represents a poor prognostic factor. Use of the CEA response may be useful for identifying a subgroup of colorectal cancer patients who are candidates for adjuvant chemotherapy.