Perioperative Carcinoembryonic Antigen Measurements to Predict Curability After Liver Resection for Colorectal Metastases: A Prospective Study | Cancer Biomarkers | JAMA Surgery | JAMA Network
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Jaeck  DBachellier  PGuiguet  M  et al. Association Francaise de Chirurgie, Long-term survival following resection of colorectal hepatic metastases.  Br J Surg 1997;84 (7) 977- 980PubMedGoogle ScholarCrossref
Abdalla  EKVauthey  JNEllis  LM  et al.  Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases.  Ann Surg 2004;239 (6) 818- 827PubMedGoogle ScholarCrossref
Nordlinger  BGuiguet  MVaillant  JC  et al. Association Francaise de Chirurgie, Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients.  Cancer 1996;77 (7) 1254- 1262PubMedGoogle ScholarCrossref
Fong  YFortner  JSun  RLBrennan  MFBlumgart  LH Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.  Ann Surg 1999;230 (3) 309- 321PubMedGoogle ScholarCrossref
Sugihara  KHojo  KMoriya  YYamasaki  SKosuge  TTakayama  T Pattern of recurrence after hepatic resection for colorectal metastases.  Br J Surg 1993;80 (8) 1032- 1035PubMedGoogle ScholarCrossref
Scheele  JStang  RAltendorf-Hofmann  APaul  M Resection of colorectal liver metastases.  World J Surg 1995;19 (1) 59- 71PubMedGoogle ScholarCrossref
Jenkins  LTMillikan  KWBines  SDStaren  EDDoolas  A Hepatic resection for metastatic colorectal cancer.  Am Surg 1997;63 (7) 605- 610PubMedGoogle Scholar
Taylor  MForster  JLanger  BTaylor  BRGreig  PDMahut  C A study of prognostic factors for hepatic resection for colorectal metastases.  Am J Surg 1997;173 (6) 467- 471PubMedGoogle ScholarCrossref
Cady  BJenkins  RLSteele  GD  Jr  et al.  Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome.  Ann Surg 1998;227 (4) 566- 571PubMedGoogle ScholarCrossref
Iwatsuki  SDvorchik  IMadariaga  JR  et al.  Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system.  J Am Coll Surg 1999;189 (3) 291- 299PubMedGoogle ScholarCrossref
Weber  SMJarnagin  WRDeMatteo  RPBlumgart  LHFong  Y Survival after resection of multiple hepatic colorectal metastases.  Ann Surg Oncol 2000;7 (9) 643- 650PubMedGoogle ScholarCrossref
Weber  JCSchneider  ARohr  S  et al.  Analysis of allelic imbalance in patients with colorectal cancer according to stage and presence of synchronous liver metastases.  Ann Surg 2001;234 (6) 795- 803PubMedGoogle ScholarCrossref
Weber  JCNakano  HBachellier  P  et al.  Is a proliferation index of cancer cells a reliable prognostic factor after hepatectomy in patients with colorectal liver metastases?  Am J Surg 2001;182 (1) 81- 88PubMedGoogle ScholarCrossref
Jaeck  DNakano  HBachellier  P  et al.  Significance of hepatic pedicle lymph node involvement in patients with colorectal liver metastases: a prospective study.  Ann Surg Oncol 2002;9 (5) 430- 438PubMedGoogle ScholarCrossref
Yamaguchi  JKomuta  KMatsuzaki  SOkudaira  SFujioka  HKanematsu  T Mode of infiltrative growth of colorectal liver metastases is a useful predictor of recurrence after hepatic resection.  World J Surg 2002;26 (9) 1122- 1125PubMedGoogle ScholarCrossref
Choti  MASitzmann  JVTiburi  MF  et al.  Trends in long-term survival following liver resection for hepatic colorectal metastases.  Ann Surg 2002;235 (6) 759- 766PubMedGoogle ScholarCrossref
Mala  TBøhler  GMathisen  ØBergan  ASøreide  O Hepatic resection for colorectal metastases: can preoperative scoring predict patient outcome?  World J Surg 2002;26 (11) 1348- 1353PubMedGoogle ScholarCrossref
Sasaki  AAramaki  MKawano  KYasuda  KInomata  MKitano  S Prognostic significance of intrahepatic lymphatic invasion in patients with hepatic resection due to metastases from colorectal carcinoma.  Cancer 2002;95 (1) 105- 111PubMedGoogle ScholarCrossref
Weber  JCBachellier  POussoultzoglou  EJaeck  D Simultaneous resection of colorectal primary tumour and synchronous liver metastases.  Br J Surg 2003;90 (8) 956- 962PubMedGoogle ScholarCrossref
Nagakura  SShirai  YYokoyama  NWakai  TSuda  THatakeyama  K Major hepatic resection reduces the probability of intrahepatic recurrences following resection of colorectal carcinoma liver metastases.  Hepatogastroenterology 2003;50 (51) 779- 783PubMedGoogle Scholar
Tanaka  KShimada  HMiura  M  et al.  Metastatic tumor doubling time: most important prehepatectomy predictor of survival and nonrecurrence of hepatic colorectal cancer metastasis.  World J Surg 2004;28 (3) 263- 270PubMedGoogle ScholarCrossref
Mann  CDMetcalfe  MSLeopardi  LNMaddern  GJ The clinical risk score: emerging as a reliable preoperative prognostic index in hepatectomy for colorectal metastases.  Arch Surg 2004;139 (11) 1168- 1172PubMedGoogle ScholarCrossref
Pawlik  TMScoggins  CRZorzi  D  et al.  Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases.  Ann Surg 2005;241 (5) 715- 724PubMedGoogle ScholarCrossref
Nagashima  ITakada  TNagawa  HMuto  TOkinaga  K Proposal of a new and simple staging system of colorectal liver metastasis.  World J Gastroenterol 2006;12 (43) 6961- 6965PubMedGoogle Scholar
Poston  GJAdam  RAlberts  S  et al.  OncoSurge: a strategy for improving resectability with curative intent in metastatic colorectal cancer.  J Clin Oncol 2005;23 (28) 7125- 7134PubMedGoogle ScholarCrossref
Zeng  ZCohen  AMUrmacher  C Usefulness of carcinoembryonic antigen monitoring despite normal preoperative values in node-positive colon cancer patients.  Dis Colon Rectum 1993;36 (11) 1063- 1068PubMedGoogle ScholarCrossref
Compton  CFenoglio-Preiser  CMPettigrew  NFielding  LP American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group.  Cancer 2000;88 (7) 1739- 1757PubMedGoogle ScholarCrossref
Bast  RC  JrRavdin  PHayes  DF  et al. American Society of Clinical Oncology Tumor Markers Expert Panel, 2000 update of recommendations for the use of tumor markers in breast and colorectal cancer: clinical practice guidelines of the American Society of Clinical Oncology [published corrections appear in J Clin Oncol. 2001;19(21):4185-4188 and 2002;20(8):2213].  J Clin Oncol 2001;19 (6) 1865- 1878PubMedGoogle Scholar
Duffy  MJvan Dalen  AHaglund  C  et al.  Clinical utility of biochemical markers in colorectal cancer: European Group on Tumour Markers (EGTM) guidelines.  Eur J Cancer 2003;39 (6) 718- 727PubMedGoogle ScholarCrossref
Choi  JSMin  JS Significance of postoperative serum level of carcinoembryonic antigen (CEA) and actual half life of CEA in colorectal cancer patients.  Yonsei Med J 1997;38 (1) 1- 7PubMedGoogle Scholar
Lokich  JEllenberg  SGerson  BKnox  WEZamcheck  N Plasma clearance of carcinoembryonic antigen following hepatic metastatectomy.  J Clin Oncol 1984;2 (5) 462- 465PubMedGoogle Scholar
Hohenberger  PSchlag  PMGerneth  THerfarth  C Pre- and postoperative carcinoembryonic antigen determinations in hepatic resection for colorectal metastases: predictive value and implications for adjuvant treatment based on multivariate analysis.  Ann Surg 1994;219 (2) 135- 143PubMedGoogle ScholarCrossref
Jaeck  DBachellier  PNakano  H  et al.  One or two-stage hepatectomy combined with portal vein embolization for initially nonresectable colorectal liver metastases.  Am J Surg 2003;185 (3) 221- 229PubMedGoogle ScholarCrossref
Jaeck  DOussoultzoglou  ERosso  EGreget  MWeber  JCBachellier  P A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases.  Ann Surg 2004;240 (6) 1037- 1051PubMedGoogle ScholarCrossref
Couinaud  C Le Foie: Etudes Anatomiques et Chirurgicales.  Paris, France Masson1957;
Kim  SBFernandes  LCSaad  SSMatos  D Assessment of the value of preoperative serum levels of CA 242 and CEA in the staging and postoperative survival of colorectal adenocarcinoma patients.  Int J Biol Markers 2003;18 (3) 182- 187PubMedGoogle Scholar
Carpelan-Holmström  MLouhimo  JStenman  UHAlfthan  HJärvinen  HHaglund  C CEA, CA 242, CA 19-9, CA 72-4 and hCGβ in the diagnosis of recurrent colorectal cancer.  Tumour Biol 2004;25 (5-6) 228- 234PubMedGoogle ScholarCrossref
Fernandes  LCKim  SBSaad  SSMatos  D Value of carcinoembryonic antigen and cytokeratins for the detection of recurrent disease following curative resection of colorectal cancer.  World J Gastroenterol 2006;12 (24) 3891- 3894PubMedGoogle Scholar
Takeda  AShimada  HImaseki  H  et al.  Clinical significance of serum vascular endothelial growth factor in colorectal cancer patients: correlation with clinicopathological factors and tumor markers.  Oncol Rep 2000;7 (2) 333- 338PubMedGoogle Scholar
Hammel  PBoissier  BChaumette  MT  et al.  Detection and monitoring of serum p53 antibodies in patients with colorectal cancer.  Gut 1997;40 (3) 356- 361PubMedGoogle Scholar
Wolmark  NFisher  BWieand  HS  et al.  The prognostic significance of preoperative carcinoembryonic antigen levels in colorectal cancer: results from NSABP (National Surgical Adjuvant Breast and Bowel Project) clinical trials.  Ann Surg 1984;199 (4) 375- 382PubMedGoogle ScholarCrossref
Wang  WSLin  JKChiou  TJ  et al.  Preoperative carcinoembryonic antigen level as an independent prognostic factor in colorectal cancer: Taiwan experience.  Jpn J Clin Oncol 2000;30 (1) 12- 16PubMedGoogle ScholarCrossref
Reiter  WStieber  PReuter  CNagel  DLau-Werner  ULamerz  R Multivariate analysis of the prognostic value of CEA and CA 19-9 serum levels in colorectal cancer.  Anticancer Res 2000;20 ((6D)) 5195- 5198PubMedGoogle Scholar
Sasaki  AIwashita  YShibata  KMatsumoto  TOhta  MKitano  S Analysis of preoperative prognostic factors for long-term survival after hepatic resection of liver metastasis of colorectal carcinoma.  J Gastrointest Surg 2005;9 (3) 374- 380PubMedGoogle ScholarCrossref
Aldrighetti  LCastoldi  RDi Palo  S  et al.  Prognostic factors for long-term outcome of hepatic resection for colorectal liver metastases.  Chir Ital 2005;57 (5) 555- 570PubMedGoogle Scholar
Chu  DZErickson  CARussell  MP  et al.  Prognostic significance of carcinoembryonic antigen in colorectal carcinoma: serum levels before and after resection and before recurrence.  Arch Surg 1991;126 (3) 314- 316PubMedGoogle ScholarCrossref
Onik  GRubinsky  BZemel  R  et al.  Ultrasound-guided hepatic cryosurgery in the treatment of metastatic colon carcinoma: preliminary results.  Cancer 1991;67 (4) 901- 907PubMedGoogle ScholarCrossref
Bakalakos  EABurak  WE  JrYoung  DCMartin  EW  Jr Is carcino-embryonic antigen useful in the follow-up management of patients with colorectal liver metastases?  Am J Surg 1999;177 (1) 2- 6PubMedGoogle ScholarCrossref
Kahlenberg  MSSullivan  JMWitmer  DDPetrelli  NJ Molecular prognostics in colorectal cancer.  Surg Oncol 2003;12 (3) 173- 186PubMedGoogle ScholarCrossref
Park  YASohn  SKSeong  J  et al.  Serum CEA as a predictor for the response to preoperative chemoradiation in rectal cancer.  J Surg Oncol 2006;93 (2) 145- 150PubMedGoogle ScholarCrossref
Park  YALee  KYKim  NKBaik  SHSohn  SKCho  CW Prognostic effect of perioperative change of serum carcinoembryonic antigen level: a useful tool for detection of systemic recurrence in rectal cancer.  Ann Surg Oncol 2006;13 (5) 645- 650PubMedGoogle ScholarCrossref
Fortner  JGSilva  JSGolbey  RBCox  EBMaclean  BJ Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer, I: treatment by hepatic resection.  Ann Surg 1984;199 (3) 306- 316PubMedGoogle ScholarCrossref
Ito  KHibi  KAndo  H  et al.  Usefulness of analytical CEA doubling time and half-life time for overlooked synchronous metastases in colorectal carcinoma.  Jpn J Clin Oncol 2002;32 (2) 54- 58PubMedGoogle ScholarCrossref
Nagashima  ITakada  TAdachi  MNagawa  HMuto  TOkinaga  K Proposal of criteria to select candidates with colorectal liver metastases for hepatic resection: comparison of our scoring system to the positive number of risk factors.  World J Gastroenterol 2006;12 (39) 6305- 6309PubMedGoogle Scholar
Original Article
December 15, 2008

Perioperative Carcinoembryonic Antigen Measurements to Predict Curability After Liver Resection for Colorectal Metastases: A Prospective Study

Author Affiliations

Author Affiliations: Centre de Chirurgie Visc[[eacute]]rale et de Transplantation, H[[ocirc]]pital de Hautepierre, H[[ocirc]]pitaux Universitaires de Strasbourg[[ndash]]Universit[[eacute]] Louis Pasteur, Strasbourg, France (Drs Oussoultzoglou, Rosso, Stefanescu, Diop, Giraudo, Pessaux, Bachellier, and Jaeck); and Department of Surgical Oncology, The Permanente Medical Group, Walnut Creek, California (Dr Fuchshuber).

Arch Surg. 2008;143(12):1150-1158. doi:10.1001/archsurg.143.12.1150

Hypothesis  Perioperative carcinoembryonic antigen (CEA) blood level is a predictor of outcome after resection of colorectal liver metastases (CLMs).

Design  Prospective clinical study.

Setting  Department of digestive surgery and transplantation.

Patients  Between January 1, 2000, and December 31, 2004, CEA levels were routinely measured 1 week before and 6 weeks after CLM resection in 213 patients. The patients were divided into the following 3 groups: group A (n = 69) with normal preoperative and postoperative CEA levels, group B (n = 111) with elevated preoperative and normal postoperative CEA levels, and group C (n = 33) with elevated preoperative and postoperative CEA levels.

Main Outcome Measures  The use of perioperative CEA levels to predict outcome after resection.

Results  The median survival was 45.4 months. The 5-year overall and disease-free survival rates were 50.2% and 21.9%, respectively, in group A, 38.5% and 18.3% in group B, and 0.0% and 0.0% in group C (P < .001). Univariate analysis showed that patients with elevated preoperative and postoperative CEA levels, multiple CLMs, large CLMs (≥5 cm), advanced Fong clinical risk score, bilobar distribution, and hepatic pedicle lymph node involvement had significantly poorer overall and disease-free survival. By multivariate analysis, only perioperative CEA level, hepatic pedicle lymph node involvement, and number and size of CLMs were independent prognostic factors. The 5-year survival rates showed good correlation with perioperative CEA levels in all 3 patient groups.

Conclusions  The predictive value of perioperative CEA levels is demonstrated. Carcinoembryonic antigen levels as early as 6 weeks after surgery may be helpful in assigning patients to adjuvant chemotherapy after resection of CLMs.