Abstract
Surgical tumor resection has evolved as a potentially curative therapy for patients with resectable colorectal liver metastases (CRLM). However, disease recurrence is common and the available preoperative stratification strategies are often imprecise to identify the ideal candidates for surgical treatment, resulting in a postoperative 5-year survival rate below 50%. Data on the prognostic value of CEA, CA19-9 and other common laboratory parameters after CRLM resection are scarce and partly inconclusive. Here, we analyzed the prognostic potential of circulating CEA and CA19-9 in comparison to other standard laboratory markers in resectable CRLM patients. Serum levels of tumor markers and other laboratory parameters were analyzed in 125 patients with CRLM undergoing tumor resection at a tertiary referral center. Results were correlated with clinical data and outcome. Both tumor markers were significantly elevated in CRLM patients compared to healthy controls. Interestingly, elevated levels of CEA, CA19-9 and C-reactive protein (CRP) were associated with an unfavorable prognosis after CRLM resection in Kaplan–Meier curve analysis. However, only CEA and not CA19-9 or CRP serum levels were an independent prognostic marker in multivariate Cox regression analysis. Our data demonstrate that circulating levels of CEA rather than CA19-9 might be a valuable addition to the existing preoperative stratification algorithms to identify patients with a poor prognosis after CRLM resection.
Highlights
Colorectal cancer (CRC) represents one of the most common types of cancer worldwide
Most studies showed that low pre-treatment carcinoembryonic antigen (CEA) levels are associated with a good patients’ outcome [21], but only very few data are available on the predictive role of CEA measurements in colorectal liver metastases (CRLM) patients undergoing curatively intended liver surgery, supporting further analyses addressing this question in large and well-characterized cohorts of patients [22,23]
Even if complete tumor resection is performed, about half of the patients will develop recurrent systemic disease within 3 years of resection, suggesting that not all CRLM patients will benefit from extensive liver surgery and that appropriate patient selection remains the key factor in the surgical management of CRLM patients [25]
Summary
Colorectal cancer (CRC) represents one of the most common types of cancer worldwide. In 2012, there were 447,000 new cases of CRC in Europe and over 1.4 million new cases worldwide, leading to 694,000 deaths [1]. Even after successful, curatively indented resection of colorectal liver metastases (CRLM), about 65% of patients develop hepatic relapse within three years after surgery [2,5,6]. In this context, decisions for or against tumor resection in CRLM patients are often conflictive and challenging. Current guidelines recommend that both “oncological“(prognostic) and “technical“ (surgical) criteria should be considered when evaluating patients for surgery [4,7,8] Both terms are only poorly defined, and prospective evaluations are missing, leaving the physician with a high degree of uncertainty when evaluating whether a CRLM patient will benefit from surgical resection in terms of overall survival
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