Abstract
Carcinoembryonic antigen (CEA) is the best circulating tumour marker for colorectal liver metastasis (CLM) but has suboptimal sensitivity and specificity. Circulating type IV collagen (COLIV) is a new potential CLM marker. Here, COLIV and CEA were measured in patients with resectable CLM. COLIV levels were also related to the type of CLM. The prognostic value of these markers and the type of CLM on survival was evaluated. Preoperative plasma samples (n = 94) from patients (n = 85) with CLM undergoing liver resection were used. Seven patients underwent repeated liver resection. Samples from 118 healthy individuals served as control. Samples after liver resection (n = 27) were analysed and related to recurrence. COLIV and CEA levels were analysed, and the type of CLM was classified using paraffinated tissue. Results were analysed by logistic regression and receiver operating characteristic (ROC) curve analysis. CLM patients had significantly elevated levels of COLIV compared to controls (p = 0.001). The sensitivity of COLIV was not better than CEA, but improved sensitivity for detecting CLM was observed with a combination of the two markers compared to using either marker alone (p = 0.001). Circulating COLIV was elevated in 81 % and CEA in 56 % of CLM patients at diagnosis, and high marker levels were related to poor survival. In follow-up samples (n = 27), patients with CLM recurrence (n = 14) had significantly elevated COLIV levels compared to patients without postoperative recurrence (n = 10) (p = 0.001). COLIV is a promising tumour marker for CLM and can possibly be used to detect postoperative CLM recurrence. The combination of COLIV and CEA is superior to either marker alone in detecting CLM.Electronic supplementary materialThe online version of this article (doi:10.1007/s13277-015-3729-z) contains supplementary material, which is available to authorized users.
Highlights
Circulating tumour markers can be used as tools for detecting disease, defining prognosis and predicting the effect of treatment and in the follow-up and surveillance of cancer patients
Patients with primary colorectal cancer (CRC) do not have increased type IV collagen levels, which indicate that the increased type IV collagen levels are related to the liver metastatic process itself
It is shown that the preoperative circulating type IV collagen levels in patients with resectable colorectal liver metastases (CLM) are significantly elevated when compared to healthy controls
Summary
Circulating tumour markers can be used as tools for detecting disease, defining prognosis and predicting the effect of treatment and in the follow-up and surveillance of cancer patients. For colorectal cancer (CRC) and colorectal liver metastases (CLM), the most commonly used circulating biomarker is carcinoembryonic antigen (CEA). This biomarker is mainly used to detect recurrence of CRC and not for screening due to low sensitivity and specificity [1, 2]. At CRC recurrence, 50– 60 % of patients have increased levels of CEA and this tumour marker is more sensitive in detecting CLM and lymph node metastases than a local recurrence or lung metastases [1,2,3]. Other circulating tumour markers have been presented, but none has yet fulfilled the criteria of high sensitivity and specificity, combined with a stable and reproducible method of analysis and measurements from an accessible compartment, such as blood or urine
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