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Perioperative Carcinoembryonic Antigen Measurements to Predict Curability After Liver Resection for Colorectal MetastasesA Prospective Study
Elie Oussoultzoglou, MD;
Edoardo Rosso, MD;
Pascal Fuchshuber, MD, PhD;
Victor Stefanescu, MD;
Bala Diop, MD;
Giorgio Giraudo, MD;
Patrick Pessaux, MD, PhD;
Philippe Bachellier, MD;
Daniel Jaeck, MD, PhD
Arch Surg. 2008;143(12):1150-1158.
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.
Author Affiliations: Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg–Université 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).
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Perioperative Carcinoembryonic Antigen Measurements to Predict Curability After Liver Resection for Colorectal Metastases—Invited Critique
Anton J. Bilchik
Arch Surg. 2008;143(12):1158-1159.
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