Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications?

Sasaki, Kazunari; Margonis, Georgios Antonios; Andreatos, Nikolaos; Wilson, Ana; Gani, Faiz; Amini, Neda; Pawlik, Timothy M.

doi:10.1016/j.hpb.2016.09.004

Cited by 27 publications

(11 citation statements)

References 36 publications

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“…Nonetheless, recent studies suggest that local therapy for liver metastases might still benefit patients with extrahepatic disease; as such, the use of RFA with or without concurrent resection might be a reasonable option in this setting (32,33). Previous studies have also identified a high serum CEA level as a predictor of poor prognosis in CRLM patients (12,(34)(35)(36)(37). This finding was confirmed in the present study for all patients, irrespective of tumor number.…”

Section: Discussionsupporting

confidence: 83%

Combined Hepatic Resection and Radio-frequency Ablation for Patients with Colorectal Cancer Liver Metastasis: A Viable Option for Patients with a Large Number of Tumors

et al. 2018

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Background/Aim: Radiofrequency ablation (RFA) is thought to result in inferior prognosis than hepatic resection among patients with colorectal liver metastasis (CRLM). However, resection plus RFA may be an option for patients with a large number of tumors (≥4 liver lesions) and borderline resectability. Materials and Methods: A total of 717 patients with CRLM who underwent hepatic resection +/-RFA at two tertiary institutions between 09/01/2000-12/01/2015 were eligible for inclusion in this study. Results: Among patients with <4 lesions (n=568), OS in the resection + RFA group (n=48) was significantly worse than in the resection alone group (n=520) (5-year OS: 34.4 % versus 58.9%, p=0.007). Conversely, in patients with ≥4 lesions, OS in the resection + RFA (n=68) and resection alone(n=81) groups were not significantly different (5-year OS: 31.9% versus 34.1%, p=0.48). In patients with <4 lesions, carcinoembryonic antigen (CEA) ≥30 ng/ml, extrahepatic metastasis, preoperative chemotherapy and resection + RFA were independently associated with poor prognosis. Interestingly, in patients with ≥4 lesions, positive primary lymph nodes, KRAS mutation, CEA ≥30 ng/ml and extrahepatic metastasis were independent predictors of poor prognosis; however, the combination of hepatic resection with RFA was not associated with worse survival (p=0.93). Conclusion: Although surgeons should always strive for R0 resection when feasible, combined resection and RFA may be a viable alternative for CRLM patients with a large number of tumors. Currently, the principal treatment strategy for patients with colorectal cancer liver metastasis (CRLM) is systemic chemotherapy, while hepatic resection can further improve survival in carefully selected patients (1-5). On the contrary, many reports concur that radio-frequency ablation (RFA) results in inferior outcomes than hepatic resection in patients with CRLM and should only be employed when surgical resection cannot be performed (6-9). Nonetheless, the presence of extensive metastatic tumor number in the liver, (especially four or more lesions) often precludes a curative hepatic resection due to either technical challenges or inadequate remnant liver function and is a wellknown poor prognostic factor (4, 5, 10-12). In fact, historically, specifically ≥4 CRLM, was considered to be a contraindication for liver resection (13, 14). Similarly, a study on a contemporary cohort (treated after 2005) demonstrated that the prognosis of patients with ≥4 CRLM who undergo surgery has not improved despite the development of modern chemotherapies (14). Interestingly, our group and others have demonstrated that hepatectomy + RFA may achieve long-term outcomes that are comparable to hepatectomy alone (15, 16). Nonetheless, the impact of combined resection and RFA on survival among patients with different levels of tumor number 6353 This article is freely accessible online.

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Section: Discussionsupporting

confidence: 83%

Combined Hepatic Resection and Radio-frequency Ablation for Patients with Colorectal Cancer Liver Metastasis: A Viable Option for Patients with a Large Number of Tumors

et al. 2018

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“…Therefore, optimal preoperative prognostic models for patient selection are required. The present study demonstrated that preoperative factors including primary tumor location, preoperative CEA level, number of liver metastases, tumor grade and positive lymph node by imaging were independent indicators to predict survival benefit from surgery, which was in line with findings of certain reports (16)(17)(18). Notably, there was no significant difference in OS between the patients receiving neoadjuvant chemoradiotherapy (nCRT) or not.…”

Section: Discussionsupporting

confidence: 90%

Preoperative nomogram to predict survival following colorectal cancer liver metastasis simultaneous resection

Meng¹,

Zheng²,

Wen³

et al. 2021

J Gastrointest Oncol

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Background: Simultaneous resection for patients with synchronous colorectal cancer liver metastases (CRLM) remains an optimal option for the sake of curability. However, few studies so far focus on outcome of this subgroup of patients (who receive simultaneous resection for CRLM). Substantial heterogeneity exists among such patients and more precise categorization is needed preoperatively to identify those who may benefit more from surgery. In this study, we formulated this internally validated scoring system as an option.Methods: Clinicopathological and follow-up data of 234 eligible CRLM patients undergoing simultaneous resection from January 2010 to March 2019 in our center were included for analysis. Patients were randomized to either a training or validation cohort. We performed multivariable Cox regression analysis to determine preoperative factors with prognostic significance using data in training cohort, and a nomogram scoring system was thus established. Time-dependent receiver operating characteristic (ROC) curve and calibration plot were adopted to evaluate the predictive power of our risk model. Results:In the multivariable Cox regression analysis, five factors including presence of node-positive primary defined by enhanced CT/MR, preoperative CEA level, primary tumor location, tumor grade and number of liver metastases were identified as independent prognostic indicators of overall survival (OS) and adopted to formulate the nomogram. In the training cohort, calibration plot graphically showed good fitness between estimated and actual 1-and 3-year OS. Time-dependent ROC curve by Kaplan-Meier method showed that our nomogram model was superior to widely used Fong's score in prediction of 1-and 3-year OS (AUC 0.702 vs. 0.591 and 0.848 vs. 0.801 for 1-and 3-year prediction in validation cohort, respectively). Kaplan-Meier curves for patients stratified by the assessment of nomogram showed great discriminability (P<0.001). Conclusions:In this retrospective analysis we identified several preoperative factors affecting survival of synchronous CRLM patients undergoing simultaneous resection. We also constructed and validated a risk model which showed high accuracy in predicting 1-and 3-year survival after surgery. Our risk model is expected to serve as a predictive tool for CRLM patients receiving simultaneous resection and assist physicians to make treatment decision.

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“…Here, a CEA cut‐off value of 20 ng/ml was determined by ROC analysis. This value approximated the weighted average of the cut‐off levels detected for the 2000–2007 and 2008–2015 periods in a previous study from this group.…”

Section: Discussionmentioning

confidence: 54%

Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases

Margonis

Sasaki

Gholami

et al. 2018

British Journal of Surgery

134

110

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Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications?

Abstract: Background: The impact of prehepatectomy carcinoembryonic antigen (CEA) levels in the era of

Cited by 27 publications

References 36 publications

Combined Hepatic Resection and Radio-frequency Ablation for Patients with Colorectal Cancer Liver Metastasis: A Viable Option for Patients with a Large Number of Tumors

Combined Hepatic Resection and Radio-frequency Ablation for Patients with Colorectal Cancer Liver Metastasis: A Viable Option for Patients with a Large Number of Tumors

Preoperative nomogram to predict survival following colorectal cancer liver metastasis simultaneous resection

Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases

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