Relevance of CEA and LDH in relation to KRAS status in patients with unresectable colorectal liver metastases

Abstract

Background While the significance of CEA, LDH and KRAS status as individual prognostic factors for patients with metastatic colorectal cancer has been addressed, the relationship and interdependence between these prognostic factors on survival is limited. Methods Patients with unresectable colorectal liver metastases with known KRAS status, and with baseline CEA and LDH levels who were treated with hepatic arterial infusion and systemic chemotherapy were identified. Patients were divided into two groups: hepatic-only disease and extra-hepatic disease. Results A total of 193 patients were included: 121 with hepatic-only and 72 with extra-hepatic disease. In the hepatic-only group, median overall survival (OS) was 55 months. On multivariate analysis, KRAS mutated tumors [HR 1.7, p<0.05], LDH >200 U/L [HR 2.0, p<0.05] and prior chemotherapy [HR 2.1, p<0.05] had lower OS. In patients with extra-hepatic disease, median OS was 32 months. On multivariate analysis, baseline CEA >200 ng/ml [HR 2.1, p=0.051], LDH >200 U/L [HR 3.8, p<0.05] and right-sided tumors [HR 2.8, p<0.05] had lower OS. Conclusions This analysis verifies two distinct patterns in terms of biomarkers in patients with unresectable colorectal liver metastases. In patients with hepatic-only disease, KRAS mutation and elevated LDH negatively influenced survival. In patients with extra-hepatic disease, elevated LDH negatively impacted survival.

Serum tumour markers combined with clinicopathological characteristics for predicting MMR and KRAS status in 2279 Chinese colorectal cancer patients: a retrospective analysis

“…In our study, right colon (OR, 1.550; P = 0.012) and well and moderately differentiated tumours (OR, 2.203; P = 0.001) were independent predictive factors of KRAS mutations. STMs were reported to not be associated with KRAS mutations in several studies [21,27,28]. However, negative CA199 was found to be signi cantly correlated with KRAS mutations in our study.…”

Impact of Kras Mutations in Clinical Features in Colorectal Cancer

“…In the mutated KRAS group, CEA levels above 5 ng/ml were identified more frequently when compared to the wild-type KRAS group (p=0.048). A recent study does not show a correlation between CEA levels (cut-off point 200) and KRAS status among 193 patients with metastatic CRC 8 . Therefore, it is difficult to sustain the correlation between CEA levels and KRAS status due to the heterogeneity of the cutoff points, the diversified laboratory methodology employed, the number and ethnicity of patients between studies.…”

The Prognostic Value of Preoperative Serum Lactate Dehydrogenase (LDH) Levels in Patients Underwent Curative-intent Hepatectomy For Colorectal Liver Metastases: A Two-Center Cohort Study

“…The prognostic value of LDH in CRC patients has remained inconsistent between non-metastatic and metastatic settings, especially between resectable and unresectable CRLM [21][22][23]. Elevated circulating LDH level was reported to be an adverse prognostic factor in unresectable CRLM patients receiving systemic therapy or hepatic arterial infusion [24][25][26].…”