Perioperative Carcinoembryonic Antigen Measurements to Predict Curability After Liver Resection for Colorectal Metastases A Prospective Study
Fiche publication
Date publication
décembre 2008
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BACHELLIER Philippe, Pr PESSAUX Patrick
Tous les auteurs :
Oussoultzoglou E, Rosso E, Fuchshuber P, Stefanescu V, Diop B, Giraudo G, Pessaux P, Bachellier P, Jaeck D
Lien Pubmed
Résumé
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, largeCLMs( < 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.
Référence
Arch Surg. 2008 Dec;143(12):1150-8; discussion 1158-9.