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Increased carcinoembryonic antigen (CEA) following neoadjuvant chemotherapy predicts poor prognosis in patients that undergo hepatectomy for liver-only colorectal metastases

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Abstract

Background

The importance of preoperative chemotherapy in a multimodality management of patients with colorectal liver metastases (CRLM) has been demonstrated. We analyse the carcinoembryonic antigen (CEA) changes following neoadjuvant chemotherapy in patients with CRLM who underwent liver resection.

Methods

The final cohort included 107 eligible patients. Increased CEA levels following neoadjuvant chemotherapy were defined as the increase of baseline CEA level at diagnosis of CRLM compared with the CEA level after completion of neoadjuvant chemotherapy. Disease-free survival (DFS), post-recurrence survival (PRS) and overall survival (OS) were calculated using both Kaplan-Meier and multivariate Cox-regression methods.

Results

CEA increase was associated with decreased PRS and OS (HR 2.69; 95 % CI, 1.28–5.63; p = 0.009, and HR 2.50; 95 % CI, 1.12–5.56; p = 0.025, respectively) in multivariate analysis, but there was no association between CEA changes and DFS. CEA increase was only associated with disease progression during preoperative chemotherapy (p = 0.014). Interestingly, this association was not absolute, as only 5 of the 11 patients with disease progression demonstrated CEA increase. Regarding the remaining 12 patients with CEA increase, according to RECIST criteria, eight patients demonstrated partial response and four patients stable disease.

Conclusion

In this study, we demonstrated the CEA increase following neoadjuvant chemotherapy as an adverse prognostic factor for PRS, and OS but not for DFS in patients undergoing liver resection for liver-only colorectal metastases.

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Authors’ contributions

Kyriakos Neofytou: conception and design of research, preparation of manuscript, statistical analysis

Alexandros Giakoustidis: conception and design of research, preparation of manuscript

Mafalda Costa Neves: preparation of manuscript

Dawn Morrison: preparation of manuscript

Dimitris Giakoustidis: critical review of manuscript

Aamir Z Khan: critical review of manuscript

Justin Stebbing: critical review of manuscript

Satvinder Mudan: conception and design of research, preparation of manuscript, critical review and approval of manuscript

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Authors and Affiliations

  1. Department of Academic Surgery, Royal Marsden Hospital, Fulham Road, London, UK

    Kyriakos Neofytou, Alexandros Giakoustidis, Mafalda Costa Neves, Aamir Z. Khan & Satvinder Mudan

  2. The London Clinic, 20 Devonshire Place, London, UK

    Alexandros Giakoustidis, Mafalda Costa Neves, Dawn Morrison & Satvinder Mudan

  3. Department of Surgery and Transplantation, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitris Giakoustidis

  4. Department of Oncology, Imperial College Healthcare National Health Service Trust, Charring Cross Hospital, Fulham Palace Rd, London, UK

    Justin Stebbing

  5. Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK

    Satvinder Mudan

Authors
  1. Kyriakos Neofytou
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  2. Alexandros Giakoustidis
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  3. Mafalda Costa Neves
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  4. Dawn Morrison
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  5. Dimitris Giakoustidis
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  6. Aamir Z. Khan
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  7. Justin Stebbing
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  8. Satvinder Mudan
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Corresponding author

Correspondence to Alexandros Giakoustidis.

Ethics declarations

This article does not contain any studies with human participants or animals performed by any of the authors.

Funding

Supported by the National Institute for Health Research Royal Marsden/Institute for Cancer Research Biomedical Research Centre

Conflicts of interest

All the authors declare no conflict of interest related to the present research.

Additional information

Mr. Neofytou and Mr. Giakoustidis contributed equally.

Synopsis

We analyse the CEA changes following neoadjuvant chemotherapy in patients with CRLM who underwent liver resection. CEA increase following neoadjuvant chemotherapy appears to be an independent prognostic factor associated with both PRS and OS in patients with liver-only colorectal metastases who undergo curative liver resection.

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Neofytou, K., Giakoustidis, A., Neves, M.C. et al. Increased carcinoembryonic antigen (CEA) following neoadjuvant chemotherapy predicts poor prognosis in patients that undergo hepatectomy for liver-only colorectal metastases. Langenbecks Arch Surg 402, 599–605 (2017). https://doi.org/10.1007/s00423-016-1415-2

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  • DOI: https://doi.org/10.1007/s00423-016-1415-2

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