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Prognostic Impact of Tumor Markers (CEA and CA19-9) on Patients with Resectable Colorectal Liver Metastases Stratified by Tumor Number and Size: Potentially Valuable Biologic Markers for Preoperative Treatment

  • Hepatobiliary Tumors
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Abstract

Background

Although patients with resectable colorectal liver metastasis (CLM), a population with good prognosis, have been treated with upfront surgery, some patients have had a poor prognosis. This study aimed to investigate biologic prognostic factors in patients with resectable CLMs.

Methods

This single-center retrospective study enrolled consecutive patients who underwent liver resection for initial CLMs at the Cancer Institute Hospital between 2010 and 2020. The study defined CLMs as resectable (tumor size < 5 cm; < 4 tumors; no extrahepatic metastasis) or borderline resectable (BR). Preoperative chemotherapy was administered to patients with BR CLMs.

Results

During the study period, 309 CLMs were classified as resectable without preoperative chemotherapy and 345 as BR with preoperative chemotherapy. For the 309 patients with resectable CLMs, the independent poor prognostic factors associated with overall survival in the multivariable analysis were high tumor marker levels (CEA ≥ 25 ng/mL and/or CA19-9 ≥ 50 U/mL; (hazard ratio [HR], 2.45; p = 0.0007), no adjuvant chemotherapy (HR, 1.69; p = 0.043), and age of 75 years or older (HR, 2.09; p = 0.012). The 5-year survival rates for the patients with high tumor marker (TM) levels (CEA ≥25 ng/mL and/or CA19-9 ≥50 U/mL) were significantly worse than for those with low TM levels (CEA < 25 ng/mL and CA19-9 < 50 U/mL) (55.3% vs. 81.1%; p <0.0001) and similar to the rate for those with BR CLMs (52.1%; p = 0.864). Postoperative adjuvant chemotherapy had an impact on prognosis only in the high-TM group (HR, 2.65; p = 0.007).

Conclusions

High TM levels have a prognostic impact on patients with resectable CLMs stratified by tumor number and size. Perioperative chemotherapy improves long-term outcomes for patients with CLM and high TM levels.

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Funding

No specific grants from funding agencies in the public, commercial, or not for profit sectors were received to fund this study.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan

    Kosuke Kobayashi MD, PhD, FACS, Yoshihiro Ono MD, PhD, Yuki Kitano MD, PhD, Atsushi Oba MD, PhD, Takafumi Sato MD, PhD, Hiromichi Ito MD, FACS, Yosuke Inoue MD, PhD & Yu Takahashi MD, PhD

  2. Department of Hepatobiliary and Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Yoshihiro Mise MD, PhD & Akio Saiura MD, PhD

  3. Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Eiji Shinozaki MD, PhD & Kensei Yamaguchi MD, PhD

Authors
  1. Kosuke Kobayashi MD, PhD, FACS
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  2. Yoshihiro Ono MD, PhD
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  3. Yuki Kitano MD, PhD
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  4. Atsushi Oba MD, PhD
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  5. Takafumi Sato MD, PhD
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  6. Hiromichi Ito MD, FACS
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  7. Yoshihiro Mise MD, PhD
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  8. Eiji Shinozaki MD, PhD
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  9. Yosuke Inoue MD, PhD
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  10. Kensei Yamaguchi MD, PhD
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  11. Akio Saiura MD, PhD
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  12. Yu Takahashi MD, PhD
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Corresponding authors

Correspondence to Yoshihiro Ono MD, PhD or Yu Takahashi MD, PhD.

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Supplementary Information

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Supplementary file1 (DOCX 21 kb)

Treatment strategy according to resectability (JPG 374 kb)

10434_2023_13781_MOESM3_ESM.jpg

Longterm outcomes of resectable colorectal liver metastases. The 3year and 5 year overall survival, time to surgical failure, and recurrence free survival were 82.9% and 73.9%, 68.5%and 64.8%, and 52.3% and 48.9% respectively. (JPG 186 kb)

10434_2023_13781_MOESM4_ESM.jpg

Overall survival in high and low tumor marker groups of resectable colorectal livermetastases and borderline resectable colorectal liver metastases. The 5year overall survival in patients with resectable colorectal liver metastases with high tumor marker levels(55.3%) was similar to those with borderline resectable colorectal liver metastases (52.1%) (p = 0.864) (JPG 326 kb)

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Kobayashi, K., Ono, Y., Kitano, Y. et al. Prognostic Impact of Tumor Markers (CEA and CA19-9) on Patients with Resectable Colorectal Liver Metastases Stratified by Tumor Number and Size: Potentially Valuable Biologic Markers for Preoperative Treatment. Ann Surg Oncol 30, 7338–7347 (2023). https://doi.org/10.1245/s10434-023-13781-0

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