Positive postoperative CEA is a strong predictor of recurrence for patients after resection for colorectal liver metastases.
Positive postoperative CEA is a strong predictor of recurrence for patients after resection for colorectal liver metastases.
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DOI：
10.1245/s10434-014-4358-2
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发表时间：
2015-09
影响因子：
3.7
通讯作者：
Fong Y
中科院分区：
文献类型：
--
作者：
Araujo RL;Gönen M;Allen P;DeMatteo R;Kingham P;Jarnagin W;D'Angelica M;Fong Y
癌胚抗原（CEA）在结直肠癌患者监测和随访中的作用仍有争议。本研究的目的是评估术后CEA作为结直肠癌肝转移（CLM）切除患者复发预测因子的实用性。从前瞻性维护的CLM数据库中识别患者，并进行回顾性研究。肝外疾病或最初不可切除的CLM患者被排除在外。本研究中的所有患者均在切除术后接受辅助全身化疗。1997年至2007年间，共有318名连续患者接受了研究，其中168名患者（53%）在2年内经历了复发。不同的术后CEA临界值作为复发的独立预测因子进行了测试。术后CEA ≥15 ng/ml获得最高风险比（1.87; 95% CI 1.09-3.2; p = 0.023），并被选择纳入多变量模型的生存分析。术后CEA ≥15 ng/ml对复发的特异性为96%，阳性预测值为82%。多因素分析显示，年龄≥70岁、原发肿瘤切除时淋巴结阳性、无病期≤12个月、病灶数>1个、最大病灶≥5 cm、切缘阳性、术后CEA ≥15 ng/ml是2年内复发的独立预测因素。本研究表明，术后CEA ≥15 ng/ml是复发的预测指标。
The role of carcinoembryonic antigen (CEA) in surveillance and follow-up of patients with colorectal cancer continues to be debated. The objective of this study was to assess the utility of postoperative CEA as a predictor of recurrence for patients with resected colorectal liver metastases (CLM). Patients were identified from a prospectively maintained CLM database, and were studied retrospectively. Patients with extrahepatic disease or initially unresectable CLM were excluded. All patients in this study received adjuvant systemic chemotherapy after resection. Between 1997 and 2007, a total of 318 consecutive patients were studied, with 168 patients (53 %) experiencing recurrence within 2 years. Various postoperative CEA cutoffs were tested as independent predictors of recurrence. A postoperative CEA ≥15 ng/ml obtained the highest hazard ratio (1.87; 95 % CI 1.09–3.2; p = 0.023) and was chosen to be included in the survival analysis in the multivariate model. A postoperative CEA ≥15 ng/ml had a specificity of 96 % and positive predictive value of 82 % for recurrence. On multivariate analysis, age ≥70 years, the presence of positive lymph node at primary tumor resection, disease-free interval ≤12 months, number of lesions >1, largest lesion ≥5 cm, presence of positive margins, and postoperative CEA ≥15 ng/ml were independent predictors of recurrence within 2 years. This study demonstrates a postoperative CEA ≥15 ng/ml to be a predictive test for recurrence.