Outcome of Patients with Colorectal Liver Metastasis: Analysis of 1,613 Consecutive Cases

Abstract

Patients with CRLM could get long-term survival benefit from different types of therapy, and resection of liver metastases was the optimal strategy. A predictive model using these above five factors may be of use in stratifying patients who may benefit from intensive surveillance and adjuvant therapy.

Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications?

“…These data were consistent with previous reports that included patients from a similar time span, which demonstrated the prognostic relevance a wide range of CEA cut-off values. [4][5][6][14][15][16][17][18] In contrast, in the current study, in the later time period of 2008-2015 pre-hepatectomy CEA levels had no prognostic significance, until a much higher-cutoff value was utilized. Of interest, in the later period, the HRs associated with OS increased sharply when the CEA level exceeded 70 ng/mL.…”

“…The following factors were included in multivariate analysis: (i) variables that were significant on univariate analysis (P < 0.10) (Supplemental Table 1) (ii) clinically relevant characteristics such as bilobar disease, and location of CRC. [4][5][6][14][15][16][17][18] The prognostic significance of pre-hepatectomy CEA level was determined by assessing the HRs associated with various CEA cut-off levels ranging from 5 to 200 ng/mL. 4,6,[14][15][16][17][18] HRs and P values for each individual CEA cutoff level were calculated after adjusting for other relevant clinicopathological variables on multivariate analysis.…”

“…4,[14][15][16][17][18] In fact, CEA levels have been incorporated into the Fong clinical risk score, as well as in several prognostic nomograms utilized to estimate long-term prognosis of patients with CRLM. 5,6,11 While the prehepatectomy CEA level is influenced by primary CRC status and CRLM tumor burden, several studies have reported that prehepatectomy CEA levels remained independently predictive of prognosis even after adjusting for clinicopathological variables.…”

“…5,6,11 While the prehepatectomy CEA level is influenced by primary CRC status and CRLM tumor burden, several studies have reported that prehepatectomy CEA levels remained independently predictive of prognosis even after adjusting for clinicopathological variables. [4][5][6][14][15][16][17][18] Pre-hepatectomy CEA levels can, however, also be influenced by receipt and response to chemotherapy, 11,12,23,24 and detailed data on the impact of CEA on prognosis in the era of modern chemotherapy are lacking. 4-6,14 -16 Therefore, the objective of the current study was to reappraise the prognostic implications of CEA levels in a contemporary clinical environment characterized by the use of modern chemotherapy regimens.…”

“…>5, 10, >30, >60, >100 and >200 ng/mL) as being independently predictive of prognosis. 4,6,[14][15][16][17][18] The introduction of novel multi-drug combination chemotherapeutic regimens, including oxaliplatin, irinotecan, and biologic agents has made curative-intent hepatectomy among initially unresectable CRLM patients feasible. [19][20][21] Advances in systemic therapy have also changed the treatment strategy for resectable CRLM.…”