Preoperative CA19-9: a competitive predictor of recurrence in patients with colorectal cancer liver metastases after hepatectomy

Liu, Jiaming; Wang, Yanyan; Liu, Wei; Xu, Da; Wang, Kun; Xing, Baocai

doi:10.1007/s00384-020-03828-z

Cited by 6 publications

(7 citation statements)

References 35 publications

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“…When evaluating the results by subgroups and different cohorts, we found the similar results. Hence, our data supports that preoperative CA19-9 is an independent prognostic factor for CRC patients [10][11][12][13][14][15][16][17][18][19]. Serum tumor markers play an important role in prognosis prediction of CRC due to their the convenience of measurement.…”

Section: Discussionsupporting

confidence: 80%

“…Preoperative CA19-9 has not been widely used prior to CRC surgery despite its availability [1][2][3][4][5][6], and current CRC guidelines do not support the routine use of CA19-9 for preoperative assessment [7][8][9]. This may be because whether preoperative CA19-9 is an independent prognostic factor for CRC patients remains controversial, and these are no multicenter studies with large sample sizes [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Fortunately, we in the present study showed that the preoperative CA19-9 is a prognostic biomarker in CRC, and our results have further confirmed in a large cohort the routine use of CA19-9 for preoperative assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Lin et al concluded that elevated CA19-9 predicts poor survival only in patients with normal preoperative CEA level [16]. These results suggested that the prognostic impact of CA19-9 may be dependent on preoperative CEA level in CRC [16][17][18][19]27]. Therefore, we hypothesize that there is an interaction between CEA and CA19-9 on the prognosis of CRC and design a multicenter cohort to explore it.…”

Section: Introductionmentioning

confidence: 91%

“…Despite of its wide use in clinical practice, the value of CA19-9 in prognosis prediction in patients with colorectal cancer (CRC) is not completely understood [7][8][9]. CA19-9 has been associated with prognosis in CRC patients independent of existing prognostic factors including T stage, N stage, carcinoembryonic antigen (CEA) in some studies [10][11][12][13][14][15][16][17][18][19][20][21], however, not in other studies [22][23][24][25][26]. A recent meta-analysis indicated that patients with elevated CA19-9 have shorter overall survival (hazard ratios [HR]: 1.58, 95% confidence interval [CI]: 1.36-1.83), disease-free survival (HR: 1.71, 95% CI: 1.38-2.13), and recurrence-free survival (RFS) (HR: 1.43, 95% CI: 1.11-1.83), but only 4 out of the 17 studies included in the meta-analysis had a sample size > 400.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study

Zhu

Pang

et al. 2022

BMC Cancer

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Objective Whether preoperative serum carbohydrate antigen 19–9 (CA19-9) is an independent prognostic factor and there are interactions of serum CA19-9 with carcinoembryonic antigen (CEA) on the risk of recurrence in colorectal cancer (CRC) patients are still not clarified. Methods Consecutive patients with CRC who underwent curative resection for stage II-III colorectal adenocarcinoma at five hospitals were collected. Based on Cox models, associations of preoperative CA19-9 with recurrence-free survival (RFS) and overall survival (OS) were evaluated in patients with or without elevated CEA, and interactions between CEA and CA19-9 were also calculated. Restricted cubic spline (RCS) curves were used to evaluate the associations between preoperative CA19-9 and CRC outcomes on a continuous scale. Results A total of 5048 patients (3029 [60.0%] men; median [interquartile range, IQR] age, 61.0 [51.0, 68.0] years; median [IQR] follow-up duration 46.8 [36.5–62.4] months) were included. The risk of recurrence increased with the elevated level of preoperative CA19-9, with the slope steeper in patients with normal CEA than those with elevated CEA. Worse RFS was observed for elevated preoperative CA19-9 (> 37 U/mL) (n = 738) versus normal preoperative CA19-9 (≤ 37 U/mL) (n = 4310) (3-year RFS rate: 59.4% versus 78.0%; unadjusted hazard ratio [HR]: 2.02; 95% confidence interval [CI]:1.79 to 2.28), and significant interaction was found between CA19-9 and CEA (P for interaction = 0.001). Increased risk and interaction with CEA were also observed for OS. In the Cox multivariable analysis, elevated CA19-9 was associated with shorter RFS and OS regardless of preoperative CEA level, even after adjustment for other prognostic factors (HR: 2.08, 95% CI:1.75 to 2.47; HR: 2.25, 95% CI:1.80 to 2.81). Subgroup analyses and sensitivity analyses yielded largely similar results. These associations were maintained in patients with stage II disease (n = 2724). Conclusions Preoperative CA19-9 is an independent prognostic factor in CRC patients. Preoperative CA19-9 can be clinically used as a routine biomarker for CRC patients, especially with preoperative normal serum CEA.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study

Zhu

Pang

et al. 2022

BMC Cancer

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“…Another tumor marker that is useful in the diagnosis of liver metastases is CA199. However, the role of CA199 in CRC patients is still controversial ( 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

Utility and specificity of plasma heat shock protein 90 alpha, CEA, and CA199 as the diagnostic test in colorectal cancer liver metastasis

Ding

Sun

Zhang

et al. 2022

J Gastrointest Oncol

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Background: Plasma heat shock protein 90 alpha (Hsp90α) has been suggested as a novel biomarker for the diagnosis and prognosis of cancer. Carcinoembryonic antigen (CEA) and carbohydrate antigen199 (CA199) are traditional tumor biomarkers for colorectal cancer (CRC). Previous studies have shown that Hsp90α and the combination of Hsp90α and CEA are optimal biomarkers for CRC at an early stage. However, research on the use of Hsp90α alone or in combination with CEA and/or CA199 in diagnosing CRC development, particularly liver metastasis, is limited. This study sought to investigate the value of Hsp90α alone or in combination with CEA/CA199 in diagnosing CRC liver metastasis. Methods:The clinical data of 472 CRC patients were retrospectively analyzed, which were confirmed by clinical manifestations and a histopathological examination associated with an imaging diagnosis.The levels of Hsp90α, and CEA, and CA199 were assessed by enzyme-linked immunoassays and electrochemiluminescence immunoassays. Liver metastasis was diagnosed by imaging or pathology of the liver. Logistic regression models were used to analyze associations between Hsp90α, CEA, and CA199, and liver metastasis in CRC. The areas under the curves (AUCs) were used to compare the utility of Hsp90α, CEA, and CA199 in the diagnosis of CRC liver metastasis (CRLM). Additionally, we compared the diagnostic utility of the models, including the Hsp90α plus 1 of the other serum markers, and a combination of the 3 serum makers. Results:The plasma levels of Hsp90α, CEA, and CA199 were positively associated with a higher risk of CRLM [odds ratios (OR) ranging from 1.36-2.72]. The AUCs of CEA, CA199, and Hsp90α for CRLM were 0.80, 0.69, and 0.55, respectively. The AUCs for the combination of Hsp90α and CEA, combination of Hsp90α and CA199, combinations of Hsp90α, CEA, and CA199 were 0.75, 0.66, 0.76, respectively. The combination of Hsp90α, CEA, and CA199 did not improve the diagnostic utility for liver metastasis in CRC. Conclusions:The level of Hsp90α was elevated in CRC and was associated with CRLM. Thus, the Hsp90α is a potential biomarker for CRLM. CEA has the largest diagnostic utility for CRLM. Adding Hsp90α to CEA/CA199 did not improve their diagnostic utility for CRLM.^ ORCID: 0000-0002-6940-7277.

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Treatment strategy for resectable colorectal cancer liver metastases from the viewpoint of time to surgical failure

Hirokawa

Ueno

Nakai

et al. 2021

Langenbecks Arch Surg

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Preoperative CA19-9: a competitive predictor of recurrence in patients with colorectal cancer liver metastases after hepatectomy

Cited by 6 publications

References 35 publications

Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study

Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study

Utility and specificity of plasma heat shock protein 90 alpha, CEA, and CA199 as the diagnostic test in colorectal cancer liver metastasis

Treatment strategy for resectable colorectal cancer liver metastases from the viewpoint of time to surgical failure

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