Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2015

01-04-2015 | Hepatobiliary Tumors

CEA Change After Neoadjuvant Chemotherapy Including Bevacizumab and Clinical Outcome in Patients Undergoing Liver Resection for Colorectal Liver Metastases

Authors: Stefan Stremitzer, MD, Judith Stift, MD, Alexandra Graf, PhD, Jagdeep Singh, MD, Patrick Starlinger, MD, Birgit Gruenberger, MD, Dietmar Tamandl, MD, Thomas Gruenberger, MD

Published in: Annals of Surgical Oncology | Issue 4/2015

Login to get access

Abstract

Background

Liver resection after neoadjuvant chemotherapy offers the chance of cure and long-term survival in patients with resectable colorectal liver metastases (CLM). Currently, there are no established biomarkers that could help identify patients with low risk of recurrence who may benefit most from liver resection in curative intent. To address this issue, the value of carcinoembryonic antigen (CEA) change after neoadjuvant chemotherapy was investigated to predict clinical outcome in this study.

Methods

CEA levels before (baseline) and after neoadjuvant chemotherapy including bevacizumab before liver resection were obtained in 154 patients with CLM from a prospectively maintained database. Changes of CEA in percent through neoadjuvant treatment were correlated with recurrence-free survival and overall survival (OS). Patients with normal CEA levels at all times (baseline and follow-up) were excluded from the analyses.

Results

After exclusion of 15 patients with normal CEA levels at all times, 139 patients were available for analysis. Receiver operating characteristic analyses revealed a CEA change (decrease) cutoff value of 50 %, which significantly separated 88 patients with respect to OS (P = 0.017). Cox regression analyses showed that the change of CEA at a cutoff value of 50 % was predictive for OS (hazard ratio 0.37, P = 0.025) independent from the baseline CEA level, but not for recurrence-free survival. Furthermore, a CEA change of >50 % was associated with a higher radiologic response rate (P = 0.016).

Conclusions

CEA change induced through neoadjuvant treatment was associated with radiologic response and OS, and this measure is a promising tool to predict clinical outcome in the future.
Literature
1.
Kopetz S, Chang GJ, Overman MJ, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol. 2009;27:3677–83.CrossRefPubMedCentralPubMed
2.
Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013;14:1208–15.CrossRefPubMed
3.
Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57.CrossRefPubMedCentralPubMed
4.
Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.CrossRefPubMed
5.
Gruenberger B, Tamandl D, Schueller J, et al. Bevacizumab, capecitabine, and oxaliplatin as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. J Clin Oncol. 2008;26:1830–35.CrossRefPubMed
6.
Klinger M, Tamandl D, Eipeldauer S, et al. Bevacizumab improves pathological response of colorectal cancer liver metastases treated with XELOX/FOLFOX. Ann Surg Oncol. 2010;17:2059–65.CrossRefPubMed
7.
Locker GY, Hamilton S, Harris J, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006;24:5313–27.CrossRefPubMed
8.
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18.CrossRefPubMedCentralPubMed
9.
Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer. 1996;77:1254–62.CrossRefPubMed
10.
Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247:125–35.CrossRefPubMed
11.
Schindl M, Wigmore SJ, Currie EJ, Laengle F, Garden OJ. Prognostic scoring in colorectal cancer liver metastases: development and validation. Arch Surg. 2005;140:183–9.CrossRefPubMed
12.
Reissfelder C, Rahbari NN, Koch M, et al. Validation of prognostic scoring systems for patients undergoing resection of colorectal cancer liver metastases. Ann Surg Oncol. 2009;16:3279–88.CrossRefPubMed
13.
Merkel S, Bialecki D, Meyer T, Muller V, Papadopoulos T, Hohenberger W. Comparison of clinical risk scores predicting prognosis after resection of colorectal liver metastases. J Surg Oncol. 2009;100:349–57.CrossRefPubMed
14.
Trillet-Lenoir V, Freyer G, Kaemmerlen P, et al. Assessment of tumour response to chemotherapy for metastatic colorectal cancer: accuracy of the RECIST criteria. Br J Radiol. 2002;75(899):903–8.CrossRefPubMed
15.
Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRefPubMed
16.
Rubbia-Brandt L, Giostra E, Brezault C, et al. Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol. 2007;18:299–304.CrossRefPubMed
17.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedCentralPubMed
18.
19.
Kim CW, Yu CS, Yang SS, et al. Clinical significance of pre- to post-chemoradiotherapys-CEA reduction ratio in rectal cancer patients treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol. 2011;18:3271–77.CrossRefPubMed
20.
Huang CS, Lin JK, Wang LW, et al. Assessment of the value of carcinoembryonic antigen reduction ratio as a prognosis factor in rectal cancer. Am J Surg. In press.
21.
Alison MR, Lin WR, Lim SM, Nicholson LJ. Cancer stem cells: in the line of fire. Cancer Treat Rev. 2012;38:589–98.CrossRefPubMed
22.
Vera R, Gomez Dorronsoro M, Lopez-Ben S, et al. Retrospective analysis of pathological response in colorectal cancer liver metastases following treatment with bevacizumab. Clin Transl Oncol. In press.
23.
Shindoh J, Loyer EM, Kopetz S, et al. Optimal morphologic response to preoperative chemotherapy: an alternate outcome end point before resection of hepatic colorectal metastases. J Clin Oncol. 2012;30:4566–72.CrossRefPubMedCentralPubMed
24.
Yi JH, Kim H, Jung M, et al. Prognostic factors for disease-free survival after preoperative chemotherapy followed by curative resection in patients with colorectal cancer harboring hepatic metastasis: a single-institute, retrospective analysis in Asia. Oncology. 2013;85:283–9.CrossRefPubMed
25.
Stremitzer S, Stift J, Gruenberger B, et al. KRAS status and outcome of liver resection after neoadjuvant chemotherapy including bevacizumab. Br J Surg. 2012;99:1575–82.CrossRefPubMed
26.
Gruenberger B, Scheithauer W, Punzengruber R, Zielinski C, Tamandl D, Gruenberger T. Importance of response to neoadjuvant chemotherapy in potentially curable colorectal cancer liver metastases. BMC Cancer. 2008;8:120.CrossRefPubMedCentralPubMed
27.
Saltz LB, Clarke S, Diaz-Rubio E, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol. 2008;26:2013–9.CrossRefPubMed
Metadata
Title
CEA Change After Neoadjuvant Chemotherapy Including Bevacizumab and Clinical Outcome in Patients Undergoing Liver Resection for Colorectal Liver Metastases
Authors
Stefan Stremitzer, MD
Judith Stift, MD
Alexandra Graf, PhD
Jagdeep Singh, MD
Patrick Starlinger, MD
Birgit Gruenberger, MD
Dietmar Tamandl, MD
Thomas Gruenberger, MD
Publication date
01-04-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 4/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4158-8

Other articles of this Issue 4/2015

Annals of Surgical Oncology 4/2015 Go to the issue

Hepatobiliary Tumors

Aggressive Therapeutic Strategies Improve the Survival of Hepatocellular Carcinoma Patients with Performance Status 1 or 2: A Propensity Score Analysis

Colorectal Cancer

Robotic Versus Laparoscopic Intersphincteric Resection for Low Rectal Cancer: Comparison of the Operative, Oncological, and Functional Outcomes

Bone and Soft Tissue Sarcomas

Accuracy of Preoperative Percutaneous Biopsy for the Diagnosis of Retroperitoneal Liposarcoma Subtypes

Pancreatic Tumors

Improved Long-Term Outcomes After Resection of Pancreatic Adenocarcinoma: A Comparison Between Two Time Periods

Bone and Soft Tissue Sarcomas

Experience of Pediatric Osteosarcoma of the Extremity at a Single Institution in Taiwan: Prognostic Factors and Impact on Survival

Endocrine Tumors

Navigating the Management of Follicular Variant Papillary Thyroid Carcinoma Subtypes: A Classic PTC Comparison