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  • Title: Perioperative carcinoembryonic antigen measurements to predict curability after liver resection for colorectal metastases: a prospective study.
    Author: Oussoultzoglou E, Rosso E, Fuchshuber P, Stefanescu V, Diop B, Giraudo G, Pessaux P, Bachellier P, Jaeck D.
    Journal: Arch Surg; 2008 Dec; 143(12):1150-8; discussion 1158-9. PubMed ID: 19075165.
    Abstract:
    HYPOTHESIS: Perioperative carcinoembryonic antigen (CEA) blood level is a predictor of outcome after resection of colorectal liver metastases (CLMs). DESIGN: Prospective clinical study. SETTING: Department of digestive surgery and transplantation. PATIENTS: Between January 1, 2000, and December 31, 2004, CEA levels were routinely measured 1 week before and 6 weeks after CLM resection in 213 patients. The patients were divided into the following 3 groups: group A (n = 69) with normal preoperative and postoperative CEA levels, group B (n = 111) with elevated preoperative and normal postoperative CEA levels, and group C (n = 33) with elevated preoperative and postoperative CEA levels. MAIN OUTCOME MEASURES: The use of perioperative CEA levels to predict outcome after resection. RESULTS: The median survival was 45.4 months. The 5-year overall and disease-free survival rates were 50.2% and 21.9%, respectively, in group A, 38.5% and 18.3% in group B, and 0.0% and 0.0% in group C (P < .001). Univariate analysis showed that patients with elevated preoperative and postoperative CEA levels, multiple CLMs, large CLMs (> or =5 cm), advanced Fong clinical risk score, bilobar distribution, and hepatic pedicle lymph node involvement had significantly poorer overall and disease-free survival. By multivariate analysis, only perioperative CEA level, hepatic pedicle lymph node involvement, and number and size of CLMs were independent prognostic factors. The 5-year survival rates showed good correlation with perioperative CEA levels in all 3 patient groups. CONCLUSIONS: The predictive value of perioperative CEA levels is demonstrated. Carcinoembryonic antigen levels as early as 6 weeks after surgery may be helpful in assigning patients to adjuvant chemotherapy after resection of CLMs.
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