title: CEA change after neoadjuvant chemotherapy including bevacizumab and clinical outcome in patients undergoing liver resection for colorectal liver metastases.
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.
authors.affiliation: Department of General Surgery, Medical University Vienna, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stremitzer
authors.forename: Judith
authors.initials: J
authors.lastname: Stift
authors.forename: Alexandra
authors.initials: A
authors.lastname: Graf
authors.forename: Jagdeep
authors.initials: J
authors.lastname: Singh
authors.forename: Patrick
authors.initials: P
authors.lastname: Starlinger
authors.forename: Birgit
authors.initials: B
authors.lastname: Gruenberger
authors.forename: Dietmar
authors.initials: D
authors.lastname: Tamandl
authors.forename: Thomas
authors.initials: T
authors.lastname: Gruenberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D015179:Colorectal Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality*; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000068258:Bevacizumab; D000077146:Irinotecan; D002166:Camptothecin