title: Increased carcinoembryonic antigen (CEA) following neoadjuvant chemotherapy predicts poor prognosis in patients that undergo hepatectomy for liver-only colorectal metastases.
abstract: BACKGROUND
  The importance of preoperative chemotherapy in a multimodality management of patients with colorectal liver metastases (CRLM) has been demonstrated. We analyse the carcinoembryonic antigen (CEA) changes following neoadjuvant chemotherapy in patients with CRLM who underwent liver resection.
  
  
  METHODS
  The final cohort included 107 eligible patients. Increased CEA levels following neoadjuvant chemotherapy were defined as the increase of baseline CEA level at diagnosis of CRLM compared with the CEA level after completion of neoadjuvant chemotherapy. Disease-free survival (DFS), post-recurrence survival (PRS) and overall survival (OS) were calculated using both Kaplan-Meier and multivariate Cox-regression methods.
  
  
  RESULTS
  CEA increase was associated with decreased PRS and OS (HR 2.69; 95 % CI, 1.28-5.63; p = 0.009, and HR 2.50; 95 % CI, 1.12-5.56; p = 0.025, respectively) in multivariate analysis, but there was no association between CEA changes and DFS. CEA increase was only associated with disease progression during preoperative chemotherapy (p = 0.014). Interestingly, this association was not absolute, as only 5 of the 11 patients with disease progression demonstrated CEA increase. Regarding the remaining 12 patients with CEA increase, according to RECIST criteria, eight patients demonstrated partial response and four patients stable disease.
  
  
  CONCLUSIONS
  In this study, we demonstrated the CEA increase following neoadjuvant chemotherapy as an adverse prognostic factor for PRS, and OS but not for DFS in patients undergoing liver resection for liver-only colorectal metastases.
authors.affiliation: Department of Academic Surgery, Royal Marsden Hospital, Fulham Road, London, UK.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Neofytou
authors.affiliation: Department of Academic Surgery, Royal Marsden Hospital, Fulham Road, London, UK. alexgiakoustidis@gmail.com.|The London Clinic, 20 Devonshire Place, London, UK. alexgiakoustidis@gmail.com.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Giakoustidis
authors.affiliation: Department of Academic Surgery, Royal Marsden Hospital, Fulham Road, London, UK.|The London Clinic, 20 Devonshire Place, London, UK.
authors.forename: Mafalda Costa
authors.initials: MC
authors.lastname: Neves
authors.affiliation: The London Clinic, 20 Devonshire Place, London, UK.
authors.forename: Dawn
authors.initials: D
authors.lastname: Morrison
authors.affiliation: Department of Surgery and Transplantation, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Giakoustidis
authors.affiliation: Department of Academic Surgery, Royal Marsden Hospital, Fulham Road, London, UK.
authors.forename: Aamir Z
authors.initials: AZ
authors.lastname: Khan
authors.affiliation: Department of Oncology, Imperial College Healthcare National Health Service Trust, Charring Cross Hospital, Fulham Palace Rd, London, UK.
authors.forename: Justin
authors.initials: J
authors.lastname: Stebbing
authors.affiliation: Department of Academic Surgery, Royal Marsden Hospital, Fulham Road, London, UK.|The London Clinic, 20 Devonshire Place, London, UK.|Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Satvinder
authors.initials: S
authors.lastname: Mudan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000556:secondary / Q000628:therapy*; D008297:Male; D020360:Neoadjuvant Therapy; D015996:Survival Rate
chemical_list: D002272:Carcinoembryonic Antigen
keywords: Adjuvant chemotherapy; CEA; Carcinoembryonic antigen; Colorectal liver metastases; Post-hepatectomy adjuvant chemotherapy; Prognostic factor