title: Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications?
abstract: The impact of prehepatectomy carcinoembryonic antigen (CEA) levels in the era of modern chemotherapy and expanded surgical indications for colorectal liver metastasis (CRLM) remains not well defined.
  
  
  
  484 patients were identified and divided into two groups by surgical time period (group 1: 2000-2007 vs. group 2: 2008-2015). The prognostic significance of pre-hepatectomy CEA was determined by assessing the HRs associated with various cut-off levels ranging from 5 to 200 ng/mL.
  
  
  
  Median CRLM number was comparable in both groups (group 1: 2 vs. group 2: 2, P = 0.504). Bilobar disease was more frequent in group 2 (30.1% vs. 42.5%, P = 0.006). The administration of modern chemotherapy and/or biologic agents increased over time (49.5% vs. 67.9%, P < 0.001). Preoperative CEA independently predicted OS in group 1, even with a cut-off as low as >5 ng/mL. However, in group 2 it predicted recurrence and survival only after exceeding 70 and 50 ng/mL, respectively. Of note, in group 2, CEA was strongly associated with survival when CEA levels exceeded 70 ng/mL (HR 4.84).
  
  
  
  While pre-hepatectomy CEA level may still have prognostic utility in CRLM resection, the optimal cut-off value has increased in the era of modern chemotherapy.
authors: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Kazunari
authors: K
authors: Sasaki
authors: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Georgios A
authors: GA
authors: Margonis
authors: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Nikolaos
authors: N
authors: Andreatos
authors: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Ana
authors: A
authors: Wilson
authors: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Faiz
authors: F
authors: Gani
authors: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Neda
authors: N
authors: Amini
authors: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: tpawlik1@jhmi.edu.
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000368:Aged; D002272:Carcinoembryonic Antigen / Q000097:blood*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen