Bakalakos E A, Burak W E, Young D C, Martin E W
Department of Surgery, Ohio State University, Columbus, USA.
Am J Surg. 1999 Jan;177(1):2-6. doi: 10.1016/s0002-9610(98)00303-1.
The role of carcino-embryonic antigen (CEA) in monitoring early detection of recurrent or metastatic colorectal cancer, and its impact on resectability rate and patient survival remains controversial. Our objective was to determine any association between the preoperative level of CEA and prognosis, and the resectability and survival by method of diagnosis of colorectal hepatic metastases.
We analyzed patients who underwent exploration for hepatic resection for metastatic colorectal cancer over a 15-year period. The patient population consisted of those patients who had undergone primary colon or rectal resection and were followed up with serial CEA levels and of patients who were followed up with physical examination, liver function tests (LFTs) or computed tomography (CT) of the abdomen and pelvis that led to the diagnosis of liver metastases. Also included in the study were patients who were diagnosed with liver metastases at the time of the primary colon or rectal resection and underwent planned hepatic resection at a later time.
Three hundred and one (301) patients who underwent a total of 345 planned hepatic resections for metastatic colorectal cancer between January 1978 and December 1993 were included in this analysis. The median preoperative CEA level was 24.8 ng/mL in the resected group, 53.0 ng/mL in the incomplete resection group, and 49.1 ng/mL in the nonresected group (P = 0.02). More of the patients who had a preoperative CEA < or =30 ng/mL were in the resected group, while those who had a preoperative CEA >30 ng/mL were likely to be in the nonresected group (P = 0.002). The median survival was 25 months for patients with a preoperative CEA level < or =30 ng/mL and 17 months for patients with a preoperative CEA >30 ng/mL (P = 0.0005). The resectability rate and the survival of patients by method of diagnosing liver metastases-rising CEA versus history and physical, elevated LFTs, CT scan versus diagnosis at the time of primary resection-was not significant (P = 0.06 and P = 0.19, respectively). Given the nonstandardized retrospective nature of the study cohort and relative small groups of patients, the power to detect small differences in survival by method of diagnosis is limited. In the complete resection group of patients with unilobar liver disease (5-year survival of 28.8%) there was no difference in survival between those patients who had normal preoperative CEA and those who had elevated preoperative CEA, and approximately 90% of them had an abnormal preoperative serum CEA level.
CEA is useful in the preoperative evaluation of patients with hepatic colorectal metastases for assessing prognosis and is complimentary to history and physical examination in the diagnosis of liver metastases. Patients with colorectal liver metastases and preoperative CEA < or =30 ng/mL are more likely to be resectable, and they have the longest survival.
癌胚抗原（CEA）在监测复发性或转移性结直肠癌的早期发现中的作用，及其对可切除率和患者生存率的影响仍存在争议。我们的目的是确定术前CEA水平与预后之间的任何关联，以及通过结直肠癌肝转移的诊断方法确定可切除性和生存率。
我们分析了在15年期间接受肝转移结直肠癌肝切除探查的患者。患者群体包括那些接受过原发性结肠或直肠切除并接受CEA水平系列随访的患者，以及那些通过体格检查、肝功能测试（LFTs）或腹部和盆腔计算机断层扫描（CT）随访并导致肝转移诊断的患者。该研究还包括在原发性结肠或直肠切除时被诊断为肝转移并在以后接受计划性肝切除的患者。
1978年1月至1993年12月期间，共有301例患者接受了345次计划性肝转移结直肠癌肝切除，纳入本分析。切除组术前CEA水平中位数为24.8 ng/mL，不完全切除组为53.0 ng/mL，未切除组为49.1 ng/mL（P = 0.02）。术前CEA≤30 ng/mL的患者更多地在切除组，而术前CEA>30 ng/mL的患者更可能在未切除组（P = 0.002）。术前CEA水平≤30 ng/mL的患者中位生存期为25个月，术前CEA>30 ng/mL的患者中位生存期为17个月（P = 0.0005）。通过诊断肝转移的方法（CEA升高与病史和体格检查、LFTs升高、CT扫描与原发性切除时的诊断）确定的患者可切除率和生存率无显著差异（分别为P = 0.06和P = 0.19）。鉴于研究队列的非标准化回顾性性质以及相对较小的患者群体，通过诊断方法检测生存率微小差异的能力有限。在单叶肝病的完全切除组患者中（5年生存率为28.8%），术前CEA正常的患者与术前CEA升高的患者生存率无差异，其中约90%的患者术前血清CEA水平异常。
CEA在肝转移结直肠癌患者的术前评估中有助于评估预后，并且在肝转移的诊断中是对病史和体格检查的补充。结直肠癌肝转移且术前CEA≤30 ng/mL的患者更有可能被切除，并且生存期最长。
