Blood tests and patient characteristics: predicting relapse after colorectal liver metastasis

This study examined whether blood markers or patient characteristics can predict if cancer will relapse in patients with colorectal cancer that has spread to the liver (colorectal liver metastases).

Carcinoembryonic antigen (CEA) is a protein found in the blood of colorectal cancer patients. Because it is not normally present in high levels it is used to monitor the response to cancer treatment. If the CEA levels drop it suggests that the treatment has worked. CEA levels can also be used to detect whether colorectal cancer has relapsed. If CEA levels begin to rise after treatment it suggests that the cancer has returned and imaging tests are used to confirm the relapse.

It is not known whether CEA levels after surgery for colorectal liver metastases could be used to predict which patients have a higher risk of relapsing.

The authors analyzed the medical records of 318 patients with colorectal liver metastases who underwent liver surgery. Each patient received chemotherapy after the surgery. CEA levels were measured within the first 6 months after surgery. Patient characteristics (such as age, sex, number of lesions and size of lesions) and CEA levels were assessed as predictors of relapse.

Overall, 53% of the patients relapsed within 2 years of surgery. Patients with CEA levels higher than 15 ng/ml had an 87% higher risk of relapse. CEA levels higher than 15 ng/ml were also associated with worse survival. Patients with levels higher than 15 ng/ml survived for an average of 29 months compared to 73 months for patients with lower levels.

A number of other patient characteristics could also predict cancer relapse. Patients over 70 had a 47% lower risk of relapse. Patients with cancer in their lymph nodes had a 78% higher risk of relapse. Patients with more than one lesion had 2 times the risk of relapse and patients with lesions larger than 5 cm had a 92% higher risk of relapse.

The authors concluded that CEA levels higher than 15 ng/ml after surgery can be used to predict cancer relapse. They suggested that CEA levels can be used as an additional tool to predict relapse in patients with colorectal liver metastases.