Role of carcinoembryonic antigen as a marker for colorectal liver metastases

Predictive Efficacy of Circulating Tumor Cells in First Drainage Vein Blood from Patients with Colorectal Cancer liver Metastasis

Circulating tumor cells (CTCs) are associated with metastasis. However, the low rate of detection of CTCs in peripheral vein blood (PVB) limits their clinical application. In this study, we observed higher positive rates of CTC in first drainage vein blood (FDVB) relative to peripheral venous blood (P < 0.001). Moreover, the CTC content was related to liver metastasis, T stage and CA19-9 levels. Our collective data suggest that CTCs in FDVB have good predictive utility for risk of liver metastasis of colorectal cancer (CRC), in particular, metachronous liver metastasis.

Role of Serum Carcinoembryonic Antigen in Predicting Recurrent Disease following Curative Resection of Rectal Cancer

Introduction Surveillance of patients following definitive treatment of rectal malignancy is based on the predicament that early detection of recurrence may provide an opportunity for cure. Available methods for monitoring include clinical, radiological, and serum tests. The purpose of this study was to determine the effectiveness of CEA in detecting recurrences.

Materials and Methods Retrospective analysis of patients with adenocarcinoma rectum treated with curative intent between 2012 to 2020 at our institute was performed. Postoperatively, patients were followed with CEA measurements according to our institution protocol and elevation of serum CEA above 5 ng/dL was considered as suspicious of recurrence.

Results One hundred ninety patients who received curative treatment were deemed eligible for the analysis. Among these 61 patients had recurrences during the follow-up period and postoperative CEA measurements at the time of recurrence were analyzed in all the patients. Sensitivity, specificity, positive predictive value, and negative predictive value of postoperative CEA to detect recurrences are 81.9, 92.2, 83.3, and 91.5%, respectively.

Conclusion CEA surveillance following definitive management of rectal cancer detects recurrences in majority of the patients and hence strongly recommended.

High-Precision Quantitative Analysis Reveals Carcinoembryonic Protein Expression Differs Among Colorectal Cancer Primary Foci and Metastases to Different Sites

The expression of carcinoembryonic protein (CEA) is an important biological marker and therapeutic target in colorectal cancer (CRC). CEA expression heterogeneity confers resistance to CEA-targeting immunotherapy antibodies. Thus, quantification of the CEA-positive cell ratio among all tumor cells would be important in identifying patients that would benefit from CEA-targeted therapies. However, the proportion of tumor cells that express CEA within primary and metastasized tumors at different sites has not been studied. Therefore, the present study aimed to determine CEA positive cell proportion in paired CRC primary foci, liver metastases, and lymph node (LN) metastases, and whether proportion of CEA positive cell differs among colorectal cancer primary foci, liver metastases, and LN metastases from 26 patients. The CEA expression was detected by immunohistochemical assay. Then we set up a quantification approach to quantify the proportion of CEA-positive cells based on the TissueGnostics (TG) system. Then the proportion of CEA positive cells were measured and compared among primary foci, liver metastases, and LN metastases. As a result, the proportion of CEA positive tumor cells was slightly higher in liver metastases than in primary foci (89.8% ± 2.71% vs 82.1% ± 5.05%, P < 0.001). The proportion of CEA-positive cells was significantly lower in LN metastases than in primary foci (82.3% ± 4.32% vs 70.28% ± 5.04%, P < 0.001). In 8 cases with matched CRC primary foci, liver metastases, and LN metastases, the proportions of CEA proportion in liver metastasis was the highest, followed by primary foci and LNs metastasis. In conclusion, this study provided an new approach for quantification of CEA positive cell in tumors and proved the percentage of CEA-positive cells varied in different metastases.

Use of a Comprehensive Geriatric Assessment to Predict Short-Term Postoperative Outcome in Elderly Patients With Colorectal Cancer

Purpose

This study was conducted to identify the effectiveness of a preoperative comprehensive geriatric assessment (CGA) for predicting postoperative morbidity in elderly patients who underwent surgery for colorectal cancer.

Methods

Elderly patients (≥70 years old) who underwent surgery for colorectal cancer at a tertiary hospital in Korea were identified, and their cases were analyzed using data from a prospectively collected database to establish an association between major postsurgical complications and 'high-risk' patient as defined by the CGA.

Results

A total of 240 patients, with a mean age of 76.7 ± 5.2 years, were enrolled. Ninety-five patients (39.6%) were classified as "high-risk" and 99 patients (41.3%) as having postoperative complications. The univariate analysis indicated that risk factors for postoperative complications were age, American Society of Anesthesiologists physical status classification, serum hemoglobin, carcinoembryonic antigen, cancer stage, and "high-risk" status. The multivariable analyses indicated that "high-risk" status (odds ratio, 2.107; 95% confidence interval, 1.168–3.804; P = 0.013) and elevated preoperative carcinoembryonic antigen (odds ratio, 2.561; 95% confidence interval, 1.346–4.871, P = 0.004) were independently associated with postoperative complications. A multivariable analysis of the individual CGA domains indicated that high comorbidities and low activities of daily living were significantly related with postoperative complications.

Conclusion

A preoperative CGA indicating "high-risk" was associated with major postoperative complications in elderly patients who underwent surgery for colorectal cancer. Thus, using the CGA to identify elderly colorectal-cancer patients who should be given more care during postoperative management may be clinically beneficial.