Prognostic Effect of CEA Cut-Off in Patients with Resectable Colorectal Liver Metastases: A Meta-Analysis and Meta-Regression.

IF 1.6 Q4 ONCOLOGY

Journal of Gastrointestinal Cancer Pub Date : 2025-05-13 DOI:10.1007/s12029-025-01244-6

Antonella Venturino, Giuseppe A Colloca

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引用次数: 0

Abstract

Background: Although preoperative carcinoembryonic antigen (CEA) is a variable used in most prognostic scores assessing the outcome of patients with colorectal liver metastases (CRLM) undergoing resection, it is unclear what the optimal cut-off is or in which patient subgroups CEA is most relevant. The purpose of this study is to evaluate the prognostic effect of CEA in resected CRLM patients and to explore in which subgroups CEA is most closely associated with overall survival (OS).

Methods: A systematic literature search was performed, selecting studies that evaluated a relationship between preoperative CEA and OS in patients undergoing CRLM radical surgery. A meta-analysis assessed the overall effect size of the relationship on the selected study cohorts, based on CEA cut-off. An evaluation of 21 baseline variables was performed to explore their possible effect on the relationship between CEA and OS.

Results: The study confirms a significant negative prognostic effect of increased CEA on OS (HR 1.46, CI 1.30-1.65), but heterogeneity among studies is significant. The effect is consistent for all CEA cut-offs, although the relationship tends to weaken in more recent studies for cut-offs < 10 ng/mL. Meta-regressions also suggest that the prognostic effect may be more pronounced in the elderly. In addition, the effect of CEA ≥ 20 ng/mL on OS appears significantly reduced in the subgroup with mutated RAS carcinoma.

Conclusions: For patients with resectable CRLM, the CEA cut-off should be increased to 20 ng/mL, and evaluation in prospective studies of the more pronounced negative prognostic effect of preoperative CEA in the elderly and wild-type RAS CRLM patients is recommended.

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CEA切断对可切除的结直肠肝转移患者预后的影响：荟萃分析和荟萃回归。

背景：尽管术前癌胚抗原（CEA）是评估结肠直肠癌肝转移（CRLM）切除术患者预后的大多数预后评分中使用的一个变量，但目前尚不清楚最佳临界值是什么，也不清楚CEA在哪些患者亚组中最相关。本研究的目的是评估CEA对切除的CRLM患者的预后影响，并探讨CEA与总生存期（OS）最密切相关的亚组。方法：进行系统的文献检索，选择评估CRLM根治性手术患者术前CEA与OS之间关系的研究。基于CEA截止值，荟萃分析评估了所选研究队列中关系的总体效应大小。我们对21个基线变量进行了评估，以探讨它们对CEA和OS之间关系的可能影响。结果：本研究证实CEA升高对OS有显著的负面预后影响（HR 1.46, CI 1.30-1.65），但研究间异质性显著。尽管在最近的研究中，对于< 10 ng/mL的CEA临界值，这种关系趋于减弱，但对所有CEA临界值的影响是一致的。meta回归也表明，对老年人的预后影响可能更为明显。此外，CEA≥20 ng/mL对OS的影响在RAS癌突变亚组中明显降低。结论：对于可切除的CRLM患者，CEA临界值应提高至20 ng/mL，并建议在前瞻性研究中评估术前CEA对老年和野生型RAS CRLM患者更明显的不良预后影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.