Low preoperative serum carcinoembryonic antigen concentration is a marker of good prognosis in patients undergoing cryotherapy for low volume hepatic metastases from colorectal cancer.

BACKGROUND: Carcinoembryonic antigen (CEA) is of prognostic value in colorectal cancer and has been shown to be related to the ability of colorectal cancer cells to implant and to metastasise and to have an effect on immune function. This study attempts to separate the prognostic effects of serum CEA level and volume of hepatic metastases following cryotherapy for liver metastases from colorectal cancer.

METHODS: Out of 195 patients undergoing cryotherapy for liver tumour between 4/90 and 5/97 we identified 94 patients who had cryoablation of colorectal liver metastases with known volume of metastases and preoperative serum CEA. Survival was estimated using the Kaplan-Meier method and the log-rank test was used to test for significant differences in survival of subgroups with different tumour volumes and preoperative serum CEA.

RESULTS: Tumour volume was prognostic, with patients with low volume-disease having a significantly better outcome than patients with medium or high volume disease. There was clearly no effect of preoperative serum CEA level on survival in patients with high volume disease. However, in the medium and low volume group the patients with low serum CEA preoperatively have a significantly better survival than patients with a high preoperative serum CEA.

CONCLUSIONS: We believe that the data supports the belief that CEA has a biological effect which significantly worsens survival following hepatic cryotherapy in patients with low volume and medium hepatic metastases from colorectal cancer. Therapeutic approaches to this phenomenon may be of value both in primary and secondary colorectal cancer.