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ASSOCIATION OF ELEVATED CA19-9 AND OUTCOMES AFTER CURATIVE-INTENT HEPATECTOMY FOR COLORECTAL LIVER METASTASES: AN INTERNATIONAL EXPERIENCE
Elena Panettieri
*1,2, Antony Haddad
2, Andrea Campisi
1, Jace P. Landry
2, Agostino Maria De Rose
1, Francesco Ardito
1, Hop S. Tran Cao
2, Ching-Wei D. Tzeng
2, Yun Shin Chun
2, Felice Giuliante
1, Jean-Nicolas Vauthey
2, Timothy E. Newhook
21Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy; 2The University of Texas MD Anderson Cancer Center, Houston, TX
Background: Identifying reliable prognostic biomarkers is pivotal in the treatment of patients with colorectal liver metastases (CLM). While the association of carcinoembryonic antigen (CEA) and oncologic outcomes after hepatectomy for CLM has been established, the prognostic significance of CA19-9 has yet to be elucidated. We sought to investigate the relationship between elevated CA19-9 and outcomes following hepatectomy for CLM.
Methods: All patients who underwent first curative-intent resection of CLM at two international high-volume centers between 2004–2023 were considered. Patients with at least one preoperative CA19-9 measurement were included and the prognostic impact of the maximum CA19-9 value was evaluated. CA19-9>35 was deemed elevated.
Results: Among 475 total patients, median maximum CA19-9 and CEA levels were 27.2 U/mL and 4.9 ng/mL, respectively. Among 204 patients (42.9%) with a maximum CA19-9 > 35 U/mL, median maximum CLMs were larger (3.5 cm vs. 2.2 cm;
p < 0.001), had a higher median number of CLMs (3 vs. 2;
p = 0.050), and more frequently underwent major hepatectomy (49.3% vs. 38.7%;
p = 0.022). Among the patients with at least one elevated CA19-9, 27.5% had a normal CEA. Patients without elevated CA19-9 had a median overall survival (OS) of 75.8 months compared to 41.2 months for patients with an elevated CA19-9 (
p < 0.001) (Figure 1). The presence of > 3 CLMs (hazard ratio [HR] 1.41,
p = 0.011), maximum CLM size > 3 cm (HR 1.42,
p = 0.003), and at least one abnormal preoperative CA19-9 (HR 1.45,
p = 0.009) were independently associated with OS (Table 1).
Conclusion: An abnormal preoperative CA19-9 is associated with worse survival following curative-intent hepatectomy for CLM and was elevated in almost one-third of patients with a normal CEA.
Figure 1. Overall survival of patients undergoing liver resection for CLM stratified by maximum CA19-9 level.Median survival was 75.8 months for patients with a maximum CA19-9 ? 35 U/mL and 41.2 months for patients with a maximum CA 19-9 > 35 U/mL.
1-, 3-, and 5-year overall survival were 94.0%, 73.0%, and 57.5% for patients with a maximum CA19-9 ? 35 U/mL and 90.0%, 53.2%, and 37.3% for patients with a maximum CA 19-9 > 35 U/mL.
Table 1. Multivariable Cox proportional hazards model analysis for overall survival for patients undergoing resection for CLM.
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