Preoperative tumor markers as prognostic factors of colorectal liver metastases.

Background/aims: Tumor recurrence develops in 45-80% of patients after liver surgery for colorectal liver metastases. To assess the significance of preoperative tumor marker levels for disease free interval (DFI) and patient survival (PS) after liver surgery.

Methodology: Preoperative serum levels of carcinoembryonic antigen--CEA, CA 19-9, CA 72-4, thymidine kinase (TK), tissue polypeptide antigen (TPA) and tissue polypeptide specific antigen (TPS) were evaluated in 173 patients operated on for colorectal liver metastases (CLM). Liver resection was performed on 114 patients and radiofrequency ablation on 59 patients.

Results: Preoperative serum levels of TPA (cut off level = 53 IU/L, Hazard ratio = 4.5, Wilcoxon test: p < 0.01, Log-Rank test: p < 0.03) and TPS (cut off level = 81 IU/L, Hazard ratio = 5.1, Wilcoxon test: p < 0.007, Log-Rank test: p < 0.009) were important for PS and DFI after liver resection (TPA: cut off level = 53 IU/L, Hazard ratio = 3.5, Wilcoxon test: n.s., Log-Rank test: n.s.; TPS: cut off level = 81 IU/l, Hazard ratio = 2.6, Wilcoxon test: p < 0.02, Log-Rank: p < 0.06). TPA serum levels were important for PS (Wilcoxon test--p < 0.003, Log-Rank test--p < 0.0002) and DFI after RFA (Wilcoxon test--p< 0.001, Log-Rank Test--p < 0.0001). TPS serum levels also correlated with PS (Wilcoxon test--p < 0.005, Log-Rank test--p < 0.003) and DFI after RFA (Wilcoxon test--p < 0.001, Log-Rank Test--p< 0.0001).

Conclusions: TPA and TPS are important predictive markers for PS and DFI after liver resections and radiofrequency ablations for CLM.