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Carcinoembryonic antigen reduction after medical treatment in patients with metastatic colorectal cancer: a systematic review and meta-analysis

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Abstract

Purpose

The introduction of new drugs and multimodal treatments for the management of patients with metastatic colorectal cancer (mCRC) has reduced the importance of time-to-event endpoints and reported the attention on the response-related endpoints. Furthermore, the prognostic role of the surgical scores before the resection of metastases has not been confirmed for multimodal treatments. The purpose of this research is to perform a meta-analysis of the studies that evaluated the relationship between carcinoembryonic antigen (CEA) response and outcome in patients with mCRC receiving systemic chemotherapy.

Methods

A systematic review of the literature on two databases and a selection of studies that evaluated the relationship between CEA response and outcome were performed according to predefined criteria. After, three meta-analyses were carried out on the selected studies, each for each outcome variable.

Results

Nineteen studies have been selected. Fourteen studies (1475 patients) have documented a close association between radiological response and CEA response (odds ratio (OR), 9.03; confidence intervals (CIs), 5.14–15.87; I2 statistic (I2), 72%). Four studies have reported a longer progression-free survival for patients with a CEA response (hazard ratio (HR), 0.73; CIs, 0.64–0.83; I2, 23%). Finally, 10 studies (13 study cohorts) have shown a strong relationship between CEA response and overall survival (OS) (HR, 0. 62; CIs, 0.55–0.70; I2, 35%).

Conclusions

CEA response merits further investigation as a surrogate endpoint of clinical trials of first-line medical therapy of patients with mCRC, and should be studied as a prognostic factor for those patients who are candidates for multimodal treatment strategies.

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  1. Department of Oncology, Ospedale Civile di Sanremo, Via G. Borea n. 56, I-18038, Sanremo (Imperia), Italy

    Giuseppe Antonio Colloca, Antonella Venturino & Domenico Guarneri

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  1. Giuseppe Antonio Colloca
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Fig. 1

suppl: Scatter plot of meta-regression (effect of age on the relationship between CEA response and ORR). (JPG 29 kb)

Table 1

suppl: Characteristics of the studies. (DOC 51 kb)

Table 2

suppl: Results of meta-regressions of moderators in the analysis of CEA response with ORR (DOC 14 kb)

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Colloca, G.A., Venturino, A. & Guarneri, D. Carcinoembryonic antigen reduction after medical treatment in patients with metastatic colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 34, 657–666 (2019). https://doi.org/10.1007/s00384-018-03230-w

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