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Normal CEA Levels After Neoadjuvant Chemotherapy and Cytoreduction with Hyperthermic Intraperitoneal Chemoperfusion Predict Improved Survival from Colorectal Peritoneal Metastases

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Normal carcinoembryonic antigen (CEA) levels (≤ 2.5 ng/ml) after resection of localized colorectal cancer or liver metastases are associated with improved survival, however, these trends are understudied for colorectal peritoneal metastases (CRPM).

Patients and Methods

We conducted a retrospective single-institution study of patients with CRPM undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) with and without neoadjuvant chemotherapy (NACT). CEA was measured before and after NACT and within 3 months after CRS/HIPEC.

Results

A total of 253 patients (mean age 55.3 years) with CRPM undergoing CRS/HIPEC had complete CEA data and 191 also underwent NACT with complete data. The median peritoneal carcinomatosis index score (PCI) of the overall cohort was 12 and 82.7% of patients had complete cytoreduction (CC0). In total, 64 (33.5%) patients had normal CEA levels after NACT with a median overall survival (OS) of 45.2 months compared with those with an elevated CEA (26.4 months, p = 0.004). Patients with normal CEA after NACT had a lower PCI found at the time of surgery than those with elevated CEA (10 versus 14, p < 0.001), 68 (26.9%) patients with an elevated preoperative CEA level experienced normalization after CRS/HIPEC, and 118 (46.6%) patients had elevated CEA after CRS/HIPEC. Patients who experienced normalization demonstrated similar OS to patients that had normal CEA levels pre- and post-surgery and improved OS compared with those with elevated postop CEA (median 41.9 versus 47 months versus 17.1 months, respectively, p < 0.001).

Conclusions

Normal CEA levels after NACT and/or CRS/HIPEC are associated with improved survival for patients with CRPM. Patients that normalize CEA levels after surgery have similar survival to those with normal preoperative levels.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. There are no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Michael M. Wach MD, Geoffrey Nunns MD, Ahmed Hamed MD, Joshua Derby MS, Matthew P. Holtzman MD, Amer H. Zureikat MD, James F. Pingpank MD, M. Haroon A. Choudry MD & Melanie Ongchin MD

  2. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Mark Jelinek MS & Curtis Tatsuoka PhD

  3. AHN Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA

    David L. Bartlett MD

  4. Department of Surgery, University of Colorado, Aurora, CO, USA

    Steven A. Ahrendt MD

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  1. Michael M. Wach MD
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Correspondence to Melanie Ongchin MD.

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Wach, M.M., Nunns, G., Hamed, A. et al. Normal CEA Levels After Neoadjuvant Chemotherapy and Cytoreduction with Hyperthermic Intraperitoneal Chemoperfusion Predict Improved Survival from Colorectal Peritoneal Metastases. Ann Surg Oncol 31, 2391–2400 (2024). https://doi.org/10.1245/s10434-024-14901-0

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