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Ann Thorac Surg 1996;62:1888-1889
© 1996 The Society of Thoracic Surgeons
Service de Chirurgie Thoracique Institut Mutualiste Montsouris Choisy 6, Place de Port-au-Prince 75013, Paris, France
Centre Chirurgical Marie Lannelongue 133 Ave de la Résistance 92350 e Plessis Robinson, France
To the Editor:
After the resection of isolated pulmonary metastases, about 25% of patients will survive 10 years, most of them free of disease [1]. Although there have been no randomized trials, operation can therefore be considered an effective treatment in selected patients with metastatic cancer. However, reliable simple prognostic factors to properly select patients who will benefit from resection are still in great demand. In patients with resectable lung metastases from colorectal cancer, two recent retrospective series evaluated the prognostic value of the prethoracotomy serum carcinoembryonic antigen (CEA) level [2, 3], which was found to be a highly significant prognostic factor. However, the subgroups of patients with normal and abnormal CEA levels were small in both series, so the reliability of serum CEA as a preoperative selection criterion might still appear uncertain.
We had the opportunity to collect and analyze the prethoracotomy serum CEA level of patients from another published series [4], which allowed us to pool the data from our two series [3, 4], representing a total of 187 patients, including 131 patients with a known prethoracotomy CEA level. Of these, 60 had normal levels, whereas 71 had elevated (>5 ng/mL) serum CEA values. The 5-year probability of survival of patients with a normal CEA level was 49%, as compared with 10% for patients with elevated CEA values, a highly significant difference (p < 0.001 by log-rank test) (Fig 1
). Except for resectability, and even in other histologic types, not a single prognostic factor (including the number of metastases, for example [3]) has been found so far to be as effective as this simple marker for predicting survival after pulmonary metastasectomy.
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These results considerably strengthen the value of prethoracotomy serum CEA level as the most reliable prognostic criterion in patients with resectable lung metastases from colorectal cancer. This extremely simple marker should become the main factor to be taken into account during the preoperative selection of these patients.
References
Section of General Thoracic Surgery Mayo Clinic 200 First St, Sw Rochester, Mn 55905
To the Editor:
The article by Dr Girard and associates from Paris is interesting. My colleagues and I found a very similar predictive value with preoperative carcinoembryonic antigen (CEA) in our patients with resectable colon metastases to the lung. We also had an almost equal number of patients with a normal CEA level and an elevated preoperative CEA level. In Girard and associates' series of 60 patients who had a normal CEA level preoperatively, their 5-year survival was 49%. In our series, 28 patients had a normal preoperative CEA level, and the 5-year survival was 46.8%. Conversely, in their series, 71 patients had an elevated preoperative CEA level, and their 5-year survival was only 10%. In our series, 24 patients who had an elevated preoperative CEA level had a 5-year survival of 16%. We agree that it is likely that CEA plays some role in determining whether or not further metastases may appear. Perhaps there is linkage between the genes that express CEA and the genes that are involved with the development of metastatic cancer. This awaits further study by molecular biologists. We do agree that it is an important marker and does show statistical significance as far as survivability; however, we would not refuse pulmonary resection based only on an elevated CEA level, because we did achieve a 16% 5-year survival even in patients with an elevated preoperative CEA level.
This article has been cited by other articles:
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  P. F. Presicci, G. Veronesi, M. D'Aiuto, and L. Spaggiari Long-Term Survival After Salvage Surgery for Colorectal Lung Metastases Ann. Thorac. Surg., January 1, 2005; 79(1): 325 - 326. [Abstract] [Full Text] [PDF]
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J.-F. Regnard, D. Grunenwald, L. Spaggiari, P. Girard, D. Elias, M. Ducreux, P. Baldeyrou, and P. Levasseur Surgical treatment of hepatic and pulmonary metastases from colorectal cancers Ann. Thorac. Surg., July 1, 1998; 66(1): 214 - 218. [Abstract] [Full Text] [PDF]
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