Carcinoembryonic antigen mRNA in the mesenteric vein is not a predictor of hepatic metastasis in patients with resectable colorectal cancer - A long-term study

PURPOSE: The clinical value of carcinoembryonic antigen messenger ribonucleic acid in the draining venous blood has been controversial because of short observation period. The authors prospectively investigated the clinical significance of detection of carcinoembryonic antigen messenger ribonucleic acid in the draining venous blood to predict hepatic metastases in patients with resectable colorectal cancer. METHODS: Drainage venous blood from 80 patients who underwent curative resections for colorectal cancer were obtained immediately before surgery to determine the presence of cancer cells by means of reverse transcription polymerase chain reaction. RESULTS: After an average follow-up period of 52.1 months, 7 of the 35 patients (20 percent) with positive carcinoembryonic antigen messenger ribonucleic acid had hepatic metastases, whereas 2 of the 45 patients (4.5 percent) with negative carcinoembryonic antigen messenger ribonucleic acid had hepatic metastases. The cumulative probability of hepatic metastatic recurrence rate differed significantly between two patient groups with positive or negative carcimoembryonic antigen messenger ribonlucleic acid expression in the drainage vein (log-rank, 4.900; P = 0.0269). However, 28 of the 35 patients (80 percent) with positive carcinoembryonic antigen messenger ribonucleic acid did not have hepatic metastases. Additionally, Cox proportional hazards models identitied the presence of lymph node metastases as the only independent predictor of hepatic metastatic recurrence. CONCLUSIONS: This study failed to demonstrate the high predictive value of carcinoembryonic antigen messenger ribonucleic acid detection in the draining venous blood for the development of hepatic metastases. However, the authors demonstrated that the presence of cancer cells in the draining venous blood was the essential and initial step to the development of hepatic metastasis.