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Clinical significance of serum CEA protein and CEA mRNA after resection of colorectal liver metastases.

BACKGROUND
It is difficult to predict the recurrence of colorectal liver metastasis after curative hepatectomy. We investigated the relationship between subsequent metastasis and both CEA protein and CEA mRNA (TaqMan PCR) diachronic levels.


PATIENTS AND METHODS
The subjects were 30 patients with colorectal liver metastases. Serum CEA protein and CEA mRNA assays were performed every month after hepatectomy.


RESULTS
Metastasis recurred in 21 of the 30 patients. The CEA mRNA assay showed 26 cases with high (H) levels and 4 with low (L). Among the 15 patients whose protein levels were not elevated (NE group), 6 had recurrence; all 6 belonged to the mRNA H group. None of the 4 patients in the mRNA L group had recurrence. In the protein-elevated (E) group (DFI > 6 months) (n = 7), mRNA was elevated in 5 cases (71.4%) 6 months before recurrence, whereas protein was elevated in 1 case. The sensitivity, specificity and accuracy of CEA protein/mRNA for identifying recurrence were 71.4/100, 100/44.4, and 80/83.3%, respectively.


CONCLUSION
CEA mRNA is more sensitive than CEA protein in detecting recurrence. CEA mRNA may be useful for identifying high-risk groups or detecting recurrence at an early stage, when the CEA protein level is still low.