OBJECTIVETo investigate the correlation between carcinoembryonic antigen (CEA) and prognosis of hepatocellular carcinoma after hepatectomy.

METHODSThis study retrospectively analyzed the surgical outcomes of hepatocellular carcinoma (HCC) in 562 patients who underwent hepatectomy between January 2002 and December 2009 in the Cancer Hospital, Chinese Academy of Medical Sciences. Postoperative prognostic factors were analyzed using univariate Kaplan-Meier analysis and multivariate Cox proportional hazards model.

RESULTSThe sensibility of serum CEA and CEA-AFP combined in the detection of HCC was 7.1% (40/562) and 55.3% (311/562), respectively. The 1-, 3- and 5-year overall survival rates and disease free survival rates of CEA-negative group (CEA<5 ng/ml) were 93.8%, 75.6%, 59.4%, and 75.0%, 55.9%, 44.5%, respectively (P = 0.003); and the 1-, 3- and 5-year overall survival rates and disease free survival rates of CEA-positive group (CEA ≥ 5 ng/ml) were 87.5%, 60.5%, 46.6% and 52.6%, 36.2%, and 25.4%, respectively (P = 0.045). In the univariate analysis, better prognosis for overall survival (OS) was associated with small tumor ( ≤ 5 cm), single lesion, high-grade histological differentiation, no vascular tumor embolus, negative serum AFP expression, negative serum CEA expression, no/mild cirrhosis, no regional lymph node metastasis, no major vascular invasion, no direct invasion of adjacent organs or with perforation of visceral peritoneum, no transfusion as well as earlier BCLC staging (P < 0.05 for all). In the Cox multivariate analysis, serum AFP-negative expression, serum CEA-negative expression, no/mild cirrhosis, no direct invasion of adjacent organs or with perforation of visceral peritoneum, no transfusion and earlier BCLC staging were independent factors for longer disease free survival (P < 0.05 for all).

CONCLUSIONSSerum CEA-positive expression is correlated to alcoholism and HCC multiple occurrences. Although serum CEA detection has limited value for HCC diagnosis, its positive expression does affect poor prognosis. Higher serum CEA level is an independent prognostic factor for poorer disease free survival.