The Prognostic and Predictive Value of Carbohydrate Antigen 19-9 in Metastatic Colorectal Cancer Patients with First Line Bevacizumab Containing Chemotherapy

Objective: We had previously demonstrated that the carbohydrate antigen 19-9 (CA19-9), lactate dehydrogenase (LDH), neutrophil lymphocyte ratio (NLR) are prognostic factors for patients with metastatic colorectal cancer (mCRC). In this study, we try to analysis the association of these blood-based biomarkers with bevacizumab efficacy in the first line setting. Methods: A total of 284 eligible consecutive mCRC patients who received first-line chemotherapy with or without bevacizumab were studied from 2007 to 2014 at Sun Yat-Sen University Cancer Center. The endpoints were overall survival (OS), progression free survival (PFS). Results: Among all the patients, the initial elevated CA19-9, high LDH, and NLR > 2.47 were confirmed as independent unfavorable prognostic factors. The CA19-9 and LDH levels were significantly associated with PFS. In the high CA19-9 subgroup, patients had favorable OS from bevacizumab administration in the first line therapy (32.1 vs. 20.1 months, P = 0.03), but without PFS benefit. In terms of different levels of LDH, and NLR, there were no survival benefit from bevacizumab treatment. Conclusions: Our results suggest that the initial CA19-9, LDH, and NLR levels could be independent prognostic biomarkers in mCRC patients. And among all these factors, the initial high CA19-9 level could be a predictor for bevacizumab effect.