Prognostic value of baseline and serial carcinoembryonic antigen and carbohydrate antigen 19.9 measurements in patients with pseudomyxoma peritonei treated with cytoreduction and hyperthermic intraperitoneal chemotherapy.
BACKGROUND
Tumor markers are useful for diagnosis and follow-up. We studied the prognostic value of baseline and serial carcinoembryonic antigen (CEA) and carbohydrate antigen 19.9 (CA19.9) measurements in patients with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).


METHODS
Sixty-three patients with pseudomyxoma peritonei were treated with cytoreductive surgery and HIPEC. The tumor markers CEA and CA19.9 were collected before therapy and at 3-month intervals during follow-up.


RESULTS
Preoperative CEA and CA19.9 levels were increased in, respectively, 75% and 58% of the patients. Baseline tumor marker values were related to the extent of tumor. Immediately after HIPEC, both tumor markers decreased markedly (P <.0001). CA19.9 was shown to be a more useful tumor marker than CEA for follow-up. During follow-up, a high absolute CA19.9 level (P =.0005) was predictive for imminent recurrence. Patients who never attained a normal CA19.9 level showed a higher recurrence rate at 1 year (53%; SE, 15%), in comparison to patients who did so (6%; SE 4%). The median lead time of increased CA19.9 to recurrence was 9 months.


CONCLUSIONS
The measurement of the tumor marker CA19.9 is useful in evaluating therapy in patients with pseudomyxoma peritonei treated with cytoreductive surgery and HIPEC. CA19.9 is a prognostic factor for predicting recurrent disease.
van Ruth
S
S
Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. s.v.ruth@nki.nl
Hart
A A M
AA
Bonfrer
J M G
JM
Verwaal
V J
VJ
Zoetmulder
F A N
FA
D000704:Analysis of Variance; D018395:CA-19-9 Antigen / Q000378:metabolism*; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D018572:Disease-Free Survival; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011553:Pseudomyxoma Peritonei / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012008:Recurrence; D015996:Survival Rate
D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen