title: Circulating CA125 in patients with peritoneal mesothelioma treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion.
abstract: BACKGROUND
  Recent phase I/II trials report encouraging results in selected patients with peritoneal mesothelioma (PM) treated with cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP). Circulating tumor markers have never been extensively investigated in the management of PM. We assessed the clinical role of markers in a large series of patients with PM undergoing CRS and IPHP.
  
  
  METHODS
  Clinical data on 60 patients with PM operated with the intention to perform adequate CRS (residual tumor nodules <or= 2.5mm) and IPHP were prospectively collected. Marker levels were determined pre-operatively, post-operatively, and routinely during long-term follow-up. Baseline diagnostic sensitivity, accuracy in monitoring response to treatment or tumor progression and prognostic significance were determined.
  
  
  RESULTS
  Baseline diagnostic sensitivity was 53.3% for CA125, 0 for CEA, 3.8% for CA19.9 and 48.5% for CA15.3. Forty-six patients underwent adequate cytoreduction and IPHP; gross residual tumor was left after the operation in fourteen. Postoperatively, CA125 became negative in 21/22 patients with elevated baseline levels undergoing adequate CRS and IPHP, while remained elevated in 9/9 patients with persistent macroscopic disease. CA125 became positive in 12/12 patients with elevated baseline levels developing disease progression after adequate CRS and IPHP. Baseline CA125 showed borderline prognostic significance only among patients not previously treated with systemic chemotherapy.
  
  
  CONCLUSIONS
  CA125 was elevated in the majority of patients with PM in the present series. Serial maker measurements paralleled tumor growth or regression after CRS and IPHP, suggesting the need of further studies to assess the role of CA125 in this clinical setting.
authors.affiliation: Department of Surgery, National Cancer Institute, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Baratti
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kusamura
authors.forename: Antonia
authors.initials: A
authors.lastname: Martinetti
authors.forename: Ettore
authors.initials: E
authors.lastname: Seregni
authors.forename: Daniela G
authors.initials: DG
authors.lastname: Oliva
authors.forename: Barbara
authors.initials: B
authors.lastname: Laterza
authors.forename: Marcello
authors.initials: M
authors.lastname: Deraco
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen