Prognostic value of circulating tumor markers in patients with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
BACKGROUND
Encouraging results have been recently reported in selected patients affected by pseudomyxoma peritonei (PMP) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The selection factors predicting clinical outcome are still a matter of clinical investigation. We assessed the prognostic reliability of serum tumor markers in a large series of patients with PMP undergoing CRS and HIPEC.


METHODS
Sixty-two patients with PMP were operated on at a single institution with the intent of performing adequate CRS (residual tumor nodules </=2.5mm) and HIPEC. Baseline and serial marker measurements were prospectively collected and tested by multivariate analysis with respect to adequate cytoreduction, overall (OS) and progression-free (PFS) survival, along with the following variables: age, sex, performance status, prior surgical score, histological subtype, prior systemic chemotherapy, disease extent, completeness of cytoreduction.


RESULTS
Baseline diagnostic sensitivity was 72.6% for CEA, 58.1% for CA19.9, 58.7% for CA125, 36.1% for CA15.3. Fifty-three patients underwent adequate CRS and HIPEC; gross residual tumor was left after surgery in nine. Adequate CRS was performed in 19/27 patients with elevated and in 19/19 with normal baseline CA125 (P = .0140). The other markers were unable to predict the completeness of CRS by univariate analysis. Baseline elevated CA19.9 was an independent predictor of reduced PFS; inadequate CRS and aggressive histology were independent prognostic factors for both reduced OS and PFS.


CONCLUSIONS
Normal CA125 correlated to the likelihood to achieve adequate CRS, which is a significant prognostic factor for PMP. Increased baseline CA19.9 was an independent predictor of worse PFS after CRS and HIPEC.
Baratti
Dario
D
Department of Surgery, National Cancer Institute, Milan, Italy.
Kusamura
Shigeki
S
Martinetti
Antonia
A
Seregni
Ettore
E
Laterza
Barbara
B
Oliva
Daniela G
DG
Deraco
Marcello
M
D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D018396:Mucin-1 / Q000097:blood; D010534:Peritoneal Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011553:Pseudomyxoma Peritonei / Q000097:blood* / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D011956:Receptors, Cell Surface / Q000097:blood; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; D018396:Mucin-1; D011956:Receptors, Cell Surface; C065686:carcinoembryonic antigen binding protein, human; D016685:Mitomycin; D002945:Cisplatin