title: Significance of serum tumor marker levels in peritoneal carcinomatosis of appendiceal origin.
abstract: BACKGROUND
  The significance of tumor markers in patients with appendiceal carcinomatosis is poorly defined. We determined preoperative and postoperative tumor marker levels in patients undergoing cytoreductive surgery (CRS) and heated intraperitoneal chemoperfusion (HIPEC) and examined their association with clinicopathologic features and survival.
  
  
  METHODS
  A total of 176 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis had at least 1 tumor marker measured. Marker levels were correlated with tumor characteristics and oncologic outcomes. Kaplan-Meier curves and multivariate Cox regression models were used to identify prognostic factors affecting progression and survival.
  
  
  RESULTS
  At least 1 marker was elevated prior to CRS/HIPEC in 70 % of patients (CEA, 54.1 %; CA19-9, 47.7 %; CA-125, 47.2 %). Among patients with elevated preoperative marker levels, normalization occurred postoperatively in 79.4 % for CEA, 92.3 % for CA19-9, and 60 % for CA-125. Absolute preoperative tumor marker levels correlated with peritoneal carcinomatosis index (PCI) (p < .0002), and the number of elevated markers was associated with PCI and progression-free survival (PFS). Elevated postoperative CEA level was associated with decreased PFS (median, 13 vs 36 months, p = .0008). On multivariate Cox regression analysis, elevated preoperative CA19-9 was associated with shorter PFS (hazard ratio [HR] 2.9, 95 % confidence interval [95 % CI] 1.5-5.3, p = .0008), whereas elevated CA-125 was associated with shorter overall survival (HR 2.6, 95 % CI 1.3-5.4, p = .01).
  
  
  CONCLUSIONS
  Most patients with appendiceal carcinomatosis will have at least 1 elevated tumor marker and will normalize following CRS/HIPEC, allowing for ongoing surveillance. CA19-9 is a promising biomarker for early progression following CRS/HIPEC, whereas CA-125 is associated with shorter survival.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Wagner
authors.forename: Frances
authors.initials: F
authors.lastname: Austin
authors.forename: Magesh
authors.initials: M
authors.lastname: Sathaiah
authors.forename: Deepa
authors.initials: D
authors.lastname: Magge
authors.forename: Ugwuji
authors.initials: U
authors.lastname: Maduekwe
authors.forename: Lekshmi
authors.initials: L
authors.lastname: Ramalingam
authors.forename: Heather L
authors.initials: HL
authors.lastname: Jones
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Holtzman
authors.forename: Steven A
authors.initials: SA
authors.lastname: Ahrendt
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Haroon A
authors.initials: HA
authors.lastname: Choudry
mesh_terms: D001063:Appendiceal Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D015415:Biomarkers / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000097:blood* / Q000401:mortality / Q000556:secondary / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen