title: Circulating tumor markers: predictors of incomplete cytoreduction and powerful determinants of outcome in pseudomyxoma peritonei.
abstract: BACKGROUND
  Incomplete cytoreduction (IC) is one of the main prognostic factor in pseudomyxoma peritonei (PMP). We evaluated the ability of preoperative Ca125, CEA, and Ca19-9 to predict IC and prognosis in PMP.
  
  
  METHODS
  One hundred fifty-six cases elected candidate to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy from 1996 to 2011 were included in the study. We assessed the: (1) optimal cut-off values for circulating Tumor markers (CTM) in predicting IC (residual disease >2.5 mm) using receiver-operating characteristics (ROC); (2) discriminant power of CTM and risk prediction models for IC by calculating the area under ROC curve (AUC-ROC); (3) prognostic factors using Cox proportional-hazard model.
  
  
  RESULTS
  Optimal cut-offs were 125 U/ml for Ca125, 18 ng/ml for CEA, and 89 U/ml for Ca19-9. The AUCs-ROC were 0.76, 0.68, and 0.69 for Ca125, CEA, and Ca19-9, respectively. The addition of CTM to risk prediction model that considered preoperative clinicopathological factors increased marginally the AUC-ROC (0.80-0.84). Ca125 > 125 U/ml, Ca19-9 > 89 U/ml independently affected overall survival.
  
  
  CONCLUSIONS
  Preoperative CTMs were reasonable but not perfect discriminators of IC. Moreover, Ca125 and Ca19-9, using new cut-off values, were proven to be new strong prognostic factors that overcome the value of disease extension and histological subtype.
authors.affiliation: Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumouri Milano, Milan, Italy.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kusamura
authors.forename: Ionut
authors.initials: I
authors.lastname: Hutanu
authors.forename: Dario
authors.initials: D
authors.lastname: Baratti
authors.forename: Marcello
authors.initials: M
authors.lastname: Deraco
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery; D016016:Proportional Hazards Models; D011553:Pseudomyxoma Peritonei / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012737:Sex Factors
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D016685:Mitomycin; D002945:Cisplatin