title: Elevated tumour markers are normalized in most patients with pseudomyxoma peritonei 7 days after complete tumour removal.
abstract: OBJECTIVE
  Elevation of the preoperative tumour markers in pseudomyxoma peritonei (PMP) is common and is a risk factor for recurrence. There has, however, been no documentation of the effect of complete tumour removal on tumour markers levels after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of the study was to compare the tumour markers 7 days after surgery in patients with elevated preoperative levels.
  
  
  METHODS
  This was an observational prospective study of patients with PMP of appendiceal origin treated in one of the UK National Referral Centres for this condition. Thirty patients [median age = 61 (range: 31-74) years; six men] with an elevated preoperative level of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA-125) and/or carbohydrate antigen 19-9 (CA19-9) underwent repeated estimation, 7 days after CRS and HIPEC for PMP.
  
  
  RESULTS
  The median preoperative CEA level of 12 μg/l fell to 0.75 μg/l postoperatively (P < 0.0001), CA-125 fell from 45 to 31 kU/l (P = 0.183) and CA19-9 fell from 134 to 37 kU/l (P = 0.003). The CEA was raised in 22 (73%) of 30 patients preoperatively and in two (7%) of 30 patients 7 days after surgery (P < 0.0001). The corresponding data for CA-125 were 18 (60%) and 13 (43%) (P = 0.196) and for CA19-9 they were 24 (80%) and 16 (53%) (P = 0.028).
  
  
  CONCLUSIONS
  This is the first documentation of a reduction or normalization of CEA 7 days after CRS, but not for CA19-9 or CA-125. This may indicate completeness of surgical resection and could aid selection for adjuvant therapy and predict prognosis. Long-term follow-up is, however, necessary to determine the significance of this observation.
authors.affiliation: Peritoneal Malignancy Institute and Colorectal Surgery, Basingstoke and North Hampshire Hospitals, Basingstoke, UK.
authors.forename: F
authors.initials: F
authors.lastname: Di Fabio
authors.affiliation: Peritoneal Malignancy Institute and Colorectal Surgery, Basingstoke and North Hampshire Hospitals, Basingstoke, UK.
authors.forename: W
authors.initials: W
authors.lastname: Aston
authors.affiliation: Peritoneal Malignancy Institute and Colorectal Surgery, Basingstoke and North Hampshire Hospitals, Basingstoke, UK.
authors.forename: F
authors.initials: F
authors.lastname: Mohamed
authors.affiliation: Peritoneal Malignancy Institute and Colorectal Surgery, Basingstoke and North Hampshire Hospitals, Basingstoke, UK.
authors.forename: K
authors.initials: K
authors.lastname: Chandrakumaran
authors.affiliation: Peritoneal Malignancy Institute and Colorectal Surgery, Basingstoke and North Hampshire Hospitals, Basingstoke, UK.
authors.forename: T
authors.initials: T
authors.lastname: Cecil
authors.affiliation: Peritoneal Malignancy Institute and Colorectal Surgery, Basingstoke and North Hampshire Hospitals, Basingstoke, UK.
authors.forename: B
authors.initials: B
authors.lastname: Moran
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001063:Appendiceal Neoplasms / Q000473:pathology*; D018394:CA-125 Antigen / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000097:blood* / Q000556:secondary / Q000628:therapy*; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011553:Pseudomyxoma Peritonei / Q000097:blood* / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen
keywords: Tumour markers; appendix tumour; carbohydrate antigen 125; carbohydrate antigen 19-9; carcinoembryonic antigen; pseudomyxoma peritonei