TY - JOUR
T1 - Prognostic Significance of Preoperative Tumor Markers in Pseudomyxoma Peritonei from Low-Grade Appendiceal Mucinous Neoplasm
T2 - a Study from the US HIPEC Collaborative
AU - Nizam, Wasay
AU - Fackche, Nadege
AU - Pessoa, Bernardo
AU - Kubi, Boateng
AU - Cloyd, Jordan M.
AU - Grotz, Travis
AU - Fournier, Keith
AU - Dineen, Sean
AU - Veerapong, Jula
AU - Baumgartner, Joel M.
AU - Clarke, Callisia
AU - Patel, Sameer H.
AU - Wilson, Gregory C.
AU - Lambert, Laura
AU - Abbott, Daniel E.
AU - Vande Walle, Kara A.
AU - Lee, Byrne
AU - Raoof, Mustafa
AU - Maithel, Shishir K.
AU - Russell, Maria C.
AU - Zaidi, Mohammad Y.
AU - Johnston, Fabian M.
AU - Greer, Jonathan B.
N1 - Publisher Copyright:
© 2021, The Society for Surgery of the Alimentary Tract.
PY - 2022/2
Y1 - 2022/2
N2 - Background: Tumor markers are commonly utilized in the diagnostic evaluation, treatment decision making, and surveillance of appendiceal tumors. In this study, we aimed to determine the prognostic significance of elevated preoperative tumor markers in patients with pseudomyxoma peritonei secondary to low-grade appendiceal mucinous neoplasm who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Methods: Using a multi-institutional database, eligible patients with measured preoperative tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), or cancer antigen 125 (CA-125)] were identified. Univariate and multivariate Cox-proportional hazards regression analysis assessed relationships between normal and elevated serum tumor markers with progression-free and overall survival in the context of multiple clinicopathologic variables. Results: zTwo hundred and sixty-four patients met criteria. CEA was the most commonly measured tumor marker (97%). Patients who had any elevated tumor marker had a higher peritoneal carcinomatosis index (PCI) as compared to those with normal range markers. Elevated CEA and CA 19-9 levels were individually associated with longer inpatient length of stay, requirement for intraoperative transfusion, and incomplete cytoreduction. Utilization of neoadjuvant chemotherapy, increased PCI score, elevated CA 19-9 (p = 0.007), and CA-125 levels (p = 0.01) were predictive of decreased progression-free survival on univariate analysis. However, in a multivariate model, only elevated PCI was a statistically significant predictor of progression-free survival. Conclusion: Elevated preoperative tumor markers indicate a higher burden of disease but are not independently associated with survival in this retrospective multi-institutional cohort. Further prospective studies are needed to clarify the utility of these markers in this patient population.
AB - Background: Tumor markers are commonly utilized in the diagnostic evaluation, treatment decision making, and surveillance of appendiceal tumors. In this study, we aimed to determine the prognostic significance of elevated preoperative tumor markers in patients with pseudomyxoma peritonei secondary to low-grade appendiceal mucinous neoplasm who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Methods: Using a multi-institutional database, eligible patients with measured preoperative tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), or cancer antigen 125 (CA-125)] were identified. Univariate and multivariate Cox-proportional hazards regression analysis assessed relationships between normal and elevated serum tumor markers with progression-free and overall survival in the context of multiple clinicopathologic variables. Results: zTwo hundred and sixty-four patients met criteria. CEA was the most commonly measured tumor marker (97%). Patients who had any elevated tumor marker had a higher peritoneal carcinomatosis index (PCI) as compared to those with normal range markers. Elevated CEA and CA 19-9 levels were individually associated with longer inpatient length of stay, requirement for intraoperative transfusion, and incomplete cytoreduction. Utilization of neoadjuvant chemotherapy, increased PCI score, elevated CA 19-9 (p = 0.007), and CA-125 levels (p = 0.01) were predictive of decreased progression-free survival on univariate analysis. However, in a multivariate model, only elevated PCI was a statistically significant predictor of progression-free survival. Conclusion: Elevated preoperative tumor markers indicate a higher burden of disease but are not independently associated with survival in this retrospective multi-institutional cohort. Further prospective studies are needed to clarify the utility of these markers in this patient population.
KW - Biomarkers
KW - Low-grade appendiceal mucinous neoplasm
KW - Pseudomyxoma peritonei
KW - Tumor
UR - http://www.scopus.com/inward/record.url?scp=85114672003&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114672003&partnerID=8YFLogxK
U2 - 10.1007/s11605-021-05075-1
DO - 10.1007/s11605-021-05075-1
M3 - Article
C2 - 34506026
AN - SCOPUS:85114672003
SN - 1091-255X
VL - 26
SP - 414
EP - 424
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 2
ER -