Faculty Collaboration Database

The Utility of Preoperative Tumor Markers in Peritoneal Carcinomatosis from Primary Appendiceal Adenocarcinoma: an Analysis from the US HIPEC Collaborative. J Gastrointest Surg 2021 Nov;25(11):2908-2919

Date

02/27/2021

Pubmed ID

33634422

DOI

10.1007/s11605-021-04953-y

Scopus ID

2-s2.0-85101751461 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

BACKGROUND: Prognostication based on preoperative clinical factors is lacking in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). This study aims to determine the value of preoperative tumor markers as predictors of progression-free survival (PFS) and overall survival (OS) for patients with peritoneal carcinomatosis from a primary mucinous adenocarcinoma of the appendix (MACA).

METHODS: We queried the United States HIPEC Collaborative, a database of patients with peritoneal carcinomatosis treated with CRS/HIPEC at twelve institutions between 2000 and 2017, identifying 409 patients with MACA. Multivariate analysis was used to identify independent predictors of disease progression. Subgroup analysis was conducted to evaluate the impact of tumor grade on the predictive value of tumor markers.

RESULTS: CA19-9 [HR 2.44, CI 1.2-3.4] emerged as an independent predictor of PFS while CEA [HR 4.98, CI 1.06-23.46] was independently predictive of OS (p <0.01). Tumor differentiation was the most potent predictor of both PFS (poorly differentiated vs well, [HR 4.5 CI 2.01-9.94]) and OS ([poorly differentiated vs well-differentiated: [HR 13.5, CI 3.16-57.78]), p <0.05. Among patients with combined CA19-9 elevation and poorly differentiated histology, 86% recurred within a year of CRS/HIPEC (p < 0.01). Similarly, the coexistence of CEA elevation and unfavorable histology led to the lowest survival rate at two years [36%, p < 0.01]. CA-125 was not predictive of PFS or OS.

CONCLUSION: Elevated preoperative CA19-9 portends worse PFS, while elevated CEA predicts worse OS after CRS/HIPEC in patients with MACA. This study provides additional evidence that CA19-9 and CEA levels should be collected during standard preoperative bloodwork, while CA-125 can likely be omitted. Tumor differentiation, when added to preoperative tumor marker levels, provides powerful prognostic information. Prospective studies are required to confirm this association.

Author List

Fackche N, Schmocker RK, Kubi B, Cloyd JM, Ahmed A, Grotz T, Leiting J, Fournier K, Lee AJ, Powers B, Dineen S, Veerapong J, Baumgartner JM, Clarke C, Gamblin TC, Patel SH, Dhar V, Hendrix RJ, Lambert L, Abbott DE, Pokrzywa C, Lafaro K, Lee B, Zaidi MY, Maithel SK, Johnston FM, Greer JB

Authors

Callisia N. Clarke MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Antineoplastic Combined Chemotherapy Protocols
Appendiceal Neoplasms
Appendix
Biomarkers, Tumor
Combined Modality Therapy
Cytoreduction Surgical Procedures
Humans
Hyperthermia, Induced
Peritoneal Neoplasms
Retrospective Studies
Survival Rate