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Prognostic Value of Circulating Tumor Markers in Patients with Pseudomyxoma Peritonei Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Encouraging results have been recently reported in selected patients affected by pseudomyxoma peritonei (PMP) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The selection factors predicting clinical outcome are still a matter of clinical investigation. We assessed the prognostic reliability of serum tumor markers in a large series of patients with PMP undergoing CRS and HIPEC.

Methods

Sixty-two patients with PMP were operated on at a single institution with the intent of performing adequate CRS (residual tumor nodules ≤2.5mm) and HIPEC. Baseline and serial marker measurements were prospectively collected and tested by multivariate analysis with respect to adequate cytoreduction, overall (OS) and progression-free (PFS) survival, along with the following variables: age, sex, performance status, prior surgical score, histological subtype, prior systemic chemotherapy, disease extent, completeness of cytoreduction.

Results

Baseline diagnostic sensitivity was 72.6% for CEA, 58.1% for CA19.9, 58.7% for CA125, 36.1% for CA15.3. Fifty-three patients underwent adequate CRS and HIPEC; gross residual tumor was left after surgery in nine. Adequate CRS was performed in 19/27 patients with elevated and in 19/19 with normal baseline CA125 (P = .0140). The other markers were unable to predict the completeness of CRS by univariate analysis. Baseline elevated CA19.9 was an independent predictor of reduced PFS; inadequate CRS and aggressive histology were independent prognostic factors for both reduced OS and PFS.

Conclusion

Normal CA125 correlated to the likelihood to achieve adequate CRS, which is a significant prognostic factor for PMP. Increased baseline CA19.9 was an independent predictor of worse PFS after CRS and HIPEC.

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Acknowledgments

The authors are indebted with Cristiana Carniti, PhD for assistance in preparing the manuscript.

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Authors and Affiliations

  1. Department of Surgery, National Cancer Institute, Milan, Italy

    Dario Baratti MD, Shigeki Kusamura MD, PhD, Barbara Laterza MD, Daniela G. Oliva MD & Marcello Deraco MD

  2. Department of Nuclear Medicine, National Cancer Institute, Milan, Italy

    Antonia Martinetti MD & Ettore Seregni MD

  3. Department of Surgery, University of Messina, Messina, Italy

    Daniela G. Oliva MD

Authors
  1. Dario Baratti MD
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  2. Shigeki Kusamura MD, PhD
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  3. Antonia Martinetti MD
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  4. Ettore Seregni MD
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  5. Barbara Laterza MD
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  6. Daniela G. Oliva MD
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  7. Marcello Deraco MD
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Correspondence to Marcello Deraco MD.

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Baratti, D., Kusamura, S., Martinetti, A. et al. Prognostic Value of Circulating Tumor Markers in Patients with Pseudomyxoma Peritonei Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 14, 2300–2308 (2007). https://doi.org/10.1245/s10434-007-9393-9

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  • DOI: https://doi.org/10.1245/s10434-007-9393-9

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