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.

中文翻译：

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低级别阑尾黏液性肿瘤腹膜假粘液瘤术前肿瘤标志物的预后意义：美国 HIPEC 合作研究

背景

肿瘤标志物通常用于阑尾肿瘤的诊断评估、治疗决策制定和监测。在这项研究中，我们旨在确定术前肿瘤标志物升高对继发于低级别阑尾粘液性肿瘤的腹膜假粘液瘤患者的预后意义，这些患者接受了细胞减灭术和腹腔热灌注化疗。

方法

使用多机构数据库，确定了术前测量肿瘤标志物 [癌胚抗原 (CEA)、碳水化合物抗原 19-9 (CA 19-9) 或癌抗原 125 (CA-125)] 的合格患者。在多个临床病理变量的背景下，单变量和多变量 Cox 比例风险回归分析评估了正常和升高的血清肿瘤标志物与无进展生存和总生存之间的关系。

结果

z264 名患者符合标准。CEA 是最常测量的肿瘤标志物 (97%)。与具有正常范围标志物的患者相比，具有任何升高的肿瘤标志物的患者具有更高的腹膜癌病指数（PCI）。CEA 和 CA 19-9 水平升高与住院时间延长、术中输血要求和细胞减灭不完全相关。在单变量分析中，新辅助化疗的使用、PCI 评分增加、CA 19-9 升高（p = 0.007）和 CA-125 水平（p = 0.01）可预测无进展生存期降低。然而，在多变量模型中，只有 PCI 升高是无进展生存期的统计学显着预测因子。

结论

在这个回顾性多机构队列中，术前肿瘤标志物升高表明疾病负担更高，但与生存率并不独立相关。需要进一步的前瞻性研究来阐明这些标志物在该患者群体中的用途。