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Prognostic Significance of Preoperative Tumor Markers in Pseudomyxoma Peritonei from Low-Grade Appendiceal Mucinous Neoplasm: a Study from the US HIPEC Collaborative

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

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.

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Acknowledgements

The authors would like to thank local database managers that were involved in data collection and maintenance of this large database.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University, 600 N. Wolfe Street/Blalock 609, Baltimore, MD, 21287, USA

    Wasay Nizam, Nadege Fackche, Bernardo Pessoa,  Boateng Kubi, Fabian M. Johnston & Jonathan B. Greer

  2. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Jordan M. Cloyd

  3. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA

    Travis Grotz

  4. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Keith Fournier

  5. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA

    Sean Dineen

  6. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA

    Jula Veerapong & Joel M. Baumgartner

  7. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Wauwatosa, WI, USA

    Callisia Clarke

  8. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Sameer H. Patel & Gregory C. Wilson

  9. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Laura Lambert

  10. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA

    Daniel E. Abbott & Kara A. Vande Walle

  11. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, USA

    Byrne Lee & Mustafa Raoof

  12. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, USA

    Shishir K. Maithel, Maria C. Russell & Mohammad Y. Zaidi

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  1. Wasay Nizam
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Contributions

W. N.: substantial contributions towards the conception and design of study, acquisition, analysis, and interpretation of data for the work, drafted the work, made revisions, and final approval of manuscript.

N. F.: substantial contributions towards the conception and design of study, acquisition, analysis, and interpretation of data for the work, made revisions, and final approval of manuscript.

B. P., B. K., J. M. C., T. G., K. F., S. D., J. V., J. M. B., C. C., S. H. P., G. C. W., L. L., D. E. A., K. A. V. W., B. L., M. R., S. K. M., M. C. R., M. Y. Z., F. M. J., and J. B. G. made substantial contributions to the acquisition of data for the work, interpretation and analysis of results, critical review of manuscript, and final approval of manuscript.

Corresponding author

Correspondence to Jonathan B. Greer.

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Nizam, W., Fackche, N., Pessoa, B. et al. Prognostic Significance of Preoperative Tumor Markers in Pseudomyxoma Peritonei from Low-Grade Appendiceal Mucinous Neoplasm: a Study from the US HIPEC Collaborative. J Gastrointest Surg 26, 414–424 (2022). https://doi.org/10.1007/s11605-021-05075-1

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