Nadege Fackche1, Ryan K Schmocker1, Boateng Kubi1, Jordan M Cloyd2, Ahmed Ahmed2, Travis Grotz3, Jennifer Leiting3, Keith Fournier4, Andrew J Lee4, Benjamin Powers5, Sean Dineen5, Jula Veerapong6, Joel M Baumgartner6, Callisia Clarke7, T Clark Gamblin7, Sameer H Patel8, Vikrom Dhar8, Ryan J Hendrix9, Laura Lambert9, Daniel E Abbott10, Courtney Pokrzywa10, Kelly Lafaro11, Byrne Lee11, Mohammad Y Zaidi12, Shishir K Maithel12, Fabian M Johnston1, Jonathan B Greer13. 1. Division of Surgical Oncology, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. 2. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 3. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA. 4. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA. 6. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, La Jolla, CA, USA. 7. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 8. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 9. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA. 10. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA. 11. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, South Pasadena, CA, USA. 12. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 13. Division of Surgical Oncology, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. jgreer13@jhmi.edu.
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.
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.
Authors: D Elias; F Gilly; F Quenet; J M Bereder; L Sidéris; B Mansvelt; G Lorimier; O Glehen Journal: Eur J Surg Oncol Date: 2010-03-12 Impact factor: 4.424
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