Abstract
Background
Appendiceal malignancies with peritoneal spread have been successfully treated with
Cytoreductive Surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
The aim of this study is to clarify the utility of common tumor markers in selecting
patients for the combined treatment.
Methods
Data on 56 patients with appendiceal neoplasms treated with CRS and HIPEC were prospectively
collected. Chi square test was used to analyze a link between common tumor markers
and completeness of cytoreduction score (CC score) and preoperative peritoneal cancer
index score (PCI score). Cox proportional hazard model was used to perform survival
analysis.
Results
Forty-two patients were alive after 3 years of follow-up. Hazard ratio of disease
related death was 5.6 (95% CI, 1.8–17.2) among patients with high CC score as compared
to those with low CC score. Number of abnormal tumor markers (0 vs 1/2/3) correlated
with PCI score 16.2 vs 32.5 (p < 0.001) but not with completeness of cytoreduction or survival. The 3-year survival
rates in patients with normal vs abnormal CA 125 levels were 83% vs 52%(p = 0.003).
Conclusions
Multiple abnormal tumor markers were not useful as an exclusion criterion for patients
undergoing CRS. Elevation in CA 125 was an important indicator of survival in these
patients. Complete cytoreduction was crucial for long-term survival.
Keywords
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References
- Appendiceal neoplasms and pseudomyxoma peritonei: a population based study.Eur J Surg Oncol (EJSO). 2008; 34: 196-201
- Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to “pseudomyxoma peritonei”.Am J Surg Pathol. 1995; 19: 1390-1408
- Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin.Am Surg. 2000; 66: 561-568
- New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome?.Lancet Oncol. 2006; 7: 69-76
- Pseudomyxoma peritonei: clinical pathological and biological prognostic factors in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).Ann Surg Oncol. 2008; 15: 526-534
- Appendiceal neoplasms with peritoneal dissemination: outcomes after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy.Ann Surg Oncol. 2006; 13: 624-634
- Prognostic features for peritoneal carcinomatosis in colorectal and appendiceal cancer patients when treated by cytoreductive surgery and intraperitoneal chemotherapy.Cancer Treat Res. 1996; 81: 89-104
- Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.Ann Surg. 1999; 230: 309-318
- Utility of CEA and CA 19-9 tumor markers in diagnosis and prognostic assessment of mucinous epithelial cancers of the appendix.J Surg Oncol. 2004; 87: 162-166
- Elevated tumour markers prior to complete tumour removal in patients with pseudomyxoma peritonei predict early recurrence.Colorectal Dis. 2005; 7: 382-386
- Prognostic value of baseline and serial carcinoembryonic antigen and carbohydrate antigen 19.9 measurements in patients with pseudomyxoma peritonei treated with cytoreduction and hyperthermic intraperitoneal chemotherapy.Ann Surg Oncol. 2002; 9: 961-967
- Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer.Int Semin Surg Oncol. 2005; 2: 3
- High levels of CA 125 (over 1,000 IU/ml) in patients with gynecologic disease and no malignant conditions: three cases and literature review.Arch Gynecol Obstet. 2007; 276: 559-561
- Incomplete cytoreduction in 174 patients with peritoneal carcinomatosis from appendiceal malignancy.Ann Surg. 2004; 240: 278-285
Article info
Publication history
Accepted:
May 17,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
