Abstract
Background
Serum tumour levels have been shown to be prognostic in patients with epithelial appendiceal
mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei (PMP)). A
singular index which incorporates both tumour activity (as depicted by serum tumour
marker levels) and tumour volume (as depicted by peritoneal carcinomatosis index (PCI)),
may give a more precise surrogate of tumour biological behaviour. The prognostic implication
of this index has not yet been reported.
Methods
A retrospective cohort study of all patients with PMP managed from 1996 to 2016 with
cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) was performed by
analysing the survival effect of the ratio of preoperative serum CEA, CA19.9 and CA125
to PCI.
Results
Three hundred and eighty-six patients were included. In patients with low-grade PMP,
elevated CA19-9/PCI ratio resulted in poorer median overall survival times (104 months
vs NR, 95%CI 83 – NR, log-rank p < 0.001) and was an independent predictor of reduced
overall survival on multivariable analysis (adjusted HR 5.60, 95%CI 1.60–19.68, p = 0.007).
In patients with high-grade PMP, no statistically significant difference in survival
was recognised.
Conclusion
CA19-9/PCI ratio is an independent prognostic factor for overall survival in patients
with low-grade PMP undergoing CRS and IPC. By accounting for both tumour activity
and tumour volume simultaneously, this novel index behaves as a surrogate of tumour
biology and provides a useful adjunct for decisions regarding treatment allocation
in this patient group.
Keywords
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Article info
Publication history
Published online: September 18, 2017
Accepted:
September 6,
2017
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
