Circulating tumor markers: Predictors of incomplete cytoreduction and powerful determinants of outcome in pseudomyxoma peritonei

Background: Pseudomyxoma peritonei (PMP) originating from appendiceal mucinous neoplasm is a rare peritoneal malignancy characterized by the progressive intraperitoneal accumulation of mucus leading to death if left untreated. In recent years, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offered increased survival rates. This study aims to identify the clinical, pathological, and surgical features influencing safety and survival outcomes of patients undergoing CRS and HIPEC for PMP of appendiceal origin.Methods: A retrospective analysis of all patients undergoing CRS and HIPEC for PMP of appendiceal origin from January 2015 to May 2019 was conducted at our institution.Results: Study population included 50 patients (74% female, 26% male). The median age at CRS was 60 (38–84). The median peritoneal cancer index (PCI) was 17. Complete cytoreductive surgery (CC 0–1) was achieved in 47 patients (94%). HIPEC chemotherapeutic regimen was based on oxaliplatin for 13 (28%) patients and mitomycin for 34 (72%) patients. We experienced a total of 19 (38%) postoperative complications, of which 14 (74%) of grade I-II and 5 (26%) of grade III-IV, according to the Clavien-Dindo classification. The median follow-up period was 27 months (12–107) from the date of cytoreductive surgery. The mean survival rate was 100 months, with a 5-year OS of 91%. The mean progression-free survival rate was 77 months (0–107), with a 5-year PFS of 63%. Multivariate analysis identified adenocarcinoma histotype and incomplete cytoreduction to significantly worsen progression-free survival, while incomplete cytoreduction was the only independent predictor of poorer overall survival.Conclusion: Complete cytoreduction and appendiceal neoplasm histotype play a crucial role in the survival of patients affected by PMP of appendiceal origin. The rates of morbidity associated with CRS and HIPEC for PMP are acceptable.

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Tumor Markers Reflect Tumor Burden of Pseudomyxoma Peritonei

10.21203/rs.3.rs-691313/v1 ◽

2021 ◽

Author(s):

Mingjian Bai ◽

Shaojun Pang ◽

Yiyan Lu ◽

Hongjiang Wei ◽

Jing Feng ◽

...

Keyword(s):

Tumor Markers ◽

Pseudomyxoma Peritonei ◽

Peritoneal Cancer Index ◽

Tumor Burden ◽

Ca 125 ◽

P Value ◽

Peritoneal Cancer ◽

Serum Tumor Markers ◽

Ca 242 ◽

Preoperative Serum

Abstract Background: Accurate assessment of preoperative tumor burden contribute to formulate a scientific surgical plan and improve the prognosis of patients with pseudomyxoma peritonei (PMP). Present study aimed to assess whether preoperative serum tumor markers could reflect tumor burden. Methods: A total of 198 PMP patients were included, the peritoneal cancer index (PCI) was employed to reflect tumor burden for PMP patients. All participants were divided into low (PCI ≤ 19) and high (PCI ≥ 20) tumor burden subgroups according to PCI. All serum tumor markers (carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), CA 19-9, CA 724, and CA 242) were compared between the two subgroups. The correlation between tumor markers and PCI will be calculated and compared with each other. Two-sided P value less than 0.05 is considered statistically significant.Results: The level of CEA (ng/ml), CA125 (U/ml), CA 19-9 (U/ml), CA 724 (U/ml), and CA 242 (kU/L) between low and high tumor burden subgroup were [3.35 (1.64, 16.31) vs. 23.12 (8.80, 67.62), Z = -5.381, p<0.001], [19.10 (7.61, 56.95) vs. 72.75 (40.41, 130.55), Z = -5.978, p < 0.001], [6.17 (3.26, 16.22) vs. 45.50 (13.95, 123.61), Z = -5.413, p < 0.001], [7.89 (1.57, 45.10) vs. 84.61 (33.87, 236.93), Z = -5.898, p < 0.001], and [13.32 (3.39, 96.50) vs. 150.00 (102.13, 308.88), Z = -5.166, p < 0.001], respectively. The Spearman correlation between tumor markers and PCI were 0.415 for CEA (p < 0.001), 0.372 for CA 125 (p < 0.001), 0.466 for CA 19-9 (p < 0.001), 0.379 for CA 724 (p < 0.001), and 0.317 for CA 242 (p < 0.001), respectively. Conclusions: Preoperative serum tumor markers could moderately reflect tumor burden for PMP, which may contribute to develop a better surgical plan before operation.

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