Elevated CEA Prior to Complete Tumour Removal in Patients with Pseudomyxoma Peritonei Indicate an Increased Risk of Recurrence
Pseudomyxoma Peritonei Centre, North Hampshire Hospital Basingstoke, United Kingdom
Introduction: Pseudomyxoma peritonei (PMP) is a rare condition with poor prognosis. Aggressive treatment regimes have changed the outlook of these patients over the past decade. In many solid tumours, preoperative elevated levels of CEA, CA 125 and CA 19.9 tumour marker levels have been shown to correlate with clinical outcome. AIM: To investigate the clinical value of preoperative serum CEA, CA 125 and CA 19.9 levels in patients with PMP who underwent a new therapeutic approach. Method: 35 consecutive patients (15 male) underwent complete cytoreduction and intraperitoneal chemotherapy for PMP, between 1996 and 2001. Serum levels of CA125, CEA and CA 19.9 were measured preoperatively and statistical association with outcome were analysed. Results: In total 69% of patients had one, 28% had two and 13% had all three markers raised. The median operating time was 10 hours and was significantly higher in patients with an elevated preoperative CEA. There were 3 (8.6%) post operative deaths. The remaining 32 patients were alive and 24 (75%) of these were disease free at a median follow up of 21 months (range 12-74). 8 (25%) patients were alive with recurrence at 10 months (range 6-13). CEA was the only marker significantly different between the recurrent and non-recurrent group (P=0.04). At follow up, 7 of 14 (50%) patients with elevated CEA presented with recurrent disease as opposed to 1 of 18 (6%) patients with normal CEA level. Patients with at least two normal markers had significantly better recurrence free survival compared wit patients who had at least two abnormal markers (P=0.03). Conclusion: Patients with an elevated CEA, or more than one abnormal tumour marker level are at significant risk of developing early recurrent disease and should be considered for further adjunctive treatment
Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Nice, France; February 7 - 10, 2004; in oral session 993 (Molecular pathology - Part II).