Preoperative tumor marker elevations in lymph node positive appendiceal mucinous neoplasms with peritoneal metastases.

BACKGROUND: The prognostic implications of elevated preoperative tumor markers in lymph node positive appendiceal mucinous neoplasm patients treated for peritoneal metastases (PM) has not been well defined.

METHODS: Clinical features in addition to preoperative tumor markers were recorded within 1 week prior to cytoreductive surgery (CRS). Impact on overall survival of these factors was analyzed by univariate and multivariate analysis.

RESULTS: Thirty-nine patients were available for study of clinical features and 28 patients for study of tumor markers. The median age was 44 (range 26-65) and there were 13 (33 %) males. In univariate analysis, young age (HR 2.4, p = 0.0256), peritoneal cancer index 0-15 (HR 2.0, p = 0.0765), response to neoadjuvant chemotherapy (HR 4.8, p = 0.323), carcinoembryonic antigen (CEA) elevation >5.0 (HR 4.3, p = 0.0040), triple tumor marker elevation (HR 3.9, p = 0.0372), CEA elevated ×3 to ×10 (HR 3.9, p = 0.0515) and CEA elevated > ×10 (HR 6.6, p = 0.0037) were significant. By multivariate modeling, CEA elevation ≥5.0 stands out strongly and all other significant clinical and tumor marker variables were eliminated (HR 4.3, p = 0.0040).

CONCLUSION: Preoperative CEA elevation >5 in 13 patients showed a median survival of 3 years as compared to 15 patients (53.6 %) with non-elevated CEA with a median survival of 16 years. Preoperative CEA measurement may signal an aberrant tumor biology that indicates patients at high risk of treatment failure for CRS and HIPEC.