Preoperative Carcinoembryonic Antigen Level Predicts Prognosis in Patients with Pseudomyxoma Peritonei Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Canbay, Emel; Ishibashi, Hiroyuki; Sako, Shouzou; Mizumoto, Akiyoshi; Hirano, Masamitsu; Ichinose, Masumi; Takao, Nobuyuki; Yonemura, Yutaka

doi:10.1007/s00268-013-1988-7

Cited by 30 publications

(26 citation statements)

References 31 publications

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“…Serum CEA levels may thus predict the probability of reaching complete cytoreduction in the surgery. Between LG and HG forms of the disease, we could not demonstrate any significant difference in the percentages of elevated CEA levels, similarly to that reported by Canbay et al [17]. In the aggressive HG tumors showing nonpolarized staining pattern, the serum CEA levels were normal, albeit with high tissue content of immunoreactive CEA and PCI values higher than 18.…”

Section: Discussionsupporting

confidence: 90%

“…When we compared the preoperative serum CEA levels and the PCI values, these 2 values showed clear correlation (P b .001). Recently, Canbay et al [17] have also reported association between preoperative CEA levels and PCI in a study comprised of 449 PMP patients. Serum CEA levels may thus predict the probability of reaching complete cytoreduction in the surgery.…”

Section: Discussionmentioning

confidence: 92%

“…CEA, CA19-9, and CA125 serum markers are used to monitor the remission of PMP tumors, and their levels have also been related to the prognosis of PMP patients [4,16,17]. The tissue expression patterns of these proteins have, however, not been well characterized in PMP specimens, the previous reports analyzing mostly overall positivity in a limited number of specimens [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Expression of CEA, CA19-9, CA125, and EpCAM in pseudomyxoma peritonei

et al. 2016

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Pseudomyxoma peritonei is a fatal clinical syndrome with mucinous tumor cells disseminated into peritoneal cavity and secreting abundant mucinous ascites. The serum tumor markers CEA, CA19-9, and CA125 are used to monitor pseudomyxoma peritonei remission, but their expression at tissue level has not been well characterized. Herein, we analyzed expression of these proteins and the adenocarcinoma marker EpCAM in 92 appendix-derived pseudomyxoma peritonei tumors by immunohistochemistry. All tumors were found to ubiquitously express CEA and EpCAM. In the majority of the tumors (94.6%), CEA showed polarized immunostaining, but in 5 aggressive high-grade tumors containing numerous signet ring cells, a nonpolarized staining was detected. We found preoperative CEA serum values to correlate with peritoneal cancer index. However, the serum values of the advanced cases with nonpolarized staining pattern were normal, and the patients died within 5 years after diagnosis. Thus, serum CEA measurements did not reflect aggressiveness of these tumors. CA19-9 showed strong immunopositivity in most of the tumors (91.3%), and mutated enzyme FUT3 was demonstrated from the cases showing negative or weak staining. CA125 was infrequently expressed by tumor cells (focal staining in 6.5% of the cases), but in most of the cases (79.3%), adjacent nonneoplastic mesothelial cells showed immunopositivity. As a conclusion, CEA and EpCAM are invariably expressed by pseudomyxoma peritonei tumor cells and could be exploited to targeted therapies against this malignancy.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Expression of CEA, CA19-9, CA125, and EpCAM in pseudomyxoma peritonei

et al. 2016

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“…Likewise, PMP patients with normal levels of these tumor markers have an overall improved prognosis. In the recent study by Canbay et al, researchers concluded that preoperative CEA levels are useful in predicting the extent of disease and surgical success as well as progress-free and overall survival in patients with PMP treated with cytoreductive surgery and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) [16]. These results agree with our case, where a progression of disease was observed postoperatively, given the high CEA and Ca 19-9 serum levels preoperatively.…”

Section: Discussionsupporting

confidence: 90%

Aggressive Pseudomyxoma Peritonei: A Case Report with an Unusual Clinical Presentation

Touloumis

Galyfos

Kavouras

et al. 2013

Case Reports in Oncological Medicine

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Introduction. Pseudomyxoma peritonei (PMP) is an uncommon surgical entity. We report a case of aggressive disease with an unusual clinical presentation and we analyze current data on diagnosis and management of PMP. Case Presentation. A 71-year-old male patient presented with intermittent diarrhea and loss of appetite during the last two months, without any other classic symptoms of PMP. The clinical examination was misleading due to patient's obesity. The radiological evaluation revealed ascites of the abdomen and possible mucocele of the appendix, whereas the laboratory exams showed high values of specific tumour markers. The patient underwent an exploratory laparotomy for definite diagnosis. Biopsies and immunohistochemical examination confirmed the diagnosis of an aggressive and extended peritoneal mucinous carcinomatosis (PMCA). The patient was programmed for adjuvant systematic chemotherapy, which was not completed due to progression of the disease. Conclusions. Progressed PMP can present with unspecific symptoms that mislead diagnosis. Cytoreductive surgery in combination with systematic chemotherapy could be appropriate for aggressive PMCA, even with an unfavourable prognosis.

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“…Levels of carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19‐9 and cancer antigen 125 (CA125) may be raised in these patients. Some studies have shown that increase in one or more of these tumour markers may be associated with worse prognosis.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing long‐term survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei originating from appendiceal neoplasms

et al. 2019

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Background Pseudomyxoma peritonei (PMP) is a rare disease, most commonly of appendiceal origin. Treatment consists of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS–HIPEC). The aim of this study was to identify prognostic factors for recurrence and survival. Methods This was an observational study using a prospectively designed database containing consecutive patients with PMP originating from the appendix, undergoing CRS–HIPEC at a tertiary referral centre between 1996 and 2015. Histopathological slides were reassessed. Cox regression was used for multivariable analyses. Results Of 225 patients identified, 36 (16·0 per cent) were diagnosed with acellular mucin, 149 (66·2 per cent) had disseminated peritoneal adenomucinosis (DPAM) and 40 (17·8 per cent) had peritoneal mucinous carcinomatosis (PMCA). The 5‐year overall survival (OS) rates were 93, 69·8 and 55 per cent respectively. Recurrence was observed in 120 patients (53·3 per cent), 39 of whom (17·3 per cent) were treated with a second CRS–HIPEC procedure. Factors independently associated with poor disease‐free survival were six or seven affected regions (hazard ratio (HR) 6·01, 95 per cent c.i. 2·04 to 17·73), incomplete cytoreduction (R2a resection: HR 1·67, 1·05 to 2·65; R2b resection: HR 2·00, 1·07 to 3·73), and more than threefold raised carcinoembryonic antigen (CEA) and/or carbohydrate antigen (CA) 19‐9 level (HR 2·31, 1·30 to 4·11). Factors independently associated with poorer OS were male sex (HR 1·74, 1·09 to 2·77), incomplete cytoreduction (R2a resection: HR 1·87, 1·14 to 3·08; R2b resection: HR 2·28, 1·19 to 4·34), and more than threefold raised CEA and/or CA19‐9 level (HR 2·89, 1·36 to 6·16). Conclusion CEA and CA19‐9 levels raised more than threefold above the upper limit identify patients with PMP of appendiceal origin and poorer survival.

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Preoperative Carcinoembryonic Antigen Level Predicts Prognosis in Patients with Pseudomyxoma Peritonei Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Abstract: Our results indicated that preoperative CEA levels are useful in predicting the extent of disease and surgical success as well as progress-free and overall survival in patients with PMP treated with cytoreductive surgery and HIPEC.

Cited by 30 publications

References 31 publications

Expression of CEA, CA19-9, CA125, and EpCAM in pseudomyxoma peritonei

Expression of CEA, CA19-9, CA125, and EpCAM in pseudomyxoma peritonei

Aggressive Pseudomyxoma Peritonei: A Case Report with an Unusual Clinical Presentation

Factors influencing long‐term survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei originating from appendiceal neoplasms

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