What the study found
Elevated serum tumor marker levels were associated with worse outcomes in patients with appendiceal adenocarcinoma (a rare gastrointestinal cancer) undergoing cytoreductive surgery (CRS, surgery to remove as much visible tumor as possible), with or without hyperthermic intraperitoneal chemotherapy (HIPEC, heated chemotherapy delivered into the abdomen).
Why the authors say this matters
The authors conclude that both preoperative and postoperative levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125) should be assessed in clinical practice. They suggest that patients with postoperative tumor marker elevation after complete CRS may represent a group with residual tumor who may need more cautious surveillance.
What the researchers tested
This retrospective cohort study used data from a single quaternary referral cancer center and identified patients with appendiceal adenocarcinoma or goblet cell adenocarcinoma who underwent CRS, with or without HIPEC, between March 2016 and August 2024. The researchers examined preoperative and postoperative CEA, CA19-9, and CA125 levels and their association with tumor burden, complete CRS, disease-free survival (DFS), and overall survival (OS).
What worked and what didn't
In appendiceal adenocarcinoma, higher preoperative tumor burden was associated with higher median levels of all three tumor markers. After CRS, the percentage of patients with elevated markers was lower overall, but marker normalization was more common after complete CRS than incomplete CRS. Elevated preoperative markers were associated with incomplete CRS and shorter DFS, but not shorter OS; postoperative marker elevation was associated with shorter DFS and OS, while postoperative normalization of all markers was associated with better DFS and OS.
What to keep in mind
This was an observational study from one cancer center, so the findings describe associations rather than proving cause and effect. The abstract does not describe additional limitations beyond the study design and setting.
Key points
- Higher preoperative CEA, CA19-9, and CA125 levels were linked to greater tumor burden in appendiceal adenocarcinoma.
- After cytoreductive surgery, fewer patients had elevated tumor markers overall.
- Complete CRS was associated with marker normalization more often than incomplete CRS.
- Elevated preoperative markers were linked to incomplete CRS and shorter disease-free survival, but not overall survival.
- Postoperative marker elevation was associated with shorter disease-free survival and overall survival.
- The authors suggest assessing both preoperative and postoperative levels of CEA, CA19-9, and CA125 in practice.
Disclosure
- Research title:
- Serum tumor markers tracked worse outcomes in appendiceal cancer
- Image credit:
- Photo by Paul_Henri on Pixabay
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