Appendiceal Adenocarcinoma Cytoreduction Outcomes and Perioperative Serum Tumor Marker Levels
Menée à partir de données portant sur 376 patients atteints d'un adénocarcinomes de l'appendice traité par chirurgie cytoréductive (durée médiane de suivi postopératoire : 35,6 mois), cette étude évalue l'association entre les niveaux préopératoires ou postopératoires de trois marqueurs sériques (antigène carcino-embryonnaire, antigène carbohydrate 19-9 et antigène CA125) et la charge tumorale, le caractère complet de la cytoréduction, la survie sans maladie et la survie globale
Background : Appendiceal adenocarcinoma (AA) is a rare gastrointestinal cancer that frequently presents with peritoneal metastases; the standard of care for resectable peritoneal metastases from AA limited to the peritoneum is cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Three serum tumor markers (TMs)—carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125)—may play a role in preoperative and postoperative risk estimation and decision-making in patients undergoing CRS-HIPEC.
Objective : To evaluate the association of preoperative and postoperative serum TM levels with outcomes in patients with AA or goblet cell adenocarcinoma (GCA) undergoing CRS-HIPEC.
Design, Setting, and Participants : This retrospective cohort study was conducted in a single quaternary referral cancer center. Software was used to query the MD Anderson internal patient database of patients with AA or GCA to identify a cohort receiving CRS with or without HIPEC between March 2016 and August 2024, with median postoperative follow-up of 35.6 months (range, 1.4-100.5 months). Data were analyzed from June 2024 to March 2025.
Exposure : Preoperative and postoperative levels of CEA, CA19-9, and CA125.
Main Outcomes and Measures : Association of preoperative and postoperative serum TM levels with tumor burden and likelihood of complete CRS, disease-free survival (DFS), and overall survival (OS).
Results : A total of 421 CRSs were included in the study, 376 (89.3%) of which were performed in patients with AA (229 [60.9%] in females; median age at surgery, 56 [IQR, 47-64] years; 290 [77.1%] were complete CRS). In AA, greater vs lesser preoperative tumor burden was associated with increased median serum TM levels (CEA: 9.5 [IQR, 3.7-42.3] ng/mL vs 3.0 [IQR, 2.1-5.9] ng/mL; CA19-9: 31.1 [IQR, 10.0-102.3] U/mL vs 15.0 [IQR, 6.1-25.5] U/mL; CA125: 28.7 [IQR, 13.9-58.5] U/mL vs 11.5 [IQR, 8.0-17.3] U/mL; all P < .001), and after CRS vs before, percentages of patients with TM elevation were significantly lower (CEA: 77 of 223 [34.5%] vs 222 of 340 [65.3%]; CA19-9: 45 of 194 [23.2%] vs 117 of 324 [36.1%]; CA125: 13 of 203 [6.4%] vs 98 of 325 [30.2%]; all P < .001). However, complete vs incomplete CRS was associated with normalized TM levels in a greater percentage of patients (55 of 90 [61.1%] vs 7 of 52 [13.5%]; P < .001). Elevated vs normal preoperative TM levels were associated with increased rate of incomplete CRS (30 of 193 [15.5%] vs 1 of 95 [1.1%]; P < .001) and shorter DFS (hazard ratio [HR], 2.30; 95% CI, 1.46-3.64; P < .001) but not shorter OS (HR, 1.36; 95% CI, 0.71-2.60; P = .36). Postoperative TM elevation was associated with shorter DFS (HR, 3.73; 95% CI, 2.33-5.95; P < .001) and OS (HR, 4.10; 95% CI, 2.02-8.31; P < .001) in univariate analyses and also in multivariate analyses (HR, 3.34; 95% CI, 1.44-7.75; P = .005), whereas postoperative normalization of all TMs was associated with improved DFS (HR, 3.54; 95% CI, 2.01-6.23; P < .001) and OS (HR, 6.00; 95% CI, 2.06-17.46; P = .001) in univariate analyses and also in multivariate analyses (HR, 4.21; 95% CI, 1.33-13.35; P = .02).
Conclusions and Relevance : In this cohort study of CRS in patients with AA, elevated serum TM levels were associated with worse outcomes, suggesting that patients with postoperative TM elevation after complete CRS may represent a cohort with residual tumor that requires more cautious surveillance and that both preoperative and postoperative levels of CEA, CA19-9, and CA125 should be assessed in clinical practice.
JAMA Network Open , article en libre accès, 2026