Measuring Triplet Perioperative Tumor Markers in Appendix Adenocarcinoma Regardless of Sex
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
In this retrospective cohort study of 376 patients who underwent cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) for appendiceal adenocarcinomas (AA) at a single tertiary cancer center, Pattalachinti et al found that preoperative elevation of any of 3 commonly available tumor markers (carcinoembryonic antigen [CEA], carbohydrate antigen 19-9 [CA19-9], and cancer antigen 125 [CA125]) was associated with lower disease-free survival (hazard ratio, 2.30; 95% CI, 1.46-3.64; P < .001). Similarly, having any of the 3 tumor markers elevated postoperatively was associated with significantly lower overall survival (OS) (hazard ratio, 4.10; 95% CI, 2.02-8.31; P < .001). This association was evident in both male and female patients. These findings support those of a smaller 2018 study of 65 patients undergoing CRS with HIPEC for AA and make a compelling case for the preoperative measurement of this triplet of tumor markers, as well as their serial measurement as part of postoperative surveillance. Undertaking CA125 measurement in a male patient may be met with resistance in many hospital laboratories across the world, but based on this evidence from Pattalachinti et al and Aziz et al, it appears to be justified. The findings by Pattalachinti et al that lower-grade tumors, compared with high-grade tumors, were associated with significantly higher CEA and CA125 levels is counterintuitive and may be due to confounding from a combination of small sample size and the heterogenous sample collection times. These are the limitations of retrospective research of this kind. Nonetheless, for a rare and aggressive tumor type, the association of this triplet of tumor markers with survival is difficult to ignore.
JAMA Network Open , éditorial en libre accès, 2026