Kozman Mathew A, Fisher Oliver M, Rebolledo Bree-Anne J, Valle Sarah J, Alzahrani Nayef, Liauw Winston, Morris David L
Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia; St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia.
Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia; St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia; School of Medicine, University of Notre Dame, Sydney, NSW, Australia.
Eur J Surg Oncol. 2017 Dec;43(12):2299-2307. doi: 10.1016/j.ejso.2017.09.009. Epub 2017 Sep 19.
Serum tumour levels have been shown to be prognostic in patients with epithelial appendiceal mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei (PMP)). A singular index which incorporates both tumour activity (as depicted by serum tumour marker levels) and tumour volume (as depicted by peritoneal carcinomatosis index (PCI)), may give a more precise surrogate of tumour biological behaviour. The prognostic implication of this index has not yet been reported.
A retrospective cohort study of all patients with PMP managed from 1996 to 2016 with cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) was performed by analysing the survival effect of the ratio of preoperative serum CEA, CA19.9 and CA125 to PCI.
Three hundred and eighty-six patients were included. In patients with low-grade PMP, elevated CA19-9/PCI ratio resulted in poorer median overall survival times (104 months vs NR, 95%CI 83 - NR, log-rank p < 0.001) and was an independent predictor of reduced overall survival on multivariable analysis (adjusted HR 5.60, 95%CI 1.60-19.68, p = 0.007). In patients with high-grade PMP, no statistically significant difference in survival was recognised.
CA19-9/PCI ratio is an independent prognostic factor for overall survival in patients with low-grade PMP undergoing CRS and IPC. By accounting for both tumour activity and tumour volume simultaneously, this novel index behaves as a surrogate of tumour biology and provides a useful adjunct for decisions regarding treatment allocation in this patient group.
血清肿瘤水平已被证明对伴有腹膜播散的上皮性阑尾黏液性肿瘤（腹膜假黏液瘤（PMP））患者具有预后价值。一个综合肿瘤活性（由血清肿瘤标志物水平表示）和肿瘤体积（由腹膜癌指数（PCI）表示）的单一指标，可能会更精确地反映肿瘤的生物学行为。该指标的预后意义尚未见报道。
对1996年至2016年接受减瘤手术（CRS）和腹腔内化疗（IPC）治疗的所有PMP患者进行回顾性队列研究，分析术前血清癌胚抗原（CEA）、糖类抗原19-9（CA19.9）和糖类抗原125（CA125）与PCI比值对生存的影响。
共纳入386例患者。在低级别PMP患者中，CA19-9/PCI比值升高导致中位总生存时间较差（104个月对未达到，95%置信区间83 - 未达到，对数秩检验p < 0.001），并且在多变量分析中是总生存降低的独立预测因素（校正风险比5.60，95%置信区间1.60 - 19.68，p = 0.007）。在高级别PMP患者中，未发现生存有统计学显著差异。
CA19-9/PCI比值是接受CRS和IPC治疗的低级别PMP患者总生存的独立预后因素。通过同时考虑肿瘤活性和肿瘤体积，这个新指标可作为肿瘤生物学的替代指标，并为该患者群体的治疗分配决策提供有用的辅助。
