F. Alexander-Sefre*, K. Chandrakumaran†, S. Banerjee†, R. Sexton†, J. M. Thomas
†The North Hampshire Hospital, Basingstoke and *Canc Services, St. Bartholomew’s and the Royal London Medical and Dental School, London, UK

Colorectal Disease, 7, 382–386 (2004)

Link to abstract

Tumor markers are chemicals that produced by some tumor cells and are measured to assess the presence of tumor cells in the body. Tumor markers that are commonly used to diagnose cancer of the intra-abdominal regions include; CEA, CA-125, and CA 19-9. It must note that these markers are only indicators and are not definitive diagnostic tools as they may be elevated in the body for reasons other than the presence of cancer.

The goal of the study, conducted at the North Hampshire hospital in the UK, is to evaluate the predictive value of elevated tumor markers prior to CRS and HIPEC for identifying patients with high risk for a recurrence of the disease following a complete CRS and HIPEC. The tumor markers used in the study were CEA, CA 19-9, and CA-125. Analysis of 32 patients with PMP probably of appendiceal origin revealed that 50% of patients with elevated CEA developed recurrence compared with only 5% in those with normal CEA levels. So patients with elevated CEA were 5.6 times more likely to develop recurrence and had shorter recurrence-free intervals. None of the patients who had three normal markers developed a recurrence. Patients with more than one abnormal tumor marker levels experienced shorter recurrence-free intervals and therefore a higher risk for recurrence.

It must be noted that the investigators in this study were not able to analyze these results in light of a clear categorization of the patients according to their pathology. So it is not clear whether these findings reflect tumor volume, histology or tumor biology. However, they think that it is likely that normal CEA levels are associated with more favorable disease, while elevated levels are associated with more aggressive disease.

Two other findings are highlighted by this study. First, elevation in CA125 is the same in men and women, therefore, it should not be used to target ovarian type chemotherapy. Second, patients with high levels of tumor makers may still be amenable to CRS and HIPEC with long-term remission or even cure.

These findings help in patient selection for surgery and in planning post operative care. For example, high risk patients may benefit from post-operative systemic chemo or a planned second-look surgery 6-12 months post complete Cytoreduction. The investigators recommend further studies with larger numbers of patients to corroborate these findings.