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Patterns of Preoperative Tumor Markers Can Predict Resectability and Prognosis of Peritoneal Metastases: A Clustering

Malin Enblad1, Peter Cashin2, Lana Ghanipour2

  • 1Department of Surgical Sciences, Colorectal Surgery, Uppsala University, Uppsala, Sweden. malin.enblad@surgsci.uu.se.

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Preoperative tumor marker patterns can predict outcomes for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Elevated markers, especially CA72-4, indicate poorer prognosis and higher risk of open-close surgery in PMP and colorectal PM patients.

Keywords:
Clustering analysisCytoreductive surgeryHIPECPeritoneal metastasesTumor markers

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Peritoneal Malignancies

Background:

  • Predicting outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is challenging.
  • Existing prognostic scores often rely on factors not available preoperatively.
  • Identifying baseline predictors for open-close surgery and patient outcomes is crucial for pseudomyxoma peritonei (PMP) and colorectal peritoneal metastases (PM).

Purpose of the Study:

  • To investigate if preoperative tumor marker patterns can predict open-close surgery decisions.
  • To analyze the association between tumor marker profiles and long-term outcomes in PMP and colorectal PM patients undergoing CRS and HIPEC.
  • To identify specific tumor markers that may serve as valuable prognostic indicators.

Main Methods:

  • Retrospective analysis of patients undergoing CRS and HIPEC for PMP or colorectal PM (2013-2021).
  • Clustering of preoperative tumor markers (CEA, CA19-9, CA125, CA72-4, CA15-3) using the k-means algorithm.
  • Determination of optimal cluster numbers using average silhouette width.

Main Results:

  • Two distinct patient clusters were identified for both PMP and colorectal PM.
  • PMPCluster-2 and ColorectalCluster-2, characterized by elevated tumor markers, showed significantly poorer 5-year overall survival and higher peritoneal cancer index (PCI).
  • Patients in PMPCluster-2 had a higher rate of open-close surgery; normal CA72-4 levels were associated with a lower likelihood of open-close surgery.

Conclusions:

  • Elevated preoperative tumor marker levels are linked to adverse outcomes and an increased likelihood of open-close surgery.
  • The tumor marker CA72-4 warrants particular attention as a potential predictor in these patient populations.
  • Tumor marker profiling offers a valuable tool for risk stratification and surgical planning in patients with peritoneal malignancies.