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Preoperative CA 19-9 Predicts Disease Progression in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: An Analysis from the US HIPEC Collaborative

  • Peritoneal Surface Malignancy
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Abstract

Introduction

Patients with colorectal peritoneal metastases (CRPM) are increasingly treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Unfortunately, data identifying preoperative risk factors for poor oncologic outcomes after this procedure are limited. We aimed to determine the prognostic value of preoperative CEA, CA 125, and CA 19-9 on disease progression after CRS/HIPEC.

Methods

Patients with CRPM treated with curative intent CRS/HIPEC from 12 participating sites in the United States from 2000 to 2017 were identified. Progression-free survival (PFS), defined as disease progression or recurrence, was the primary outcome.

Results

In 279 patients who met inclusion criteria, the rate of disease progression was 63.8%, with a median PFS of 11 months (interquartile range [IQR] 5–20). Elevated CA 19-9 was associated with dismal PFS at 2 years (8.9% elevated vs. 30% not elevated, p < 0.01). In 113 patients who underwent upfront CRS/HIPEC, CA 19-9 emerged as the sole tumor marker independently predictive of worse PFS (hazard ratio [HR] 2.88, p = 0.048). In the subgroup of patients who had received neoadjuvant therapy (NAT), no variable was independently predictive of PFS. CA 19-9 levels over 37 U/ml were highly specific for accelerated disease progression after CRS/HIPEC. Lastly, there was no association between PFS and elevated CEA or CA 125.

Conclusions

Elevated CA 19-9 is associated with decreased PFS in patients with CRPM. While traditionally CEA is the main tumor marker assessed in colon cancer, we found that CA 19-9 may better inform preoperative risk stratification for poor oncologic outcomes in patients with CRPM. However, prospective studies are required to confirm this association.

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Authors and Affiliations

  1. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA

    Nadege T. Fackche MD & Sean P. Dineen MD

  2. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA

    Ryan K. Schmocker MD, MS, Richard Nudotor MD, PMH, Boateng Kubi BS, Fabian M. Johnston MD, MHS & Jonathan B. Greer MD

  3. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Jordan M. Cloyd MD

  4. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA

    Travis E. Grotz MD

  5. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Keith F. Fournier MD

  6. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA

    Jula Veerapong MD & Joel M. Baumgartner MD, MAS

  7. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Callisia N. Clarke MD

  8. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Sameer H. Patel MD & Gregory C. Wilson MD

  9. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Laura A. Lambert MD

  10. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA

    Courtney Pokrzywa MD & Daniel E. Abbott MD

  11. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA

    Byrne Lee MD

  12. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Charles A. Staley MD & Mohammad Y. Zaidi MD

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  1. Nadege T. Fackche MD
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Correspondence to Jonathan B. Greer MD.

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Fackche, N.T., Schmocker, R.K., Nudotor, R. et al. Preoperative CA 19-9 Predicts Disease Progression in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: An Analysis from the US HIPEC Collaborative. Ann Surg Oncol 31, 3314–3324 (2024). https://doi.org/10.1245/s10434-024-14890-0

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