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Prognostic scores often include factors not known at baseline. Therefore, we aimed to analyze whether patterns of preoperative tumor markers could aid in prediction of open\u2013close surgery and outcome in patients with pseudomyxoma peritonei (PMP) or colorectal peritoneal metastases (PM).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients and Methods<\/jats:title>\n            <jats:p>All patients accepted for CRS and HIPEC for PMP or colorectal PM at Uppsala University Hospital in 2013\u20132021 were included. The tumor markers CEA, CA19-9, CA125, CA72-4, and CA15-3 were clustered using the <jats:italic>k<\/jats:italic>-means algorithm; the average silhouette width determined the optimal numbers of clusters.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Clustering of patients with PMP (<jats:italic>n<\/jats:italic> = 138) and colorectal PM (<jats:italic>n<\/jats:italic> = 213) resulted in two clusters each. PMPCluster-1 (<jats:italic>n<\/jats:italic> = 124) had a 5-year overall survival (OS) of 77% (95% CI 69\u221285%), 11 (9%) open\u2013close surgeries, and a median peritoneal cancer index (PCI) of 17. PMPCluster-2 (<jats:italic>n<\/jats:italic> = 14) patients had poorer prognosis (36%, 95% CI 15\u201385%, <jats:italic>p<\/jats:italic> = 0.003), more often open\u2013close (<jats:italic>n<\/jats:italic> = 6, 43%, <jats:italic>p<\/jats:italic> = 0.002), and higher PCI (median 36, <jats:italic>p<\/jats:italic> &lt; 0.001). ColorectalCluster-1 (<jats:italic>n<\/jats:italic> = 191) had a 5-year OS of 28% (95% CI 21\u201337%), median PCI of 11, and 38 (20%) open\u2013close surgeries. ColorectalCluster-2 (<jats:italic>n<\/jats:italic> = 22) had poorer prognosis (10%, 95% CI 3\u201336%, <jats:italic>p<\/jats:italic> = 0.02), higher PCI (median 26, <jats:italic>p<\/jats:italic> &lt; 0.001), higher completeness of cytoreduction score (<jats:italic>p<\/jats:italic> = 0.005), but no difference in open\u2013close surgery (<jats:italic>n<\/jats:italic> = 6, 27%, <jats:italic>p<\/jats:italic> = 0.411). PMPCluster-2 and ColorectalCluster-2 were characterized by markedly elevated tumor markers. Open\u2013close surgery was unusual in cases of normal CA72-4.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Elevation of several preoperative tumor markers is associated with poor prognosis and increased risk of open\u2013close. CA72-4 deserves increased attention.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1245\/s10434-024-16860-y","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T14:41:15Z","timestamp":1737556875000},"page":"3638-3647","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Patterns of Preoperative Tumor Markers Can Predict Resectability and Prognosis of Peritoneal Metastases: A Clustering Analysis"],"prefix":"10.1245","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5900-0900","authenticated-orcid":false,"given":"Malin","family":"Enblad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Cashin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lana","family":"Ghanipour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilhelm","family":"Graf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"issue":"9","key":"16860_CR1","doi-asserted-by":"crossref","first-page":"2426","DOI":"10.1245\/s10434-008-9966-2","volume":"15","author":"VJ Verwaal","year":"2008","unstructured":"Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. 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The study was funded by research grants from Uppsala University Hospital for M.E., the Bengt Ihre Research Fellowship, and the Lion\u2019s Research Foundation in Uppsala.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}