Clinical utility of elevated tumor markers in patients with disseminated appendiceal malignancies treated by cytoreductive surgery and HIPEC

Eur J Surg Oncol. 2010 Aug;36(8):772-6. doi: 10.1016/j.ejso.2010.05.024. Epub 2010 Jun 18.


Background: Appendiceal malignancies with peritoneal spread have been successfully treated with Cytoreductive Surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study is to clarify the utility of common tumor markers in selecting patients for the combined treatment.

Methods: Data on 56 patients with appendiceal neoplasms treated with CRS and HIPEC were prospectively collected. Chi square test was used to analyze a link between common tumor markers and completeness of cytoreduction score (CC score) and preoperative peritoneal cancer index score (PCI score). Cox proportional hazard model was used to perform survival analysis.

Results: Forty-two patients were alive after 3 years of follow-up. Hazard ratio of disease related death was 5.6 (95% CI, 1.8-17.2) among patients with high CC score as compared to those with low CC score. Number of abnormal tumor markers (0 vs 1/2/3) correlated with PCI score 16.2 vs 32.5 (p < 0.001) but not with completeness of cytoreduction or survival. The 3-year survival rates in patients with normal vs abnormal CA 125 levels were 83% vs 52%(p = 0.003).

Conclusions: Multiple abnormal tumor markers were not useful as an exclusion criterion for patients undergoing CRS. Elevation in CA 125 was an important indicator of survival in these patients. Complete cytoreduction was crucial for long-term survival.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Appendiceal Neoplasms / drug therapy
  • Appendiceal Neoplasms / immunology*
  • Appendiceal Neoplasms / mortality
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / surgery*
  • Biomarkers, Tumor / blood*
  • CA-125 Antigen / blood
  • CA-19-9 Antigen / blood
  • Carcinoembryonic Antigen / blood
  • Chemotherapy, Adjuvant
  • Chemotherapy, Cancer, Regional Perfusion* / methods
  • Confounding Factors, Epidemiologic
  • Female
  • Humans
  • Hyperthermia, Induced*
  • Male
  • Middle Aged
  • Patient Selection
  • Peritoneal Neoplasms / drug therapy
  • Peritoneal Neoplasms / immunology*
  • Peritoneal Neoplasms / metabolism
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / surgery*
  • Predictive Value of Tests
  • Prospective Studies
  • Survival Analysis


  • Biomarkers, Tumor
  • CA-125 Antigen
  • CA-19-9 Antigen
  • Carcinoembryonic Antigen