Pre-operative tumour marker status predicts recurrence and survival after complete cytoreduction and hyperthermic intraperitoneal chemotherapy for appendiceal Pseudomyxoma Peritonei: Analysis of 519 patients

Eur J Surg Oncol. 2014 May;40(5):515-520. doi: 10.1016/j.ejso.2013.12.021. Epub 2014 Jan 12.


Background: Cytoreductive surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the optimal treatment for Pseudomyxoma Peritonei (PMP). Despite treatment, disease often recurs and may not be amenable to further CRS. Clinical experience suggests a spectrum of disease which may correlate with tumour marker levels. The aim of this study was to analyse the influence of markers on recurrence and survival.

Methods: The details of all patients undergoing surgery for PMP of appendiceal origin at a national centre for peritoneal malignancy were recorded in a dedicated prospective database. The data on all patients who had CRS and HIPEC between March 1994 and January 2012 was analysed and recurrence and survival correlated with pre-operative levels of CEA, CA-125 and CA19-9.

Results: Overall, 519 (69%) of 752 consecutive patients, underwent complete CRS and HIPEC. The median (range) age was 56 (20-82) years with 342/519 (66%) females. The mean overall (OS) and disease free survival (DFS) in the 131/519 patients who had normal preoperative tumour markers was 168 (128-207) and 125 (114-136) months respectively, significantly higher when compared with the 109/519 (21%) who had all three tumour markers elevated (OS of 65 (42-88) and DFS of 55 (41-70) months respectively) (P = 0.002).

Conclusions: Elevated tumour markers predict an increased risk of recurrence and reduced survival after complete CRS. This may reflect cell biology in low grade tumours and is an independent prognostic feature. Further analysis may help to select patients for post-operative chemotherapy, second look procedures or stratification of follow up.

Keywords: Appendix tumours; CA125; CA19-9; CEA; Prognosis; Pseudomyxoma Peritonei; Tumour markers.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Appendiceal Neoplasms / metabolism*
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / therapy
  • Biomarkers, Tumor / metabolism*
  • CA-125 Antigen / metabolism*
  • CA-19-9 Antigen / metabolism*
  • Carcinoembryonic Antigen / metabolism*
  • Female
  • Humans
  • Hyperthermia, Induced
  • Infusions, Parenteral
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / metabolism*
  • Peritoneal Neoplasms / metabolism*
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy
  • Peritoneum / pathology
  • Peritoneum / surgery
  • Prognosis
  • Pseudomyxoma Peritonei / metabolism*
  • Pseudomyxoma Peritonei / mortality
  • Pseudomyxoma Peritonei / therapy
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult


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