Prognostic Significance of Preoperative Tumor Markers in Pseudomyxoma Peritonei from Low-Grade Appendiceal Mucinous Neoplasm: a Study from the US HIPEC Collaborative

J Gastrointest Surg. 2022 Feb;26(2):414-424. doi: 10.1007/s11605-021-05075-1. Epub 2021 Sep 10.


Background: Tumor markers are commonly utilized in the diagnostic evaluation, treatment decision making, and surveillance of appendiceal tumors. In this study, we aimed to determine the prognostic significance of elevated preoperative tumor markers in patients with pseudomyxoma peritonei secondary to low-grade appendiceal mucinous neoplasm who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Methods: Using a multi-institutional database, eligible patients with measured preoperative tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), or cancer antigen 125 (CA-125)] were identified. Univariate and multivariate Cox-proportional hazards regression analysis assessed relationships between normal and elevated serum tumor markers with progression-free and overall survival in the context of multiple clinicopathologic variables.

Results: zTwo hundred and sixty-four patients met criteria. CEA was the most commonly measured tumor marker (97%). Patients who had any elevated tumor marker had a higher peritoneal carcinomatosis index (PCI) as compared to those with normal range markers. Elevated CEA and CA 19-9 levels were individually associated with longer inpatient length of stay, requirement for intraoperative transfusion, and incomplete cytoreduction. Utilization of neoadjuvant chemotherapy, increased PCI score, elevated CA 19-9 (p = 0.007), and CA-125 levels (p = 0.01) were predictive of decreased progression-free survival on univariate analysis. However, in a multivariate model, only elevated PCI was a statistically significant predictor of progression-free survival.

Conclusion: Elevated preoperative tumor markers indicate a higher burden of disease but are not independently associated with survival in this retrospective multi-institutional cohort. Further prospective studies are needed to clarify the utility of these markers in this patient population.

Keywords: Biomarkers; Low-grade appendiceal mucinous neoplasm; Pseudomyxoma peritonei; Tumor.

Publication types

  • Multicenter Study

MeSH terms

  • Appendiceal Neoplasms* / drug therapy
  • Biomarkers, Tumor
  • Cytoreduction Surgical Procedures
  • Humans
  • Hyperthermia, Induced*
  • Hyperthermic Intraperitoneal Chemotherapy
  • Peritoneal Neoplasms* / drug therapy
  • Prognosis
  • Pseudomyxoma Peritonei* / drug therapy
  • Pseudomyxoma Peritonei* / pathology
  • Retrospective Studies
  • Survival Rate


  • Biomarkers, Tumor