Tumor markers in rare appendiceal cancer may predict treatment outcomes

MD Anderson Research News May 04, 2026

• Researchers monitored levels of common blood markers before and after surgery to remove cancer
• Study found elevated levels of CEA, CA19-9 and CA125 prior to surgery were strongly associated with poorer outcomes
• If levels remained high after surgery, patients were more likely to experience recurrence and had lower survival rates

A new retrospective study led by researchers at The University of Texas MD Anderson Cancer Center found that levels of commonly measured serum tumor markers – CEA, CA19-9 and CA125 – can play a significant role in predicting outcomes in patients with appendiceal adenocarcinoma undergoing cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC). 

The study, published in JAMA Network Open, analyzed patients treated between 2016 and 2024, with a median follow-up of over 32 months. Researchers found elevated levels of these biomarkers prior to surgery were strongly associated with higher tumor burden and reduced likelihood of completely removing the tumor, leading to shorter periods before recurrence.

Researchers led by John Paul Shen, M.D., assistant professor in Gastrointestinal Medical Oncology, also discovered that patients with elevated tumor markers within six months after surgery had substantially poorer survival outcomes, including a higher risk of mortality within five years. In contrast, normalized marker levels following surgery were associated with significantly improved survival, underscoring the importance of both preoperative and postoperative monitoring.  

“Routine measurement of CEA, CA19-9 and CA125 before and after surgery can help clinicians better stratify risk, monitor for residual disease and tailor postoperative surveillance,” Shen said. “Moving forward, being able to identify patients at high risk of relapse will help select patients for novel therapies to eliminate minimal residual disease following surgery.”

Why do these findings matter for patients with appendiceal adenocarcinoma?

Appendiceal adenocarcinoma is a rare cancer originating from the glandular cells lining the appendix that often spreads within the abdominal cavity. Early detection and complete surgical removal often lead to long-term survival.

These findings suggest that combining tumor marker measurements before and after surgery offers a powerful decision-making tool for clinicians and an earlier insight into how the disease is likely to behave and how well treatment works.

What is cytoreduction and why is it important?  

Currently, CRS, sometimes followed by HIPEC, is the standard treatment for patients with rare appendiceal cancers. CRS is a procedure aimed at removing as much visible cancer as possible from the abdominal cavity. Therefore, achieving complete cytoreduction – meaning no visible disease remains – is critical to improving longer-term outcomes. 

Researchers hope that by monitoring levels of CEA, CA19-9 and CA125 in blood samples, clinicians will soon have a clearer and earlier way to understand individual risk and act quickly if the cancer shows signs of returning.

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Funding was supported by the Col. Daniel Connelly Memorial Fund, the Andrew Sabin Family Fellowship, the National Cancer Institute (P30 CA016672), the Cancer Prevention and  Research Institute of Texas (RR180035 & RP240392), the Appendix Cancer Pseudomyxoma Peritonei Research Foundation, and a Conquer Cancer Career Development Award. A full list of collaborating authors and their disclosures can be found with the paper in JAMA Network Open.