The greater survival association seen with CEA, CA19-9, and CA125 suggests that these tumor markers should be included in appendiceal adenocarcinoma staging to stratify patients with metastatic disease in a similar manner to human chorionic gonadotropin, α fetoprotein, and lactate dyhydrogenase in germ cell tumors.41 This evidence concerns the gene CEACAM5 and metastatic neoplasm.