Do Lymph Node Metastases Matter in Appendiceal Cancer with Peritoneal Carcinomatosis? A US HIPEC Collaborative Study

Turner, Kevin M.; Morris, Mackenzie C.; Delman, Aaron M.; Hanseman, Dennis J.; Johnston, Fabian M.; Greer, Jonathan B.; Walle, Kara Vande; Abbott, Daniel E.; Raoof, Mustafa; Grotz, Travis E.; Fournier, Keith F.; Dineen, Seán; Veerapong, Jula; Maduekwe, Ugwuji N.; Kothari, Anai; Staley, Charles A.; Maithel, Shishir K.; Lambert, Laura; Kim, Alex C.; Cloyd, Jordan M.; Wilson, Gregory C.; Sussman, Jeffrey J.; Ahmad, Syed A.; Patel, Sameer H.

doi:10.1007/s11605-022-05489-5

Cited by 3 publications

(6 citation statements)

References 33 publications

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“…Limited observational evidence has shown benefit associated with the use of adjuvant chemotherapy in node-positive, highgrade, and/or non-mucinous disease. 48,53,54,59,60,[71][72][73]78 Others studies have shown minimal benefit or even detriment after adjuvant therapy; it is unclear how much of this variation reflects selection bias, as the patients who are most likely to undergo adjuvant therapy are those who are well enough to do so. 47,49,51,52,56 To our knowledge, no studies have comprehensively evaluated the role of modern neoadjuvant therapy for resectable appendix tumors without peritoneal involvement; at present expert consensus opinion is not in favor of neoadjuvant therapy in that setting, as it would delay definitive resection.…”

Section: Cytotoxic Chemotherapy For Localized Appendix Tumorsmentioning

confidence: 99%

“…The rate of lymph node positivity has been shown to be low in well-and some moderately-differentiated mucinous lesions, decreasing the survival benefit of RHC. 72,133,150 % Agreement: First round 94%, second round 97%…”

Section: Blockmentioning

confidence: 99%

“…52,54,60,72,72,73,[73][74][75][76][77][78] High-risk features are summarized in the systemic chemotherapy section above. 52,54,[71][72][73][74][75][76][77]147 Adjuvant chemotherapy regimens, described under the systemic chemotherapy section, typically last 3-6 months, depending on patient toleration, with a goal of 6 months of therapy. 26,32,57 Patients should be subsequently surveilled, as described in Block 7.…”

Section: Blockmentioning

confidence: 99%

“…High-risk features validated in appendiceal malignancy include lymph node involvement, signet ring cells, and less differentiated or non-mucinous histology. 52,54,[71][72][73][74][75][76][77] The rationale for this is partly mechanistic, as tumors with poor biology are anticipated to have higher likelihood of distant spread . Limited observational evidence has shown benefit associated with the use of adjuvant chemotherapy in node-positive, highgrade, and/or non-mucinous disease.…”

Section: Cytotoxic Chemotherapy For Localized Appendix Tumorsmentioning

confidence: 99%

“…Patients with stage III appendiceal adenocarcinoma (spread to at least one regional lymph node) or stage II appendiceal adenocarcinoma with any high-risk features should be considered for adjuvant systemic chemotherapy following surgical resection. 52,54,60,72,72,73,[73][74][75][76][77][78] High-risk features are summarized in the systemic chemotherapy section above. 52,54,[71][72][73][74][75][76][77]147 Adjuvant chemotherapy regimens, described under the systemic chemotherapy section, typically last 3-6 months, depending on patient toleration, with a goal of 6 months of therapy.…”

Section: Blockmentioning

confidence: 99%

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Consensus guideline for the management of patients with appendiceal tumors Part 1: Appendiceal tumors without peritoneal involvement

Turaga

2024

Preprint

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Background: Appendiceal tumors comprise a heterogeneous group of tumors which may be localized or disseminate throughout the peritoneum. Limited high quality clinical data exists and many practices have been extrapolated from colorectal cancer without validation in appendiceal cohorts. Many controversies exist regarding their treatment, and practices vary widely between centers and care settings. A national consensus update of best management practices for appendiceal malignancies was performed to better standardize care. Methods The 2018 Chicago consensus guideline was updated via modified Delphi consensus, performed over two rounds using nationally circulated surveys. Supporting evidence was evaluated using rapid systematic reviews. Key systemic therapy concepts were summarized by content experts. Results Most supporting literature consists of observational studies, but increasingly high-quality studies are becoming available to drive management. Two consensus-based pathways were generated for localized appendiceal tumors, one for epithelial mucinous neoplasms and another for appendiceal adenocarcinoma. Of 138 participants responding in the first round, 133 (96%) engaged in the second round. Over 90% consensus was achieved for all pathway blocks. Key points include minimizing intervention invasiveness where permitted by pathologic classification and margin status, and determining what margin and pathologic findings are indications for consideration of cytoreduction with or without intraperitoneal chemotherapy. Surveillance and systemic therapy recommendations are also presented. Conclusion With growing but still primarily observational evidence currently dictating care, these consensus recommendations provide expert guidance in the treatment of appendiceal tumors without peritoneal involvement.

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Section: Cytotoxic Chemotherapy For Localized Appendix Tumorsmentioning

confidence: 99%

Section: Blockmentioning

confidence: 99%

Section: Blockmentioning

confidence: 99%

Section: Cytotoxic Chemotherapy For Localized Appendix Tumorsmentioning

confidence: 99%

Section: Blockmentioning

confidence: 99%

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Consensus guideline for the management of patients with appendiceal tumors Part 1: Appendiceal tumors without peritoneal involvement

Turaga

2024

Preprint

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Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Multi-institutional Analysis

et al. 2023

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Extent of Resection and Long-Term Outcomes for Appendiceal Adenocarcinoma: a SEER Database Analysis of Mucinous and non-Mucinous Histologies

Tsagkalidis,

Choe,

Beninato

et al. 2024

Ann Surg Oncol

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Background Mucinous appendiceal adenocarcinomas (MAA) and non-mucinous appendiceal adenocarcinomas (NMAA) demonstrate differences in rates and patterns of recurrence, which may inform the appropriate extent of surgical resection (i.e., appendectomy versus colectomy). The impact of extent of resection on disease-specific survival (DSS) for each histologic subtype was assessed. Patients and Methods Patients with resected, non-metastatic MAA and NMAA were identified in the Surveillance, Epidemiology, and End Results database (2000–2020). Multivariable models were created to examine predictors of colectomy for each histologic subtype. DSS was calculated using Kaplan–Meier estimates and examined using Cox proportional hazards modeling. Results Among 4674 patients (MAA: n = 1990, 42.6%; NMAA: n = 2684, 57.4%), the majority (67.8%) underwent colectomy. Among colectomy patients, the rate of nodal positivity increased with higher T-stage (MAA: T1: 4.6%, T2: 4.0%, T3: 17.1%, T4: 21.6%, p < 0.001; NMAA: T1: 6.8%, T2: 11.4%, T3: 25.6%, T4: 43.8%, p < 0.001) and higher tumor grade (MAA: well differentiated: 7.7%, moderately differentiated: 19.2%, and poorly differentiated: 31.3%; NMAA: well differentiated: 9.0%, moderately differentiated: 20.5%, and 44.4%; p < 0.001). Nodal positivity was more frequently observed in NMAA (27.6% versus 16.4%, p < 0.001). Utilization of colectomy was associated with improved DSS for NMAA patients with T2 (log rank p = 0.095) and T3 (log rank p = 0.018) tumors as well as moderately differentiated histology (log rank p = 0.006). Utilization of colectomy was not associated with improved DSS for MAA patients, which was confirmed in a multivariable model for T-stage, grade, and use of adjuvant chemotherapy [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.81–1.22]. Conclusions Colectomy was associated with improved DSS for patients with NMAA but not MAA. Colectomy for MAA may not be required.

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Do Lymph Node Metastases Matter in Appendiceal Cancer with Peritoneal Carcinomatosis? A US HIPEC Collaborative Study

Cited by 3 publications

References 33 publications

Consensus guideline for the management of patients with appendiceal tumors Part 1: Appendiceal tumors without peritoneal involvement

Consensus guideline for the management of patients with appendiceal tumors Part 1: Appendiceal tumors without peritoneal involvement

Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Multi-institutional Analysis

Extent of Resection and Long-Term Outcomes for Appendiceal Adenocarcinoma: a SEER Database Analysis of Mucinous and non-Mucinous Histologies

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