Improved survival after retrieval of 12 or more regional lymph nodes in appendiceal cancer

Fleischmann, Iréne; Warschkow, René; Beutner, Ulrich; Marti, Lukas; Schmied, Bruno M.; Steffen, Thomas

doi:10.1016/j.ejso.2017.06.015

Cited by 19 publications

(14 citation statements)

References 24 publications

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“…Given the relatively low proportion of younger patients with appendiceal adenocarcinoma, continued studies over time would be beneficial to help further understand any changing We additionally noted that patients diagnosed in the later time cohort were more likely to have greater than 12 regional lymph nodes harvested during the time of surgery, likely reflective of increasing literature supportive of the value of adequate nodal harvest for improved staging, prognostication, and treatment. 36 Interestingly, we did not note a difference in the type of surgical procedures performed between the two time cohorts (i.e., more extensive hemicolectomy vs. appendectomy), suggesting that the differences noted in nodal harvest may be attributable to changes in surgical technique or in improved pathologic scrutiny of specimens. 37 Interestingly, approximately a quarter of patients in both time cohorts received less than a right hemicolectomy for treatment, which is less than the recommended surgical management for this patient recurrence.…”

Section: Discussionmentioning

confidence: 71%

“…We additionally noted that patients diagnosed in the later time cohort were more likely to have greater than 12 regional lymph nodes harvested during the time of surgery, likely reflective of increasing literature supportive of the value of adequate nodal harvest for improved staging, prognostication, and treatment 36 . Interestingly, we did not note a difference in the type of surgical procedures performed between the two time cohorts (i.e., more extensive hemicolectomy vs. appendectomy), suggesting that the differences noted in nodal harvest may be attributable to changes in surgical technique or in improved pathologic scrutiny of specimens 37 .…”

Section: Discussionmentioning

confidence: 87%

“…These changes in aggressive surgical management may reflect the increased proportion of pT4 tumors over the time periods. Increased utilization of HIPEC may also be reflective of an increasing number of institutions offering this modality of treatment for locally advanced tumors with high incidence of peritoneal recurrence 36,37 …”

Section: Discussionmentioning

confidence: 99%

“…37 Interestingly, approximately a quarter of patients in both time cohorts received less than a right hemicolectomy for treatment, which is less than the recommended surgical management for this patient recurrence. 36,37 The overall survival of appendiceal adenocarcinoma varies de- This study has several limitations, including its retrospective study design. The NCDB does not provide information regarding timing of treatment of appendiceal cancer relative to the timing of presentation of patients with appendiceal symptoms (i.e., appendicitis, if applicable), and, specifically, as to whether some patients were managed conservatively with delayed appendectomy.…”

Section: Discussionmentioning

confidence: 99%

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National trends in the presentation of surgically resected appendiceal adenocarcinoma over a decade

Shannon

Song

Roses

et al. 2020

Journal of Surgical Oncology

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BackgroundRates of nonoperative management of acute appendicitis and appendiceal adenocarcinoma have increased over a decade, but the presentation and outcomes of appendiceal adenocarcinoma over this period is not well‐characterized.MethodsPatients with surgically resected Stage I–III appendiceal adenocarcinoma were identified from the 2006 to 2015 National Cancer Data Base and classified into two cohorts, 2006–2010 and 2011–2015, based on year of diagnosis. Three‐year overall survival (OS) was analyzed using Cox proportional hazards regression and Kaplan–Meier survival estimates.ResultsOf 4233 patients, 1369 (32.3%) and 2864 (67.7%) were diagnosed in 2006–2010 and 2011–2015, respectively. Following multivariable analysis, patients in 2011–2015 were more likely to be <40 years of age (6.4% vs. 4.7%, odds ratio [OR] 1.53, p .015), present with pT4 tumors (40.2% vs. 34.4%, OR 1.46, p .004), and undergo hyperthermic intraperitoneal chemotherapy (4.4% vs. 2.4%, OR 1.97, p .001). Comparing patients diagnosed in 2011–2015 to 2006–2010, adjusted 3‐year OS was no different among all patients (81.1% vs. 79%, p .778).ConclusionsThere has been an increase in the proportion of patients with pT4 appendix tumors over time, primarily among older (≥60 years) patients. Even so, these shifts in presentation have not resulted in differences in survival outcomes.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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National trends in the presentation of surgically resected appendiceal adenocarcinoma over a decade

Shannon

Song

Roses

et al. 2020

Journal of Surgical Oncology

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“…Although median survival was indeed shorter in patients with lymph node involvement than in other patients, this was not statistically significant. Fleischmann et al [12] studied the date between 2004 and 2012 in the SEER database including 1046 patients with primary carcinoma of the appendix, and the results showed that with 12 or more of regional lymph nodes removed, a significant advantage concerning OS and DSS emerged.…”

Section: Discussionmentioning

confidence: 99%

Nomogram to predict overall survival and disease-specific survival with appendiceal mucinous adenocarcinoma

et al. 2019

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To predict the survival of appendiceal mucinous adenocarcinoma (AMA) by prognostic nomogram.A total of 3234 patients with AMA were collected from the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2015. Univariate and multivariate Cox proportional hazards (PH) regression analyses were used to generate independent prognostic factors. These variables were included in the nomogram to predict overall survival (OS) and disease-specific survival (DSS) at 1-, 3-, and 5- years. These data are validated both internally and externally. The consistency index (C-index) and calibration chart were used to estimate the accuracy of the nomogram.The study cohort was randomly divided into the training (n = 2155) and validation group (n = 1799). According to univariate and multivariate analyses, age at diagnosis, marital status, sex, histological differentiation, SEER extent of disease, number of local lymph nodes examined, whether they were positive, and surgical methods were independent prognostic factors for OS and DSS. These factors were incorporated into the nomogram. Internal validation in the training cohort showed that the C-index values for nomogram predictions of OS and DSS were 0.73 (95% CI 0.70–0.76) and 0.77 (95% CI 0.73–0.81), respectively. Similarly, the corresponding C-index values in the external validation cohort were 0.76 (95% CI 0.70–0.81) and 0.75 (95% CI 0.71–0.80). The Calibration plots revealed that the actual survival and nomogram prediction had a good consistency.Build a nomogram in the SEER database to predict OS and DSS in patients with AMA. It can provide accurate and personalised survival prediction for clinicians and patients.

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Continued increasing incidence of malignant appendiceal tumors in Canada and the United States: A population‐based study

Singh

Koomson

Decker

et al. 2020

Cancer

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BACKGROUND:To the authors' knowledge, there are limited data regarding the epidemiology of malignant appendiceal tumors. It remains unknown whether the previously reported trends are occurring in different countries and/or continuing in recent years and/or whether they are possibly due to increasing rates of appendectomies. In the current study, the authors investigated the patterns and time trends of malignant appendiceal tumor diagnosis by age group, sex, stage of disease, and histology in Canada and the United States and concomitant rates of appendectomies in Canada. METHODS: The Canadian Cancer Registry and the US Surveillance, Epidemiology, and End Results incidence databases were used to identify incident patients of malignant appendiceal tumors in the 2 countries between 1992 and 2016. The Canadian national hospitals Discharge Abstract Database was used to identify appendectomies performed between 2004 and 2015. Joinpoint regression analyses were performed to determine time trends. RESULTS: There was an overall increase in the incidence of malignant appendiceal tumors of 232% in the United States and 292% in Canada between 2000 and 2016. The increase was noted for malignant adenocarcinomas and neuroendocrine appendiceal tumors in both countries. The increase occurred across all age groups, sexes, and stages of disease. The highest rate of increase was noted for appendiceal neuroendocrine malignant tumors diagnosed among the youngest age groups. The rate of appendectomies was stable in the recent time periods, resulting in a decreasing rate of appendectomies per malignant appendiceal tumor diagnosis. CONCLUSIONS: The incidence of malignant appendiceal tumor is continuing to increase, which is not likely due to the increasing diagnosis of asymptomatic tumors at the time of appendectomies.

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Improved survival after retrieval of 12 or more regional lymph nodes in appendiceal cancer

Cited by 19 publications

References 24 publications

National trends in the presentation of surgically resected appendiceal adenocarcinoma over a decade

National trends in the presentation of surgically resected appendiceal adenocarcinoma over a decade

Nomogram to predict overall survival and disease-specific survival with appendiceal mucinous adenocarcinoma

Continued increasing incidence of malignant appendiceal tumors in Canada and the United States: A population‐based study

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