Appendiceal adenocarcinoma-patterns of tumor spread and prognosis.

IF 3.5 2区 医学 Q2 ONCOLOGY
Ejso Pub Date : 2024-10-10 DOI:10.1016/j.ejso.2024.108755
D Madonia, P Cashin, W Graf, L Ghanipour
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引用次数: 0

Abstract

Introduction: Appendiceal adenocarcinoma represents a diagnostic and therapeutic challenge since it is prone to early lymphatic and peritoneal spread. We aimed to analyze the proportion of lymph node metastases in completion right hemicolectomy specimens, risk factors for peritoneal metastases (PM), and prognosis after definitive treatment.

Methods: Ninety-three patients with appendiceal adenocarcinoma scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) in Uppsala 2004-2020 were identified from a prospectively maintained registry. Risk factors for PM were assessed based on the presence (CT + group, n = 55) or absence (CT - group, n = 37) of visible PM at baseline CT scan. Prognostic factors were analyzed based on the actual presence (PM group, n = 66) or absence (no PM group, n = 27) of PM.

Results: The median age was 60 (26-78). Forty-eight patients were women. Resection of PM at initial surgery indicated an 80 % risk of finding PM at a follow-up exploration. R1 appendectomy and perforated appendix had a similar risk for PM (24 %,26 %) which increased to 38 % if both were present. Regional lymph node metastases occurred in 31 % in the CT + group vs. 14 % in the CT - group (p = 0.005) and was associated with poor survival HR 5.16 (1.49-17.81). The 5-year OS and DFS rates were 54 % and 29 % in the PM group.

Conclusions: Patients with certain risk factors have a high likelihood of PM despite a normal CT scan, which justifies selective exploration at a HIPEC center. Regional lymph node spread supports the current practice of completion right hemicolectomy and is a significant prognostic factor.

阑尾腺癌--肿瘤扩散模式和预后。
简介:阑尾腺癌容易发生早期淋巴和腹膜扩散,因此是诊断和治疗的难题。我们旨在分析右半结肠切除术标本中淋巴结转移的比例、腹膜转移(PM)的风险因素以及明确治疗后的预后:方法:从乌普萨拉2004-2020年的一项前瞻性登记中确定了93名阑尾腺癌患者,这些患者计划接受囊肿切除手术和腹腔内热化疗(CRS + HIPEC)。根据基线 CT 扫描时可见 PM 的存在(CT + 组,n = 55)或不存在(CT - 组,n = 37)评估 PM 的风险因素。预后因素根据实际存在(PM 组,n = 66)或不存在(无 PM 组,n = 27)PM 进行分析:中位年龄为 60 岁(26-78 岁)。48名患者为女性。初次手术切除原发性阑尾炎表明,在后续检查中发现原发性阑尾炎的风险为 80%。R1阑尾切除术和阑尾穿孔发生阑尾炎的风险相似(分别为24%和26%),如果两者同时存在,则发生阑尾炎的风险增至38%。CT+组发生区域淋巴结转移的比例为31%,而CT-组为14%(P = 0.005),且与不良生存率HR 5.16(1.49-17.81)相关。PM组的5年OS和DFS率分别为54%和29%:结论:尽管CT扫描结果正常,但具有某些危险因素的患者极有可能患有原发性淋巴瘤,因此有必要在HIPEC中心进行选择性检查。区域淋巴结扩散支持目前的右半结肠切除术,也是一个重要的预后因素。
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来源期刊
Ejso
Ejso 医学-外科
CiteScore
6.40
自引率
2.60%
发文量
1148
审稿时长
41 days
期刊介绍: JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.
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