Presentation Patterns and Treatment Outcomes in Appendix Cancer Patients Traveling to a High-Volume Peritoneal Surface Malignancy Center.

IF 0.9 4区医学 Q3 SURGERY

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-05-05 DOI:10.1177/00031348251337155

Vladislav Kovalik, Armando Sardi, Mary Caitlin King, Sergei Iugai, Luis Felipe Falla-Zuniga, Carol Nieroda, Vadim Gushchin

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引用次数: 0

Abstract

IntroductionMucinous appendix cancer (MAC) treatment is centralized at peritoneal surface malignancy centers (PSMCs), requiring patients to travel for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). We compared presentation patterns and outcomes for patients accessing a high-volume PSMC from in-state (I-S) vs out-of-state (O-S).MethodsThis cohort study of MAC patients with peritoneal metastases treated with CRS/HIPEC (1998-2023) used a prospective database. Travel distance, presentation (time from diagnosis [TFD], peritoneal cancer index [PCI], prior surgery score [PSS], and systemic chemotherapy [SCh]), quality (complete cytoreduction [CC-0/1] and grade III/IV Clavien-Dindo complications), and overall survival (OS) were compared between O-S and I-S patients. A hazard ratio (HR) with 95% confidence interval (CI) for 10-year OS was evaluated using Cox regression for O-S travel, adjusting for age, histology, PCI, and prior treatment.ResultsOverall, 369 patients were included: 223 (60.4%) O-S and 146 (39.6%) I-S, with median travel distances of 180 [IQR: 83-729] and 29 [IQR: 14-59] miles, respectively. Compared to I-S, O-S had longer TFD (median: 4.6 vs 2.8 months, P < 0.001), higher PCI (median: 32 vs 24, P = 0.001), and higher rates of PSS-2/3 (40.4% vs 28.6%, P = 0.023) and SCh (31.8% vs 19.2%, P = 0.007). CC-0/1 (84.8% vs 91.4%, P = 0.063) and major complication (15.2% vs 21.4%, P = 0.132) rates were comparable. O-S travel did not affect OS (HR: 1.08 [95% CI: 0.73, 1.61]).ConclusionTraveling to a PSMC is associated with delayed presentation, more advanced disease, and prior treatments. However, quality and survival outcomes remain unaffected. Early referral and support for travel are essential.

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阑尾癌患者前往大容量腹膜表面恶性肿瘤中心的表现模式和治疗结果。

阑尾黏液性癌（MAC）的治疗集中在腹膜表面恶性肿瘤中心（PSMCs），需要患者进行细胞减少手术和腹腔内高温化疗（CRS/HIPEC）。我们比较了从州内（I-S）和州外（O-S）获得大容量PSMC的患者的表现模式和结果。方法采用前瞻性数据库，对1998-2023年接受CRS/HIPEC治疗的MAC腹膜转移患者进行队列研究。比较O-S和I-S患者的旅行距离、表现（距离诊断时间[TFD]、腹膜癌指数[PCI]、既往手术评分[PSS]、全身化疗[SCh]）、质量（完全细胞减少[CC-0/1]和III/IV级Clavien-Dindo并发症）和总生存期（OS）。采用Cox回归评估10年OS的风险比（HR）， 95%可信区间（CI），调整年龄、组织学、PCI和既往治疗。结果共纳入369例患者：223例（60.4%）为O-S， 146例（39.6%）为I-S，中位出行距离分别为180 [IQR: 83-729]和29 [IQR: 14-59]英里。与I-S相比，O-S的TFD更长（中位数：4.6 vs 2.8个月，P < 0.001）， PCI更高（中位数：32 vs 24， P = 0.001）， PSS-2/3发生率更高（40.4% vs 28.6%, P = 0.023）和SCh （31.8% vs 19.2%, P = 0.007）。CC-0/1发生率（84.8% vs 91.4%, P = 0.063）和主要并发症发生率（15.2% vs 21.4%, P = 0.132）具有可比性。O-S旅行不影响OS （HR: 1.08 [95% CI: 0.73, 1.61]）。结论：去PSMC就诊与延迟就诊、疾病进展和既往治疗相关。然而，质量和生存结果不受影响。及早转诊和支持旅行是必不可少的。

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来源期刊

American Surgeon 医学-外科

CiteScore

1.40

自引率

0.00%

发文量

623

期刊介绍： The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.