Nussbaum Daniel P, Speicher Paul J, Gulack Brian C, Keenan Jeffrey E, Ganapathi Asvin M, Englum Brian R, Tyler Douglas S, Blazer Dan G
Department of Surgery, Duke University, Durham, NC.
Department of Surgery, Duke University, Durham, NC.
J Am Coll Surg. 2015 May;220(5):894-903. doi: 10.1016/j.jamcollsurg.2015.01.005. Epub 2015 Jan 22.
The management of 1- to 2-cm appendiceal carcinoid tumors remains controversial. Here we use the National Cancer Data Base (NCDB) to compare long-term outcomes for patients treated via resection of the primary tumor alone vs right hemicolectomy (RHC).
The 1998 to 2011 NCDB User File was queried to identify patients with 1- to 2-cm appendiceal carcinoids. Patients were stratified by surgical technique: resection of the primary tumor alone vs RHC with regional lymphadenectomy. Multivariable logistic regression was used to compare short-term outcomes. Survival was estimated using the Kaplan-Meier method with comparisons based on the log-rank test.
A total of 916 patients were identified, including 42% managed with primary resection and 58% with RHC. Patients who underwent RHC had slightly larger tumors and higher-stage tumors; otherwise, there were no baseline differences between groups. The rates of positive margins were similar (5.5% vs 4.5%; p = 0.60). Among all patients, 1- and 5-year survival were 98.1% and 88.7% vs 96.7% and 87.4% (p = 0.52) for those managed via primary resection vs RHC, respectively. Among patients with moderate/high-grade/anaplastic carcinoids, 1- and 5-year survival were 93.3% and 72.0% vs 92.3% and 71.9%, respectively (p = 0.78). After adjustment with Cox proportional hazards modeling, we confirmed that there was no survival benefit for patients undergoing RHC (hazard ratio = 1.14; p = 0.72).
For 1- to 2-cm appendiceal carcinoids, formal resection of the right colon does not appear to improve survival, even for higher-grade tumors. Our findings suggest that resection of the primary tumor alone is adequate for all carcinoids <2 cm.
1至2厘米的阑尾类癌肿瘤的治疗仍存在争议。在此，我们使用国家癌症数据库（NCDB）来比较仅通过原发性肿瘤切除术与右半结肠切除术（RHC）治疗的患者的长期预后。
查询1998年至2011年的NCDB用户文件，以识别患有1至2厘米阑尾类癌的患者。患者按手术技术分层：仅原发性肿瘤切除术与行区域淋巴结清扫的RHC。使用多变量逻辑回归比较短期预后。采用Kaplan-Meier方法估计生存率，并基于对数秩检验进行比较。
共识别出916例患者，其中42%接受原发性切除术，58%接受RHC。接受RHC的患者肿瘤稍大且分期更高；除此之外，两组之间无基线差异。切缘阳性率相似（5.5%对4.5%；p = 0.60）。在所有患者中，原发性切除术与RHC治疗的患者1年和5年生存率分别为98.1%和88.7%对96.7%和87.4%（p = 0.52）。在中/高分级/间变性类癌患者中，1年和5年生存率分别为93.3%和72.0%对92.3%和71.9%（p = 0.78）。经Cox比例风险模型调整后，我们证实接受RHC的患者无生存获益（风险比 = 1.14；p = 0.72）。
对于1至2厘米的阑尾类癌，即使是更高分级的肿瘤，右半结肠的正规切除术似乎也不能提高生存率。我们的研究结果表明，对于所有<2厘米的类癌，仅切除原发性肿瘤就足够了。
