Rosendahl Mikkel, Haueberg Oester Laura Amalie, Høgdall Claus Kim
From the Department of Gynecology and Obstetrics, Copenhagen University Hospital - RIGSHOPITALET, København Ø, Denmark.
Int J Gynecol Cancer. 2017 Mar;27(3):430-436. doi: 10.1097/IGC.0000000000000910.
The aim of this study was to assess the importance of appendectomy during surgery for mucinous ovarian cancer. It can be difficult to distinguish between primary ovarian and primary appendiceal cancers clinically, histologically, and immunohistochemically. Removal of the appendix may facilitate differential diagnosis, improve staging, and possibly increase 5-year survival but may also be associated with increased postsurgical morbidity. In the largest population published to date, we analyze and discuss these matters.
Prospectively gathered data on 269 patients with confirmed mucinous ovarian adenocarcinoma from a national database were analyzed. The impact of appendectomy and metastases to the appendix on 5-year and overall survival was analyzed.
Appendectomy was performed in 172 cases (64%), and in 10 cases (4%), pathologic evaluation of the removed appendix revealed metastases from ovarian cancer. Three of the cases were macroscopically normal, and metastases were discovered only during microscopic evaluation. Patients with metastatic disease to the appendix had significantly worse 5-year survival (22%) compared with patients without metastases (73%) (χ = 31.998, P < 0.0001). Equally, 5-year survival was significantly higher in patients who had been adequately staged with hysterectomy, omentectomy, bilateral salpingo-oophorectomy, and appendectomy (74% vs 52%, χ = 7.322, P = 0.007). In multivariate analysis, increase in revised 2013 International Federation of Gynecology and Obstetrics classification stage (IA reference) was significantly associated with worsened prognosis (hazard ratio, 1.13; P < 0.0001). Equally, each stepwise increase in performance status score was related to a poorer prognosis with hazard ratio of 1.63 (P < 0.0001). Metastases to the appendix and staging did not remain significant factors of survival in multivariate analysis.
Univariate analysis suggests that metastatic disease to the appendix and failure to perform complete staging including appendectomy are related to a worsened prognosis. A normal-looking appendix does not exclude metastatic disease, and because appendectomy is easily performed and does not increase morbidity, it should be performed during surgery for suspected mucinous ovarian cancer.
本研究旨在评估在黏液性卵巢癌手术中进行阑尾切除术的重要性。在临床、组织学及免疫组化方面，原发性卵巢癌与原发性阑尾癌可能难以区分。切除阑尾或许有助于鉴别诊断、完善分期，并可能提高5年生存率，但也可能增加术后发病率。在迄今发表的最大规模人群研究中，我们对这些问题进行分析和讨论。
对从一个国家数据库前瞻性收集的269例确诊黏液性卵巢腺癌患者的数据进行分析。分析阑尾切除术及阑尾转移对5年生存率和总生存率的影响。
172例（64%）患者接受了阑尾切除术，10例（4%）患者切除阑尾的病理评估显示存在卵巢癌转移。其中3例肉眼观察正常，转移仅在显微镜评估时发现。阑尾转移患者的5年生存率（22%）显著低于无转移患者（73%）（χ = 31.998，P < 0.0001）。同样，接受子宫切除术、大网膜切除术、双侧输卵管卵巢切除术及阑尾切除术进行充分分期的患者5年生存率显著更高（74% 对52%，χ = 7.322，P = 0.007）。多因素分析中，2013年国际妇产科联盟修订分类分期（以IA期为参照）的增加与预后恶化显著相关（风险比，1.13；P < 0.0001）。同样，体能状态评分每逐步增加一级，预后越差，风险比为1.63（P < 0.0001）。阑尾转移和分期在多因素分析中并非生存的显著因素。
单因素分析表明，阑尾转移及未进行包括阑尾切除术在内的完整分期与预后恶化相关。外观正常的阑尾不能排除转移，且由于阑尾切除术操作简便且不增加发病率，对于疑似黏液性卵巢癌的手术应进行阑尾切除术。
