辅助化疗对 II-III 期阑尾杯状细胞类癌/杯状细胞腺癌是否有益？
Is adjuvant chemotherapy beneficial for stage II-III goblet cell carcinoid/goblet cell adenocarcinoma of the appendix?
机构信息
Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Winship Research Informatics, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
出版信息
Surg Oncol. 2021 Mar;36:120-129. doi: 10.1016/j.suronc.2020.12.003. Epub 2020 Dec 10.
BACKGROUND
Goblet cell carcinoma (GCC), formerly known as goblet cell carcinoid, of the appendix constitutes less than 14% of all primary appendiceal neoplasms. Surgical resection is the main treatment and the role of adjuvant chemotherapy (AC) is not established. This study aims to evaluate the impact of AC in stage II-III appendiceal GCC.
METHODS
Patients with pathological stage II and III GCC who underwent surgical resection between 2006 and 2015 were identified from the National Cancer Database (NCDB) using ICD-O-3 morphology and topography codes: 8243/3 (goblet cell carcinoid) and C18.1. Patients treated with neoadjuvant systemic and/or radiation therapy and adjuvant radiation were excluded. Univariate and multivariable analyses were conducted, and Kaplan-Meier Curves were used to compare overall survival (OS) based on treatment received with Log-rank test.
RESULTS
A total of 619 patients were identified. 54.4% males and 89.0% Caucasian; median age 56 (range, 23-90) years. Distribution across pathological stages II-III was 82.7% (N = 512) and 17.3% (N = 107) respectively. AC was administered in 9.4% (N = 48) of stage II and 47.7% (N = 51) of stage III patients. For stage II patients, AC was not associated with better OS in univariate (HR 0.32; 95% CI 0.04-2.34; p = 0.261) or multivariable analyses (HR 0.29; 95% CI 0.04-2.12; p = 0.221). By contrast, in stage III patients, AC was associated with better OS in univariate (HR 0.35; 95% CI 0.17-0.71; p = 0.004) and multivariable analyses (HR 0.25; 95% CI 0.07-0.88; p = 0.031). In the entire cohort 5-year OS for patients that received AC was 85.5% (74.0%, 92.1%) versus 82.7% (77.5%, 86.8%) (p = 0.801) with no AC. For stage II patients, 5-year OS was 96.9% with AC vs. 89.1% with no AC (p = 0.236). For stage III patients, 5-year OS was 77.1% with AC vs. 42.8% with no AC (p = 0.003).
CONCLUSION
AC was associated with improved OS in patients with pathological stage III GCC of the appendix, but not with pathological stage II.
背景
阑尾的杯状细胞癌（GCC）以前称为杯状细胞类癌，占所有阑尾原发性肿瘤的不到 14%。手术切除是主要的治疗方法，辅助化疗（AC）的作用尚未确定。本研究旨在评估 AC 在 II-III 期阑尾 GCC 中的作用。
方法
使用国际疾病分类肿瘤学第三版形态学和解剖学代码 ICD-O-3：8243/3（杯状细胞类癌）和 C18.1，从国家癌症数据库（NCDB）中确定了 2006 年至 2015 年间接受手术切除的病理 II 和 III 期 GCC 患者。排除接受新辅助全身和/或放射治疗以及辅助放射治疗的患者。进行单变量和多变量分析，并使用 Kaplan-Meier 曲线和对数秩检验根据接受的治疗比较总生存期（OS）。
结果
共确定了 619 名患者。男性占 54.4%，白种人占 89.0%；中位年龄为 56 岁（范围，23-90 岁）。病理分期 II-III 期的分布分别为 82.7%（N=512）和 17.3%（N=107）。在 II 期患者中，9.4%（N=48）和 III 期患者中 47.7%（N=51）接受了 AC。对于 II 期患者，AC 在单变量（HR 0.32；95%CI 0.04-2.34；p=0.261）或多变量分析（HR 0.29；95%CI 0.04-2.12；p=0.221）中与更好的 OS 无关。相比之下，在 III 期患者中，AC 在单变量（HR 0.35；95%CI 0.17-0.71；p=0.004）和多变量分析（HR 0.25；95%CI 0.07-0.88；p=0.031）中与更好的 OS 相关。在整个队列中，接受 AC 治疗的患者 5 年 OS 为 85.5%（74.0%，92.1%）与未接受 AC 治疗的患者 82.7%（77.5%，86.8%）（p=0.801）。对于 II 期患者，接受 AC 治疗的患者 5 年 OS 为 96.9%，未接受 AC 治疗的患者为 89.1%（p=0.236）。对于 III 期患者，接受 AC 治疗的患者 5 年 OS 为 77.1%，未接受 AC 治疗的患者为 42.8%（p=0.003）。
结论
AC 与 III 期阑尾 GCC 患者的 OS 改善相关，但与 II 期患者无关。
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