Division of Surgical Oncology, Department of Surgery, Mayo Clinic, Arizona, USA.
Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic, Arizona, USA.
J Surg Oncol. 2021 Jul;124(1):88-96. doi: 10.1002/jso.26493. Epub 2021 Apr 26.
Appendiceal cancers represent a diverse group of malignancies with varying biological behavior. The significance of lymph node metastases in relation to long-term survival and chemotherapy response is poorly defined.
The National Cancer Database was queried to find patients diagnosed with appendiceal cancer from 1998 to 2012. Kaplan-Meier curves and multivariable Cox regression analyses were used to study the association between lymph node status and overall survival. Stage IV patients were excluded.
The rate of nodal positivity of the 9841 patients with known node status was: signet ring 47.4%, carcinoid 42.3%, nonmucinous adenocarcinoma 28.8%, goblet cell 21.9%, and mucinous adenocarcinoma 20.4%. Node-positive patients had worse long-term survival for all subtypes with the exception of carcinoid tumors (p < 0.001). The strongest association was for signet cell and goblet cell. Adjuvant chemotherapy in node-positive patients improved survival for mucinous, nonmucinous, and signet ring cell histology (p < 0.01), but not for goblet cell.
Nodal involvement in patients with appendiceal cancer varies in incidence, association with adverse survival, and response to systemic therapy. Individualized treatment algorithms for the management of the subtypes of appendiceal cancer are needed.
阑尾癌是一组具有不同生物学行为的恶性肿瘤。淋巴结转移与长期生存和化疗反应的关系尚未明确。
从 1998 年到 2012 年，国家癌症数据库被用来寻找被诊断为阑尾癌的患者。通过 Kaplan-Meier 曲线和多变量 Cox 回归分析，研究淋巴结状态与总生存率之间的关系。排除了 IV 期患者。
在 9841 例已知淋巴结状态的患者中，淋巴结阳性率为：印戒细胞癌 47.4%，类癌 42.3%，非黏液性腺癌 28.8%，杯状细胞癌 21.9%，黏液性腺癌 20.4%。除类癌外，所有亚型的淋巴结阳性患者的长期生存率均较差（p<0.001）。印戒细胞癌和杯状细胞癌的相关性最强。淋巴结阳性患者接受辅助化疗可改善黏液性、非黏液性和印戒细胞癌的生存（p<0.01），但对杯状细胞癌无效。
阑尾癌患者的淋巴结受累在发病率、与不良生存的相关性和对系统治疗的反应方面存在差异。需要为阑尾癌的亚型制定个体化的治疗方案。
