Division of Surgical Oncology, Department of Surgery, UPMC Cancer Pavilion, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ann Surg Oncol. 2021 Dec;28(13):8916-8925. doi: 10.1245/s10434-021-10191-y. Epub 2021 Aug 18.
Appendiceal goblet cell adenocarcinomas (GCC) are rare tumors with clinical behavior between classic carcinoids and adenocarcinomas. Current guidelines recommend right hemicolectomy for all GCCs.
The National Cancer Database was retrospectively queried for appendiceal GCCs undergoing appendectomy or right hemicolectomy between 2004 and 2016. Demographics, tumor characteristics, and post-operative outcomes were collected. The primary outcome was overall survival, which was examined by surgical type and tumor T stage. Multivariate logistic regression was utilized to identify predictors of survival.
In total, 1083 GCCs were included, and 81.8% underwent right hemicolectomy. Mean age was 57 years, and 89% were White. Patients undergoing hemicolectomy had higher T-stage tumors (66.6%/14.4% T3/T4 vs. 55.8%/8.1%, p < 0.001). Lymph node positivity increased with T stage (1.1%, 2.1%, 9.9%, and 29.1% for T1-T4). GCCs undergoing colectomy were more frequently moderately or poorly differentiated (16.7%/9.0% vs. 12.2%/6.6%, p = 0.011). Appendectomy surgical margins were positive in 17.3% (3.4% hemicolectomy, p < 0.001). In T3/T4 tumors, a significant survival benefit at 5 years was observed in patients undergoing colectomy as compared with appendectomy (85.4% vs. 82.0%, p = 0.028). On multivariate analysis, lymph node positivity markedly decreased survival overall for the entire cohort (HR 7.58, p < 0.001) and for T3/T4 tumors (HR 7.63, p < 0.001). In patients with T3/T4 tumors, there was a trend towards improved survival with right hemicolectomy (HR 0.42, p = 0.068).
Omitting right hemicolectomy can be considered for select T1/T2 appendiceal GCCs with negative appendectomy margins, given low rates of lymph node metastases and lack of survival benefit with right hemicolectomy.
阑尾杯状细胞腺癌（GCC）是一种罕见的肿瘤，其临床行为介于典型类癌和腺癌之间。目前的指南建议对所有 GCC 行右半结肠切除术。
本研究通过回顾性分析 2004 年至 2016 年间在国家癌症数据库中接受阑尾切除术或右半结肠切除术的阑尾 GCC 患者的临床资料，收集患者的人口统计学、肿瘤特征和术后结局等信息。主要结局指标为总生存率，通过手术类型和肿瘤 T 分期进行检查。采用多因素逻辑回归分析确定影响生存的预测因素。
共纳入 1083 例 GCC 患者，其中 81.8%行右半结肠切除术。患者的平均年龄为 57 岁，89%为白人。行半结肠切除术的患者 T 期肿瘤更高（66.6%/14.4% T3/T4 与 55.8%/8.1%，p<0.001）。淋巴结阳性率随 T 分期增加（1.1%、2.1%、9.9%和 29.1%，T1-T4）。行结肠切除术的 GCC 组织分化程度更差（16.7%/9.0%与 12.2%/6.6%，p=0.011）。阑尾切除术的手术切缘阳性率为 17.3%（3.4%行半结肠切除术，p<0.001）。在 T3/T4 肿瘤中，与阑尾切除术相比，结肠切除术患者的 5 年生存率显著提高（85.4%与 82.0%，p=0.028）。多因素分析显示，淋巴结阳性对整个队列的总生存率（HR 7.58，p<0.001）和 T3/T4 肿瘤的总生存率（HR 7.63，p<0.001）均有显著影响。在 T3/T4 肿瘤患者中，右半结肠切除术的生存获益有增加的趋势（HR 0.42，p=0.068）。
对于阴性切缘的 T1/T2 阑尾 GCC 患者，可以考虑省略右半结肠切除术，因为淋巴结转移率低，且右半结肠切除术对生存没有获益。
