原发性阑尾黏液性肿瘤的临床病理特征及根治性切除术后复发情况
Clinicopathological Characteristics of Primary Appendiceal Mucinous Neoplasm and Recurrence After Radical Resection.
作者信息
Wang Zaibiao, Yin Manman, Shao Jiayun, Yin Zhipeng, Peng Jie, Lu Zhengmao
机构信息
Department of General Surgery, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China.
Department of Science and Education, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China.
出版信息
Front Surg. 2022 May 4;9:902543. doi: 10.3389/fsurg.2022.902543. eCollection 2022.
OBJECTIVE
Appendiceal mucinous neoplasm (AMN) is a rare obstructive dilatation of the appendix caused by an intraluminal accumulation of mucoid material, showing an insidious onset and few specific clinical manifestations. The purpose of the study is to analyze clinicopathological characteristics of primary AMN and recurrence after radical resection.
METHODS
A total of 50 patients were included in the retrospective cohort study of AMN. Patient data, such as demographics, tumor characteristics, surgical management, preoperative serum carcinoembryonic antigen (CEA), and carcinoembryonic antigen 19-9 (CA19-9) levels, were collected. All patients were followed-up with interval CT scans until the end of December 2021, with overall survival (OS) and progression-free survival (PFS) being calculated.
RESULTS
All patients were confirmed as AMN by pathological diagnosis after surgery, including 28 cases (56.00%) of low-grade AMN (LAMN) and 22 cases (44.00%) of non-LAMN. Among 50 patients with AMN, there were 12 cases (24.00%) complicated with pseudomyxoma peritonei (PMP). Higher proportions of patients with pTis, pT3, pT4a, ruptured at presentation, and PMP were found in patients with non-LAMN patients than LAMN ( < 0.05). There was a remarkable difference about preoperative serum CA19-9 levels between patients with LAMN and non-LAMN ( = 0.044). Patients complicated with PMP had a higher proportion of patients with ruptured at presentation than those who were not ( < 0.001). The patients with PMP had increased tumor size compared with those without PMP ( = 0.031). Remarkable differences were observed in terms of preoperative serum CA19-9 ( = 0.009) levels between patients with PMP and without PMP. We performed a multivariate analysis of the presence or absence of PMP and found that ruptured at presentation was found to be a risk factor for PMP in patients with AMN ( = 0.003). The PFS in the patients with PMP and those without was 33.33% (4/12) and 2.63% (1/38), showing a significant difference ( = 0.002).
CONCLUSION
The study demonstrates that ruptured at presentation and PMP may influence the prognosis and survival of patients with AMN.
目的
阑尾黏液性肿瘤（AMN）是一种由管腔内黏液物质积聚引起的阑尾罕见梗阻性扩张，起病隐匿，特异性临床表现较少。本研究旨在分析原发性AMN的临床病理特征及根治性切除术后的复发情况。
方法
本回顾性队列研究共纳入50例AMN患者。收集患者的人口统计学、肿瘤特征、手术治疗、术前血清癌胚抗原（CEA）和癌胚抗原19-9（CA19-9）水平等数据。所有患者均接受定期CT扫描随访至2021年12月底，计算总生存期（OS）和无进展生存期（PFS）。
结果
所有患者术后经病理诊断确诊为AMN，其中低级别AMN（LAMN）28例（56.00%），非LAMN 22例（44.00%）。50例AMN患者中，12例（24.00%）合并腹膜假黏液瘤（PMP）。非LAMN患者中pTis、pT3、pT4a、术中破裂及PMP的比例高于LAMN患者（<0.05）。LAMN患者与非LAMN患者术前血清CA19-9水平存在显著差异（=0.044）。合并PMP的患者术中破裂的比例高于未合并者（<0.001）。与未合并PMP的患者相比，合并PMP的患者肿瘤体积增大（=0.031）。PMP患者与未合并PMP患者术前血清CA19-9水平存在显著差异（=0.009）。我们对PMP的有无进行多因素分析，发现术中破裂是AMN患者发生PMP的危险因素（=0.003）。合并PMP患者与未合并PMP患者的PFS分别为33.33%（4/12）和2.63%（1/38），差异有统计学意义（=0.002）。
结论
本研究表明，术中破裂和PMP可能影响AMN患者的预后和生存。
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