From the Department of Surgery (Salazar), Yale School of Medicine, New Haven, Connecticut.
National Clinician Scholars Program (Salazar), Yale School of Medicine, New Haven, Connecticut.
J Am Coll Surg. 2022 Jun 1;234(6):1082-1089. doi: 10.1097/XCS.0000000000000172. Epub 2022 Mar 17.
Nonoperative management of acute appendicitis is increasingly common. However, small studies have demonstrated high rates of appendiceal cancer in interval appendectomy specimens. Therefore, we sought to identify national trends in appendiceal cancer incidence and histology.
The National Cancer Database was queried for patients 18 years or older, diagnosed with a right-sided colon cancer (including appendiceal) from 2004 to 2017 who had undergone surgery. Outcomes included trends in appendiceal cancer compared with right-sided colon cancers and trends in appendiceal cancer histology. Logistic regression was used to assess trends over time while adjusting for patient age, insurance, income, area of residence, and comorbidity. Predicted probabilities of the outcomes were derived from the logistic regression models.
Of 387,867 patients with right-sided colon cancer, 19,570 had appendiceal cancer and of those 5,628 had a carcinoid tumor. Odds of appendiceal cancer, relative to other right-sided colon cancers, increased from 2004 to 2017 (odds ratio [OR] 2.56, 95% CI 2.35-2.79). The increase occurred in all age groups; however, it was more markedly increased in patients 40-49 years old (2004: 10%, 95% CI 9-12 to 2017: 18%, 95% CI 16-20; pairwise comparisons p < 0.001). Odds of appendiceal carcinoid, relative to other appendiceal histologies, increased from 2004 to 2017 (OR 1.70, 95% CI 1.40-2.07) with the greatest increase in probability of a carcinoid in patients younger than 40 years old (2004: 24%, 95% CI 15-34 to 2017: 45%, 95% CI 37-53; pairwise comparisons p < 0.001).
Appendiceal cancer has increased over time, and the increase appears to be driven by a rise in carcinoids, most prevalent in patients 49 years of age or younger. When nonoperative management of acute appendicitis is undertaken, close follow-up may be appropriate given these findings.
急性阑尾炎的非手术治疗越来越常见。然而，一些小型研究表明，在间隔期阑尾切除标本中阑尾癌的发生率较高。因此，我们试图确定全国范围内阑尾癌发病率和组织学的趋势。
从 2004 年至 2017 年，国家癌症数据库对接受过手术的 18 岁及以上、诊断为右侧结肠癌（包括阑尾）的患者进行了检索。结果包括与右侧结肠癌相比，阑尾癌的发病率趋势以及阑尾癌的组织学趋势。使用逻辑回归来评估随时间的趋势，同时调整患者年龄、保险、收入、居住地和合并症。从逻辑回归模型中得出结果的预测概率。
在 387867 例右侧结肠癌患者中，有 19570 例患有阑尾癌，其中 5628 例患有类癌肿瘤。与其他右侧结肠癌相比，阑尾癌的发病几率从 2004 年到 2017 年增加（比值比 [OR] 2.56，95%CI 2.35-2.79）。这种增加发生在所有年龄组中，但在 40-49 岁的患者中更为明显（2004 年：10%，95%CI 9-12；2017 年：18%，95%CI 16-20；两两比较 p < 0.001）。与其他阑尾组织学相比，阑尾类癌的发病几率从 2004 年到 2017 年增加（OR 1.70，95%CI 1.40-2.07），在 40 岁以下的患者中，类癌的发病几率增加最大（2004 年：24%，95%CI 15-34；2017 年：45%，95%CI 37-53；两两比较 p < 0.001）。
阑尾癌的发病率呈上升趋势，这种上升似乎是由类癌的增加所驱动，而类癌在 49 岁及以下的患者中最为常见。因此，在对急性阑尾炎进行非手术治疗时，鉴于这些发现，密切随访可能是合适的。
