Wang Ying, Geng Yiting, Hu Wenwei
Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
J Gastrointest Oncol. 2022 Jun;13(3):1433-1443. doi: 10.21037/jgo-22-454.
The factors affecting the postoperative survival of patients with primary appendiceal cancer (PAC) have yet to be fully explored. And there are no clear guidelines for adjuvant treatment after appendectomy. Whether chemotherapy can prolong patient survival after appendectomy, is critical in guiding postoperative medications. The majority of studies on appendiceal cancer are single case reports, and they focused on the incidence of appendiceal cancer. The present study aimed to investigate the survival characteristics of patients with primary appendiceal cancer after surgery using the Surveillance, Epidemiology, and End Results (SEER) database.
The data of 2,891 cases of primary appendiceal cancer between 2004 to 2015 were obtained from the SEER database and subjected to survival analysis using the Kaplan-Meier method and Cox proportional-hazards model. The annual percentage change (APC) was calculated using the weighted least squares method.
The overall age-adjusted incidence rate per 100,000 population steadily increased from 0.58 in 2004 to 1.63 in 2015. For patients who received chemotherapy, the median overall survival (OS) was 65 months and the 5-year OS rate was 51.9%, and for patients who did not receive chemotherapy or whose chemotherapy status was unknown, the median OS was not reached and the 5-year OS rate was 78.9%. Age [35< age <69: hazard radio (HR) =2.147; 95% confidence interval (CI): 1.442-3.197, P<0.001; age >69: HR =5.259; 95% CI: 3.485-7.937, P<0.001], race (White race: HR =0.728; 95% CI: 0.590-0.899, P=0.003), histologic type (mucinous neoplasm: HR =0.690; 95% CI: 0.580-0.821, P<0.001; malignant carcinoid: HR =0.657; 95% CI: 0.536-0.806, P<0.001), grade (II: HR =1.794; 95% CI: 1.471-2.187, P<0.001; III: HR =2.905; 95% CI: 2.318-3.640, P<0.001; IV: HR =3.128; 95% CI: 2.159-4.533, P<0.001), and stage (localized: HR =0.236; 95% CI: 0.194-0.287, P<0.001; regional: HR =0.425; 95% CI: 0.362-0.499, P<0.001) were identified as independent predictors of survival. And after adjusting for known factors (age, sex, race, tumor size, marital status, histologic type, grade, stage), chemotherapy (HR =1.220; 95% CI: 1.050-1.417, P=0.009) was revealed to be an independent indicator of poor prognosis.
There was an increasing trend in the incidence of appendiceal cancer in the United States between 2004 and 2015. Chemotherapy was revealed to be an independent indicator of poor prognosis, which provide valuable insight into the therapy of primary appendiceal cancer. Large clinical trials of chemotherapy and targeted therapy for appendiceal cancer are urgently needed.
影响原发性阑尾癌（PAC）患者术后生存的因素尚未得到充分研究。阑尾切除术后辅助治疗尚无明确指南。化疗能否延长阑尾切除术后患者的生存期，对指导术后用药至关重要。大多数关于阑尾癌的研究都是单病例报告，且主要关注阑尾癌的发病率。本研究旨在利用监测、流行病学和最终结果（SEER）数据库调查原发性阑尾癌患者术后的生存特征。
从SEER数据库中获取2004年至2015年间2891例原发性阑尾癌病例的数据，并采用Kaplan-Meier法和Cox比例风险模型进行生存分析。使用加权最小二乘法计算年度百分比变化（APC）。
每10万人口的总体年龄调整发病率从2004年的0.58稳步上升至2015年的1.63。接受化疗的患者，中位总生存期（OS）为65个月，5年OS率为51.9%；未接受化疗或化疗状态未知的患者，中位OS未达到，5年OS率为78.9%。年龄[35＜年龄＜69：风险比（HR）=2.147；95%置信区间（CI）：1.442 - 3.197，P＜0.001；年龄＞69：HR =5.259；95% CI：3.485 - 7.937，P＜0.001]、种族（白种人：HR =0.728；95% CI：0.590 - 0.899，P =0.003）、组织学类型（黏液性肿瘤：HR =0.690；95% CI：0.580 - 0.821，P＜0.001；恶性类癌：HR =0.657；95% CI：0.536 - 0.806，P＜0.001）、分级（II级：HR =1.794；95% CI：1.471 - 2.187，P＜0.001；III级：HR =2.905；95% CI：2.318 - 3.640，P＜0.001；IV级：HR =3.128；95% CI：2.159 - 4.533，P＜0.001）和分期（局限性：HR =0.236；95% CI：0.194 - 0.287，P＜0.001；区域性：HR =0.425；95% CI：0.362 - 0.499，P＜0.001）被确定为生存的独立预测因素。在调整已知因素（年龄、性别、种族、肿瘤大小、婚姻状况、组织学类型、分级、分期）后，化疗（HR =1.220；95% CI：1.050 - 1.417，P =0.009）被证明是预后不良的独立指标。
2004年至2015年美国阑尾癌发病率呈上升趋势。化疗被证明是预后不良的独立指标，这为原发性阑尾癌的治疗提供了有价值的见解。迫切需要开展关于阑尾癌化疗和靶向治疗的大型临床试验。
