Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of Surgery and Transplantation, Sheba Medical Center, Ramat Gan, Tel Aviv University, Tel Aviv, Israel.
Surg Oncol. 2024 Feb;52:102034. doi: 10.1016/j.suronc.2024.102034. Epub 2024 Jan 5.
This study aimed to determine predictors of overall survival (OS) after surgical treatment of stage I-III appendiceal adenocarcinoma and compare the outcomes of partial colectomy and hemicolectomy.
A retrospective analysis of the U.S. National Cancer Database (NCDB) including patients who underwent surgery for stage I-III appendiceal adenocarcinoma between 2005 and 2019 was conducted. A propensity-score matched analysis was undertaken to compare the outcomes of partial and hemicolectomy and multivariate analysis was performed to determine predictive factors of OS. The main outcome was OS and its independent predictors.
2607 patients (51.6 % male) with a mean age of 61.6 ± 13.9 years were included. 61.7 % of patients underwent hemicolectomy while 31.7 % underwent partial colectomy. After matching, partial colectomy, and hemicolectomy had similar OS (117.3 vs 117.2 months; p = 0.08), positive resection margins, short-term mortality, and 30-day readmission. The hemicolectomy group was associated with more examined lymph nodes and longer hospital stays. Older age (HR: 1.047, p < 0.0001), rural residence area (HR: 3.6, p = 0.025), higher Charlson score (HR: 1.6, p = 0.016), signet-ring cell carcinoma (HR: 2.37, p = 0.009), adjuvant systemic treatment (HR: 1.55, p = 0.015), positive surgical margins (HR: 1.83, p = 0.017), positive lymph nodes number (HR: 1.09, p < 0.0001), and examined lymph nodes number (HR: 0.962, p = 0.001) were independent predictors of OS.
Partial colectomy and hemicolectomy had similar OS and clinical outcomes. Older age, rural residence, higher Charlson score, signet-ring pathology, adjuvant systemic treatment, positive surgical margins, positive lymph node number, and examined lymph node number were independent predictors of OS.
本研究旨在确定手术治疗 I-III 期阑尾腺癌患者的总生存期（OS）的预测因素，并比较部分结肠切除术和结肠半切除术的结果。
对美国国家癌症数据库（NCDB）进行回顾性分析，纳入 2005 年至 2019 年间接受 I-III 期阑尾腺癌手术的患者。采用倾向评分匹配分析比较部分结肠切除术和结肠半切除术的结果，并进行多变量分析确定 OS 的预测因素。主要结局是 OS 及其独立预测因素。
纳入 2607 例（51.6%为男性）患者，平均年龄为 61.6±13.9 岁。61.7%的患者行结肠半切除术，31.7%的患者行部分结肠切除术。匹配后，部分结肠切除术和结肠半切除术的 OS 相似（117.3 与 117.2 个月；p=0.08），切缘阳性、短期死亡率和 30 天再入院率相似。结肠半切除术组的检查淋巴结数更多，住院时间更长。年龄较大（HR：1.047，p<0.0001）、农村居住地区（HR：3.6，p=0.025）、Charlson 评分较高（HR：1.6，p=0.016）、印戒细胞癌（HR：2.37，p=0.009）、辅助全身治疗（HR：1.55，p=0.015）、切缘阳性（HR：1.83，p=0.017）、阳性淋巴结数（HR：1.09，p<0.0001）和检查淋巴结数（HR：0.962，p=0.001）是 OS 的独立预测因素。
部分结肠切除术和结肠半切除术的 OS 和临床结局相似。年龄较大、农村居住、Charlson 评分较高、印戒细胞病理、辅助全身治疗、切缘阳性、阳性淋巴结数和检查淋巴结数是 OS 的独立预测因素。
