阑尾腺癌的切除范围及长期预后：基于监测、流行病学和最终结果（SEER）数据库对黏液性和非黏液性组织学类型的分析
Extent of Resection and Long-Term Outcomes for Appendiceal Adenocarcinoma: a SEER Database Analysis of Mucinous and non-Mucinous Histologies.
作者信息
Tsagkalidis Vasileios, Choe Jennie K, Beninato Toni, Eskander Mariam F, Grandhi Miral S, In Haejin, Kennedy Timothy J, Langan Russell C, Maggi Jason C, Pitt Henry A, Alexander H Richard, Ecker Brett L
机构信息
Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
出版信息
Ann Surg Oncol. 2024 Jul;31(7):4203-4212. doi: 10.1245/s10434-024-15233-9. Epub 2024 Apr 9.
BACKGROUND
Mucinous appendiceal adenocarcinomas (MAA) and non-mucinous appendiceal adenocarcinomas (NMAA) demonstrate differences in rates and patterns of recurrence, which may inform the appropriate extent of surgical resection (i.e., appendectomy versus colectomy). The impact of extent of resection on disease-specific survival (DSS) for each histologic subtype was assessed.
PATIENTS AND METHODS
Patients with resected, non-metastatic MAA and NMAA were identified in the Surveillance, Epidemiology, and End Results database (2000-2020). Multivariable models were created to examine predictors of colectomy for each histologic subtype. DSS was calculated using Kaplan-Meier estimates and examined using Cox proportional hazards modeling.
RESULTS
Among 4674 patients (MAA: n = 1990, 42.6%; NMAA: n = 2684, 57.4%), the majority (67.8%) underwent colectomy. Among colectomy patients, the rate of nodal positivity increased with higher T-stage (MAA: T1: 4.6%, T2: 4.0%, T3: 17.1%, T4: 21.6%, p < 0.001; NMAA: T1: 6.8%, T2: 11.4%, T3: 25.6%, T4: 43.8%, p < 0.001) and higher tumor grade (MAA: well differentiated: 7.7%, moderately differentiated: 19.2%, and poorly differentiated: 31.3%; NMAA: well differentiated: 9.0%, moderately differentiated: 20.5%, and 44.4%; p < 0.001). Nodal positivity was more frequently observed in NMAA (27.6% versus 16.4%, p < 0.001). Utilization of colectomy was associated with improved DSS for NMAA patients with T2 (log rank p = 0.095) and T3 (log rank p = 0.018) tumors as well as moderately differentiated histology (log rank p = 0.006). Utilization of colectomy was not associated with improved DSS for MAA patients, which was confirmed in a multivariable model for T-stage, grade, and use of adjuvant chemotherapy [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.81-1.22].
CONCLUSIONS
Colectomy was associated with improved DSS for patients with NMAA but not MAA. Colectomy for MAA may not be required.
背景
黏液性阑尾腺癌（MAA）和非黏液性阑尾腺癌（NMAA）在复发率和复发模式上存在差异，这可能有助于确定合适的手术切除范围（即阑尾切除术与结肠切除术）。评估了切除范围对每种组织学亚型的疾病特异性生存率（DSS）的影响。
患者与方法
在监测、流行病学和最终结果数据库（2000 - 2020年）中识别出接受切除的非转移性MAA和NMAA患者。创建多变量模型以检查每种组织学亚型结肠切除术的预测因素。使用Kaplan - Meier估计值计算DSS，并使用Cox比例风险模型进行检验。
结果
在4674例患者中（MAA：n = 1990，42.6%；NMAA：n = 2684，57.4%），大多数（67.8%）接受了结肠切除术。在接受结肠切除术的患者中，淋巴结阳性率随T分期升高而增加（MAA：T1：4.6%，T2：4.0%，T3：17.1%，T4：21.6%，p < 0.001；NMAA：T1：6.8%，T2：11.4%，T3：25.6%，T4：43.8%，p < 0.001）以及肿瘤分级升高（MAA：高分化：7.7%，中分化：19.2%，低分化：31.3%；NMAA：高分化：9.0%，中分化：20.5%，低分化：44.4%；p < 0.001）。NMAA中更常观察到淋巴结阳性（27.6%对16.4%，p < 0.001）。对于T2（对数秩p = 0.095）和T3（对数秩p = 0.018）肿瘤以及中分化组织学的NMAA患者，结肠切除术的应用与DSS改善相关（对数秩p = 0.006）。结肠切除术的应用与MAA患者的DSS改善无关，这在T分期、分级和辅助化疗使用的多变量模型中得到证实[风险比（HR）1.00，95%置信区间（CI）0.81 - 1.22]。
结论
结肠切除术与NMAA患者的DSS改善相关，但与MAA患者无关。可能不需要对MAA进行结肠切除术。
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