Aguirre Nicole, Chung Sebastian K, Foote Michael B, Shia Jinru, Vakiani Efsevia, Gowda Tina, Paty Philip B, Weiser Martin R, Garcia-Aguilar Julio, Karagkounis Georgios, Cercek Andrea, Nash Garrett M
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2025 Feb;32(2):695-702. doi: 10.1245/s10434-024-16366-7. Epub 2024 Nov 27.
Appendiceal epithelial tumors are rare and encompass a broad set of adenocarcinoma histologies, including mucinous (mAC), colonic-type (cAC), and goblet cell (GCA) adenocarcinomas. It has previously been reported that nodal disease predicted recurrence in patients with nonmetastatic appendiceal adenocarcinomas, supporting diagnostic laparoscopy with right hemicolectomy for staging and assessment for risk of recurrence. In this update, we sought to identify predictors of nodal disease on initial diagnostic pathology in nonmetastatic adenocarcinomas.
Patients with nonmetastatic appendiceal adenocarcinoma at a single institution from 1994 to 2020 were included. Clinicopathologic characteristics that predict recurrence and lymph node metastasis were analyzed. Workup included staging laparoscopy with right hemicolectomy, seriel imaging and biochemical monitoring.
A total of 147 patients with mAC (18%), cAC (22%), and GCAs (59%) were included. After median follow-up of 53 months, 23 (16%) patients recurred, most commonly in the peritoneal cavity (17/23, 74%). Recurrence rates were higher among node-positive patients (59% vs. 5%, P < 0.001). Nodal disease was more common in mAC (27%) and cAC (37%) than in GCA (11%); however, adenocarcinoma grade was not associated with nodal involvement.
Nodal metastasis was more common in mAC and cAC compared with GCA and was the only significant predictor of recurrence in appendix cancer.
阑尾上皮肿瘤较为罕见，涵盖多种腺癌组织学类型，包括黏液性（mAC）、结肠型（cAC）和杯状细胞（GCA）腺癌。此前有报道称，淋巴结疾病可预测非转移性阑尾腺癌患者的复发情况，支持采用诊断性腹腔镜联合右半结肠切除术进行分期及复发风险评估。在本次更新中，我们试图确定非转移性腺癌初始诊断病理中淋巴结疾病的预测因素。
纳入1994年至2020年在单一机构就诊的非转移性阑尾腺癌患者。分析预测复发和淋巴结转移的临床病理特征。检查包括分期腹腔镜联合右半结肠切除术、系列影像学检查和生化监测。
共纳入147例mAC（18%）、cAC（22%）和GCA（59%）患者。中位随访53个月后，23例（16%）患者复发，最常见于腹腔（17/23，74%）。淋巴结阳性患者的复发率更高（59%对5%，P<0.001）。淋巴结疾病在mAC（27%）和cAC（37%）中比在GCA（11%）中更常见；然而，腺癌分级与淋巴结受累无关。
与GCA相比，mAC和cAC中的淋巴结转移更为常见，并且是阑尾癌复发的唯一重要预测因素。
