Johansson Joel, Andersson Roland E, Loftås Per, Redéen Stefan
Department of Surgery, County Hospital Ryhov, Jönköping, Sweden.
Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
BJS Open. 2025 Sep 8;9(5). doi: 10.1093/bjsopen/zraf109.
Appendiceal adenocarcinomas and low-grade appendiceal mucinous neoplasms (LAMNs) are rare tumours. Much of the existing knowledge is derived from registry-based studies, particularly the Surveillance, Epidemiology, and End Results database in the USA.
This retrospective cohort study used data from the Swedish Cancer Registry, Swedish Cause of Death Registry, and the National Patient Registry to analyse demographic characteristics and outcomes of patients diagnosed with appendiceal adenocarcinoma or LAMN between 2005 and 2019. Kaplan-Meier survivor function, multivariate Cox regression analysis, standardized mortality ratio, and net survival were used to assess survival. Incidence was estimated by direct standardization from 2005 to 2019.
In all, 1159 patients with appendiceal neoplasms were included, with a mean age at diagnosis of 63.3 years. The incidence of adenocarcinomas was stable, whereas the incidence of LAMNs increased from 2012 onwards. Patients with non-mucinous adenocarcinomas who underwent colonic resection had better survival outcomes than patients treated with appendicectomy alone. For mucinous adenocarcinomas, colonic resection did not improve survival outcomes compared with appendicectomy. Patients with non-mucinous adenocarcinoma, mucinous adenocarcinoma, or LAMN who underwent cytoreductive surgery and heated intraperitoneal chemotherapy (CRS-HIPEC) had favourable overall and net survival.
Colonic resection increased survival only for patients with non-mucinous adenocarcinomas. Since 2012, the incidence of LAMN has increased, most likely due to changes in diagnostic and coding practices, but the incidence of appendiceal adenocarcinomas has remained stable. The survival benefit of CRS-HIPEC is observed in a very specific patient population, emphasizing the importance of careful patient selection.
阑尾腺癌和低度阑尾黏液性肿瘤（LAMN）是罕见肿瘤。现有知识大多来源于基于登记处的研究，尤其是美国的监测、流行病学和最终结果数据库。
这项回顾性队列研究使用了瑞典癌症登记处、瑞典死亡原因登记处和国家患者登记处的数据，分析2005年至2019年期间被诊断为阑尾腺癌或LAMN的患者的人口统计学特征和预后。采用Kaplan-Meier生存函数、多变量Cox回归分析、标准化死亡率和净生存来评估生存情况。通过对2005年至2019年的数据进行直接标准化来估计发病率。
总共纳入了1159例阑尾肿瘤患者，诊断时的平均年龄为63.3岁。腺癌的发病率稳定，而LAMN的发病率从2012年起有所上升。接受结肠切除术的非黏液性腺癌患者的生存结局优于仅接受阑尾切除术的患者。对于黏液性腺癌，与阑尾切除术相比，结肠切除术并未改善生存结局。接受细胞减灭术和热灌注化疗（CRS-HIPEC）的非黏液性腺癌、黏液性腺癌或LAMN患者的总生存和净生存情况良好。
结肠切除术仅提高了非黏液性腺癌患者的生存率。自2012年以来，LAMN的发病率有所上升，很可能是由于诊断和编码方式的改变，但阑尾腺癌的发病率保持稳定。CRS-HIPEC的生存获益仅在非常特定的患者群体中观察到，强调了谨慎选择患者的重要性。
