Cortina R, McCormick J, Kolm P, Perry R R
Division of Surgical Oncology, Eastern Virginia Medical School, Norfolk 23507-1912, USA.
Dis Colon Rectum. 1995 Aug;38(8):848-52. doi: 10.1007/BF02049842.
Adenocarcinoma of the appendix is a rare neoplasm, and controversies persist regarding management. The purpose of this study was to identify prognostic factors and define management strategies for patients with adenocarcinoma of the appendix.
A retrospective case series was conducted at three medical school teaching hospitals over a 20-year period from 1972 to 1992. Overall survival was determined by the actuarial life table method. Comparisons of prognostic factors were made using exact nonparametric log-rank tests.
Thirteen patients were diagnosed during the study period. Median age was 62 years. There were five males and eight females. The disease was not suspected in any patient preoperatively. Seventy-seven percent of patients had metastatic disease at presentation. Second primary malignancies were found in 15 percent of patients. Thirty-eight percent of female patients had synchronous ovarian lesions. Median survival was 22 months, with an estimated five-year survival of 43 percent (95 percent confidence interval, 22-84 percent). Patients with colonic histology had significantly worse survival than patients with mucinous histology (P = 0.0093). Patients with carcinomatosis had a significantly worse survival than noncarcinomatosis patients (P = 0.0078). Patients who underwent right hemicolectomy had a better prognosis for survival than appendectomy patients, but the difference was not statistically significant.
Carcinoma of the appendix is very difficult to diagnose preoperatively, and most patients are not identified until disease is advanced. Good prognostic factors include mucinous histology and the absence of carcinomatosis. Right hemicolectomy appears to be a reasonable option, although its superiority to appendectomy alone has not been definitively proven. High frequency of ovarian metastases in women suggests a role for bilateral oophorectomy. In addition, a complete work-up of the patient for a synchronous malignancy, especially in the gastrointestinal tract, should be considered.
阑尾腺癌是一种罕见的肿瘤，其治疗方法仍存在争议。本研究的目的是确定阑尾腺癌患者的预后因素并明确治疗策略。
对1972年至1992年期间在三所医学院教学医院进行的一项回顾性病例系列研究。通过精算生命表法确定总生存率。使用精确非参数对数秩检验对预后因素进行比较。
在研究期间诊断出13例患者。中位年龄为62岁。男性5例，女性8例。术前所有患者均未怀疑患有该病。77%的患者在就诊时已有转移性疾病。15%的患者发现有第二原发性恶性肿瘤。38%的女性患者有同步性卵巢病变。中位生存期为22个月，估计五年生存率为43%（95%可信区间，22 - 84%）。结肠组织学类型的患者生存率明显低于黏液性组织学类型的患者（P = 0.0093）。有癌性腹膜炎的患者生存率明显低于无癌性腹膜炎的患者（P = 0.0078）。接受右半结肠切除术的患者生存率预后优于单纯阑尾切除术患者，但差异无统计学意义。
阑尾癌术前很难诊断，大多数患者直到疾病进展才被发现。良好的预后因素包括黏液性组织学类型和无癌性腹膜炎。右半结肠切除术似乎是一个合理的选择，尽管其相对于单纯阑尾切除术的优越性尚未得到明确证实。女性卵巢转移的高发生率提示双侧卵巢切除术可能有用。此外，应考虑对患者进行同步恶性肿瘤的全面检查，尤其是胃肠道的检查。
