The Role of Adjuvant Chemotherapy Following Right Hemicolectomy for Non-metastatic Mucinous and Nonmucinous Appendiceal Adenocarcinoma.
Adjuvant chemotherapy
Appendiceal adenocarcinoma
Mucinous
Nonmucinous
Survival
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
17
03
2021
accepted:
10
06
2021
pubmed:
23
7
2021
medline:
27
1
2022
entrez:
22
7
2021
Statut:
ppublish
Résumé
Appendiceal adenocarcinoma (AA) represents a heterogenous group of neoplasms with distinct histologic features. The role and efficacy of adjuvant chemotherapy (AC) in non-metastatic disease remain controversial. The aim of this study was to ascertain the role of AC in non-metastatic AA in a national cohort of patients. The National Cancer Database (NCDB) was queried to identify patients diagnosed with stage I-III mucinous and nonmucinous AA who underwent right hemicolectomy between 2006 and 2016. Kaplan-Meier and Cox regression analyses were used to evaluate the impact of AC on overall survival (OS) stratified by each pathologic stage. A total of 1433 mucinous and 1954 nonmucinous AA were identified; 578 (40%) and 722 (40%) received AC respectively. In both AC groups, there was a higher proportion of T4 disease, lymph node metastasis, pathologic stage III, and poorly/undifferentiated grade (all P<0.05). On unadjusted analysis, there was no significant association between AC and OS for stage I-III mucinous AA. For nonmucinous AA, AC significantly improved OS only for stage II and III disease. On adjusted analysis, AC was independently associated with an improved OS for stage III nonmucinous AA (HR: 0.61, 95%CI 0.45-0.84, P=0.002), while for mucinous AA, AC was associated with worse outcomes for stage I/II disease (HR: 1.4, 95%CI 1.02-1.91, P=0.038) and had no significant association with OS for stage III disease. This current analysis of a national cohort of patients suggests a beneficial role for AC in stage III nonmucinous AA and demonstrates no identifiable benefit for stage I-III mucinous AA.
Sections du résumé
BACKGROUND
Appendiceal adenocarcinoma (AA) represents a heterogenous group of neoplasms with distinct histologic features. The role and efficacy of adjuvant chemotherapy (AC) in non-metastatic disease remain controversial. The aim of this study was to ascertain the role of AC in non-metastatic AA in a national cohort of patients.
METHODS
The National Cancer Database (NCDB) was queried to identify patients diagnosed with stage I-III mucinous and nonmucinous AA who underwent right hemicolectomy between 2006 and 2016. Kaplan-Meier and Cox regression analyses were used to evaluate the impact of AC on overall survival (OS) stratified by each pathologic stage.
RESULTS
A total of 1433 mucinous and 1954 nonmucinous AA were identified; 578 (40%) and 722 (40%) received AC respectively. In both AC groups, there was a higher proportion of T4 disease, lymph node metastasis, pathologic stage III, and poorly/undifferentiated grade (all P<0.05). On unadjusted analysis, there was no significant association between AC and OS for stage I-III mucinous AA. For nonmucinous AA, AC significantly improved OS only for stage II and III disease. On adjusted analysis, AC was independently associated with an improved OS for stage III nonmucinous AA (HR: 0.61, 95%CI 0.45-0.84, P=0.002), while for mucinous AA, AC was associated with worse outcomes for stage I/II disease (HR: 1.4, 95%CI 1.02-1.91, P=0.038) and had no significant association with OS for stage III disease.
CONCLUSION
This current analysis of a national cohort of patients suggests a beneficial role for AC in stage III nonmucinous AA and demonstrates no identifiable benefit for stage I-III mucinous AA.
Identifiants
pubmed: 34291365
doi: 10.1007/s11605-021-05076-0
pii: 10.1007/s11605-021-05076-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
171-180Informations de copyright
© 2021. The Society for Surgery of the Alimentary Tract.
Références
Marmor S, Portschy PR, Tuttle TM, Virnig BA. The Rise in Appendiceal Cancer Incidence: 2000–2009. J Gastrointest Surg. 2015:19:743–750.
doi: 10.1007/s11605-014-2726-7
Turaga KK, Pappas SG, Gamblin C. Importance of Histologic Subtype in the Staging of Appendiceal Tumors. Ann Surg Oncol. 2012;19:1379-1385.
doi: 10.1245/s10434-012-2238-1
Pai RK, Longacre TA. Appendiceal Mucinous Tumors and Pseudomyxoma Peritonei: Histologic Features, Diagnostic Problems, and Proposed Classification. Adv Anat Pathol. 2005;12:291-311.
doi: 10.1097/01.pap.0000194625.05137.51
Overman MJ, Fournier K, Hu CY, Eng C, Taggart M, Royal R, Mansfield P, Chang GJ. Improving the AJCC/ TNM staging for adenocarcinomas of the appendix: the prognostic impact of histological grade. Ann Surg. 2013;257:1072–1078.
doi: 10.1097/SLA.0b013e318269d680
Glasgow S, Gaertner W, Stewart D, Davids J, Alavi K, Paquette IM, Steele SR, Feingold DL. The American Society of Colon and Rectal Surgeons, Clinical Practice Guidelines for the Management of Appendiceal Neoplasms. Dis Colon Rectum. 2019;62:1425-1438.
doi: 10.1097/DCR.0000000000001530
Chicago Conesus Working Group. The Chicago Consensus on Peritoneal Surface Malignancies: Management of Appendiceal Neoplasms. Ann Surg Oncol. 2020;27:1753-1760.
doi: 10.1245/s10434-020-08316-w
Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO Classification of Tumours of the Digestive System. 4th ed. Lyon, France: IARC Press; 2010.
Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, González-Moreno S, Taflampas P, Chapman S, Moran BJ, Peritoneal Surface Oncology Group International. A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process. Am J Surg Pathol. 2016;40:14-26.
doi: 10.1097/PAS.0000000000000535
McCusker ME, Coté TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973–1998. Cancer 2002;94:3307–3312.
doi: 10.1002/cncr.10589
Kelly K. Management of Appendix Cancer. Clin Colon And Rectal Surg. 2015;28:247-255.
doi: 10.1055/s-0035-1564433
Smeenk RM, van Velthuysen ML, Verwaal VJ, Zoetmulder FA. Appendiceal neoplasms and pseudomyxoma peritonei: a population-based study. Eur J Surg Oncol. 2008;34:196–201.
doi: 10.1016/j.ejso.2007.04.002
Blackham AU, Swett K, Eng C, Sirintrapun J, Bergman S, Geisinger KR, Votanopoulos K, Stewart JH, Shen P, Levine EA. Perioperative systemic chemotherapy for appendiceal mucinous carcinoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Surg Oncol. 2014;109:740-745.
doi: 10.1002/jso.23547
Asare EA, Compton CC, Hanna NN, Kosinski LA, Washington MK, Kakar S, Weiser MR, Overman MJ. The impact of stage, grade, and mucinous histology on the efficacy of systemic chemotherapy in adenocarcinomas of the appendix: analysis of the National Cancer Data Base. Cancer. 2016;122:213-221.
doi: 10.1002/cncr.29744
Shapiro JF, Chase JL, Wolff RA, Lambert LA, Mansfield PF, Overman MJ, Ohinata A, Liu J, Wang X, Eng C.. Modern systemic chemotherapy in surgically unresectable neoplasms of appendiceal origin: a single institution experience. Cancer. 2010;116:316-322.
doi: 10.1002/cncr.24715
Farquharson AL, Pranesh N, Witham G, Swindell R, Taylor MB, Renehan AG, Rout S, Wilson MS, O’Dwyer ST, Saunders OP. A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei. Br J Cancer. 2008;99:591-596.
doi: 10.1038/sj.bjc.6604522
American College of Surgeons. About the National Cancer Database. https:// www.facs.org/quality-programs/cancer/ncdb/about . Accessed January 15, 2021.
Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis.1987;40:373–383.
doi: 10.1016/0021-9681(87)90171-8
Sugarbaker PH, Bijelic L, Chang D, Yoo D. Neoadjuvant FOLFOX chemotherapy in 34 consecutive patients with mucinous peritoneal carcinomatosis of appendiceal origin. J Surg Oncol. 2010;102:576-581
doi: 10.1002/jso.21679
Tejani MA, Ter Veer A, Milne D, Rebecca O, Bekaii-Saab T, Benson AB III, Schrag D, Shibata S, Skibber J, Weiser M, Wilkinson N, Cohen SJ. Systemic Therapy for Advanced Appendiceal Adenocarcinoma: An Analysis From the NCCN Oncology Outcomes Database for Colorectal Cancer. J Natl Compr Canc Netw. 2014;12:1123–1130.
doi: 10.6004/jnccn.2014.0109
Turaga KK, Pappas S, Gamblin TC. Right hemicolectomy for mucinous adenocarcinoma of the appendix: just right or too much? Ann Surg Oncol. 2013;20:1063-1067.
doi: 10.1245/s10434-012-2783-7
Kolla BC, Petersen A, Chengappa M, Gummadi T, Ganesan C, Gaertner WB, Blaes A .Impact of adjuvant chemotherapy on outcomes in appendiceal cancer. Cancer Med. 2020;9:3400-3406.
doi: 10.1002/cam4.3009
Lu P, Fields AC, Meyerhardt JA, Davids JS, Shabat G, Bleday R, Goldberg JE, Nash GM, Melnitchouk N. Systemic chemotherapy and survival in patients with metastatic low-grade appendiceal mucinous adenocarcinoma. J Surg Oncol. 2019;120(3):446-451
doi: 10.1002/jso.25599
Lieu CH, Lambert LA, Wolff RA, Eng C, Zhang N, Wen S, Rafeeq S, Taggart M, Fournier K, Royal R, Mansfield P, Overman MJ. Systemic chemotherapy and surgical cytoreduction for poorly differentiated and signet ring cell adenocarcinomas of the appendix. Ann Oncol. 2012;23:652-658.
doi: 10.1093/annonc/mdr279
Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am J Surg Pathol. 2003;27:1089–1103.
doi: 10.1097/00000478-200308000-00006
Choudry H, Pai R, Parimi A, Jones HJ, Pingpank JF, Ahrendt SS, Holtzman MP, Bartlett DL. Discordant Diagnostic Terminology and Pathologic Grading of Primary Appendiceal Mucinous Neoplasms Reviewed at a High-Volume Center. Ann Surg Oncol. 2019;26:2607-2614.
doi: 10.1245/s10434-019-07447-z